dialogue_id,testset_index,dialogue_index,drop_reasons,drop_justification,ID,section_header,section_text,dialogue
1:2,1,2,same side twice at turn 5,same side twice at turn 5,2,ROS,"MSK: Negative myalgia, negative joint pain, negative stiffness, negative weakness, negative back pain.","Doctor: Any pain in your muscles? 
Patient: No, no pain.
Doctor: How about joint pain? 
Patient: Um no, I don't feel any joint pain.
Doctor: Okay, good.
Doctor: Do you feel any stiffness or weakness in your muscle? 
Patient: Um, nothing like that.
Doctor: Do you have any back pain? 
Patient: No.
Doctor: Okay."
1:6,1,6,no patient/guest patient turns,no patient/guest patient turns,6,GENHX,The patient is a 77-year-old female who is unable to give any information.  She has been sedated with Ativan and came into the emergency room obtunded and unable to give any history.  On a chest x-ray for what appeared to be shortness of breath she was found to have what was thought to be free air under the right diaphragm.,"Guest_clinician: How old is the patient? 
Doctor: Seventy seven. 
Guest_clinician: She was sedated with Ativan, correct? 
Doctor: Yeah, we had to sedate her. She wasn't doing so well upon arrival and appeared short of breath. She couldn't give us a history and we immediately had Xray come in to scan her lungs. 
Guest_clinician: Did they find anything? 
Doctor: The report showed what we believe to be free air under her right diaphragm."
1:8,1,8,same side twice at turn 2,same side twice at turn 2,8,FAM/SOCHX,He is retired from the social security administration x 20 years.  He travels a lot and is extremely active.  He does not smoke.  He consumes alcohol socially only.  He does not use illicit drugs.  He is married.,"Doctor: Are you still working, sir? 
Patient: No, I am retired now. I worked for twenty years in social security administration. 
Patient: Now I just enjoy my life with my wife, we travel a lot. I like to be extremely active. 
Doctor: That's awesome. 
Doctor: Do you drink?
Patient: Yes, but only socially. 
Doctor: How about smoking or any drugs?
Patient: No, I don't smoke or do any kind of drugs or anything. 
Doctor: Okay."
1:9,1,9,only 2 turns (min 3),only 2 turns (min 3),9,ALLERGY,No known drug allergies.,"Doctor: Do you know about any allergies from any medications?
Patient: No."
1:11,1,11,"non doctor/patient speakers: guest_family, guest_family_2","non doctor/patient speakers: guest_family, guest_family_2",11,ROS,"Non-contributory. The patient denied fever, chills, ulcers, liver disease or history of gallstones. Vaccines: The patient was vaccinated with BCG before starting elementary school in the Philippines.","Doctor: Did he get his B C G vaccine?
Guest_family: Yes, he did back in the Philippines before starting his elementary school. 
Doctor: Okay, did you have his immunization records?
Guest_family_2: Yes, we submitted it at the front desk.
Doctor: Okay, how long has he been complaining of uneasiness in his stomach?
Guest_family_2: For a few days.
Doctor: Any history of liver problems or gallbladder stones?
Guest_family: No, he had his physical and blood tests and everything came out normal.
Doctor: Okay, good. Any fever or chills?
Guest_family: No.
Doctor: Any history of ulcers?
Guest_family_2: No."
1:18,1,18,only 2 turns (min 3),only 2 turns (min 3),18,ASSESSMENT,1.  Hypertension. 2.  Hypercholesterolemia. 3.  Osteoarthritis. 4.  Fatigue.,"Patient: I am always tired, I don't know what to do.
Doctor: Yeah, your fatigue can be due to so many reasons. You have many underlying conditions. You have hypertension, high cholesterol, and osteoarthritis. All this can add up and lead to fatigue. I think you need to really take care of your health."
1:22,1,22,doctor refers to prior patient (kimi),"Turn 2 ('Wow, that's remarkable.') is entirely an acknowledgment/reaction to the patient's immediately preceding answer about being married for forty-five years. It contains no standalone question or new topic and would not make sense on its own without that context.",22,FAM/SOCHX,"Remarkable for being married, retired, quit smoking in 1997, rare use of alcohol, lives locally with his wife.","Doctor: And how long have you been married?
Patient: I have been happily married for forty five years.
Doctor: Wow, that's remarkable. 
Patient: Yes, we have a small house by the bay just two miles away from your office. This is my dream house. I always dreamt of living in a house with a waterfront and when I retired, I moved here with my wife. It's nice and peaceful. 
Doctor: That's amazing! Okay so tell me something do you drink or smoke?
Patient: Oh, I quit smoking long time ago. Was it ninety six or ninety seven? Hm I think I quit smoking in nineteen ninety seven. I do enjoy a glass of wine or beer but very occasionally. 
Doctor: Okay."
1:23,1,23,non doctor/patient speakers: guest_clinician,non doctor/patient speakers: guest_clinician,23,ALLERGY,The patient has sinus and CVA.  He is a nonsmoker.  No known drug allergies.,"Guest_clinician: Hello, my name is Mary. I will ask you a few questions about your medical and family history and then Doctor Smith will come and check you. Okay?
Patient: Okay. 
Guest_clinician: Do you have any other previously diagnosed medical issues?
Patient: I have sinus. I also had a stroke around two years ago.
Guest_clinician: Do you smoke or drink?
Patient: Nope, never did any of those.
Guest_clinician: Do you have any kind of allergies?
Patient: No, no known allergies.
Guest_clinician: Thank you for answering all my questions, I will let Doctor Smith know that you are ready."
1:24,1,24,doctor refers to prior patient (kimi),Turn 4 ('Because it is harmful for your current condition.') is entirely an answer to the patient's immediately preceding 'Why?' and cannot stand alone without that context; it contains no separate question or new topic.,24,PLAN,To follow a low-salt diet.,"Doctor: Do you know what foods have a high level of salt?
Patient: Do you mean like chips and junk food?
Doctor: Yes mostly. And pickles.. I want you to avoid them.
Patient: Okay. Why?
Doctor: Because it is harmful for your current condition. 
Patient: Okay I will cut it.
Doctor: Yes, so follow a low salt diet.
Patient: Okay."
1:27,1,27,doctor refers to prior patient (kimi),Turn 2 ('Okay.') is entirely an acknowledgment of the patient's immediately preceding answer. It contains no standalone question or new topic and would not make sense on its own without that prior context.,27,CC,"Nausea, vomiting, diarrhea, and fever.","Doctor: Any nausea, vomiting diarrhea, or fever?
Patient: Yes, all of the above. 
Doctor: Okay."
1:28,1,28,no patient/guest patient turns,no patient/guest patient turns,28,DISPOSITION,The patient is discharged home.,"Doctor: So, Doctor Pai how is your patient that you told me about?
Guest_clinician: Oh, we discharged her, she went home.
Doctor: That's great!
Guest_clinician: Yeah."
1:32,1,32,only 2 turns (min 3),only 2 turns (min 3),32,EDCOURSE,"I discussed the case with Poison Control and apparently this is actually relatively small quantity and it is likely to be a nontoxic ingestion if she even ingested, which should does not appear likely to be the case.","Doctor: I spoke with Poison Control regarding the possible ingestion of the liquid. They let me know that it is actually a relatively small amount and is likely to be a nontoxic ingestion of the liquid, if she did end up ingesting it. It is not likely to be the case as she is behaving as if she did not ingest any of the liquid.
Guest_family: Thank god! Thank you."
1:33,1,33,doctor refers to prior patient (kimi),"Doctor turns 2 and 6 are entirely reactions to the immediately preceding patient answers and lack any standalone question or new topic. Turn 2 ('Good, no one should.') only makes sense as a response to the patient denying smoking, and turn 6 ('Okay.') is a bare acknowledgment of the patient denying drinking.",33,FAM/SOCHX,The patient does not smoke nor drink alcohol.,"Doctor: Do you smoke cigarettes?
Patient: No, I do not.
Doctor: Good, no one should.
Patient: Yeah, it's a bad habit.
Doctor: Okay. How about alcohol?
Patient: No, I don't drink either.
Doctor: Okay.
Patient: Yeah."
1:35,1,35,doctor refers to prior patient (kimi),Doctor turns 4 and 6 are brief acknowledgments/reactions ('I see.' and 'Interesting.') that are entirely about the immediately preceding patient answers and do not make sense as standalone utterances without that context.,35,ALLERGY,"Bactrim, which causes nausea and vomiting, and adhesive tape.","Doctor: And how about any allergies? Are you allergic to any drug or anything?
Patient: Ah, yes I am very allergic to Bactrim. 
Doctor: It causes you side effects?
Patient: Yes, It causes me nausea and vomiting. 
Doctor: I see. 
Patient: I think I am also allergic to adhesive tape. I get this skin rash almost immediately if I use adhesive tapes. 
Doctor: Interesting."
1:37,1,37,doctor refers to prior patient (kimi),"Turn 2 ('Each day, is it?') is entirely a clarifying question about the immediately preceding patient answer ('Yes, I've been smoking around one pack.') and does not make sense on its own without that context; the pronoun 'it' requires the prior utterance for reference.",37,FAM/SOCHX,polysubstance abuse. smoked 1 pack per day for 15years.,"Doctor: Have you ever smoked? 
Patient: Yes, I've been smoking around one pack. 
Doctor: Each day, is it? 
Patient: Yes.
Doctor: For how long? 
Patient: Around fifteen years. 
Doctor: Do you take any other drug or consume alcohol? 
Patient: Yeah, I'm an addict. I take oxy and a few more narco stuff, which I get from the street, and I drink a lot. I need help."
1:38,1,38,doctor refers to prior patient (kimi),"Turn 16 ('Yes, that's not out all the way.') is entirely a reaction to the patient's immediately preceding answer and would not make sense on its own; it contains no separate question or new topic.",38,GENHX,"This is a 36-year-old white female who presents to the office today with a complaint of left knee pain.  She is approximately five days after a third Synvisc injection.  She states that the knee is 35% to 40 % better, but continues to have a constant pinching pain when she full weight bears, cannot handle having her knee in flexion, has decreased range of motion with extension.  Rates her pain in her knee as a 10/10.  She does alternate ice and heat.  She is using Tylenol No. 3 p.r.n. and ibuprofen OTC p.r.n. with minimal relief.","Doctor: Good morning, ma'am. Did you have a good thirty-sixth birthday?
Patient: Yes, thank you. It was a nice day, despite the knee pain. 
Doctor: That's good, we'll get back to that knee in a moment. Just to confirm, you identify as white, correct? 
Patient: Yes, I do. 
Doctor: Thank you. I just needed to make sure my chart was correct. So, is this left knee still bothering you? 
Patient: Yes, unfortunately, it still is.
Doctor: You've had three Synvisc injections, correct? When was your last one?
Patient: Yes, that was about five days ago, right before my birthday. 
Doctor: Did that provide any relief at all?  
Patient: Well, I'd say there's been, um, thirty-five or forty percent improvement. 
Doctor: Are you still having the pinching pain?
Patient: Yes, it's so bad when I try to put my full weight onto this knee. 
Doctor: Can you bend this knee at all?
Patient: Ow, no, please stop. I can't handle that bending, doctor. 
Doctor: Can you straighten the knee out for me, please? 
Patient: No, not all the way, look. 
Doctor: Yes, that's not out all the way. 
Patient: It hurts really bad, doctor. 
Doctor: With ten being the worst pain ever, how would you rate your pain today out of ten?
Patient: Oh, it's easily a ten out of ten. 
Doctor: Have you used ice or heat? 
Patient: Yes, I use both. I alternate the two. 
Doctor: What medicines are you taking?
Patient: I'm using that Tylenol with codeine you gave me and then some ibuprofen I got from the grocery store. 
Doctor: Have those helped at all?
Patient: I'd say they helped pretty minimally."
1:40,1,40,doctor refers to prior patient (kimi),Turn 4 ('Yeah.') is entirely a backchannel/acknowledgment that depends completely on the previous patient turn and lacks any standalone content or new topic.,40,PASTMEDICALHX,"Hypertension, hyperlipidemia, recent C. diff colitis, which had resolved based on speaking to Dr. X.  Two weeks ago, he had seen the patient and she was clinically well.","Doctor: So I talked to Doctor X about your problems.
Patient: And?
Doctor: And he said your recent intestine infction is resolved. Which is C Diff colitis. You saw him two weeks back right?
Patient: Oh Thank God! Yes thanks, recently i saw him.
Doctor: Yeah.
Patient: Ok alright. 
Doctor: And we have Hypertension and high Cholesterol as well which we talked about.
Patient: Thanks doc."
1:43,1,43,no patient/guest patient turns,no patient/guest patient turns,43,ASSESSMENT,No intra-abdominal pathology.,"Guest_clinician: Is there any notable intra abdominal pathology? 
Doctor: None whatsoever. 
Guest_clinician: Well, that's good news."
1:47,1,47,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,47,CC,A 2-month-old female with 1-week history of congestion and fever x2 days.,"Doctor: I hear she hasn't been doing so well. 
Guest_family: My poor two-month-old baby girl has been congested for a whole week. I'm so worried about her. 
Doctor: I completely understand. It's never easy to see your baby sick. Have you taken her temperature recently? 
Guest_family: Yes, I've been using an anal thermometer. She's been running a fever for the past two days. 
Doctor: I'm glad you brought her in today. I'll go ahead and take her temperature again. Is she experiencing any other symptoms, such as difficulty breathing or wheezing at all? 
Guest_family: Not that we've noticed. 
Doctor: Is she taking down milk? 
Guest_family: Barely. Not as much as she used to the week before she started to feel bad. 
Doctor: How often have you been changing her diapers? 
Guest_family: Hm three or four times. I should've kept better track."
1:49,1,49,doctor refers to prior patient (kimi),"Turn 2 (""Happy birthday!"") is entirely a reaction to the patient's immediately preceding statement about turning seventy-seven. It contains no standalone question or new topic and would not make sense without that prior patient turn.",49,GENHX,"The patient comes back to see me today.  She is a pleasant 77-year-old Caucasian female who had seen Dr. XYZ with right leg pain.  She has a history of prior laminectomy for spinal stenosis.  She has seen Dr. XYZ with low back pain and lumbar scoliosis post laminectomy syndrome, lumbar spinal stenosis, and clinical right L2 radiculopathy, which is symptomatic.  Dr. XYZ had performed two right L2-L3 transforaminal epidural injections, last one in March 2005.  She was subsequently seen and Dr. XYZ found most of her remaining symptoms are probably coming from her right hip.  An x-ray of the hip showed marked degenerative changes with significant progression of disease compared to 08/04/2004 study.  Dr. XYZ had performed right intraarticular hip injection on 04/07/2005.  She was last seen on 04/15/2005.  At that time, she had the hip injection that helped her briefly with her pain.  She is not sure whether or not she wants to proceed with hip replacement.  We recommend she start using a cane and had continued her on some pain medicines. The patient comes back to see me today.  She continues to complain of significant pain in her right hip, especially with weightbearing or with movement.  She said she had made an appointment to see an orthopedic surgeon in Newton as it is closer and more convenient for her.  She is taking Ultracet or other the generic it sounds like, up to four times daily.  She states she can take this much more frequently as she still has significant pain symptoms.  She is using a cane to help her ambulate.","Doctor: Good morning, ma'am. You're here for a follow up, correct? 
Patient: Yes, doctor. Guess what, I just had my seventy seventh birthday. 
Doctor: Happy birthday!
Patient: Thank you, doctor. 
Doctor:  Just to confirm, ma'am, you identify as White, correct? 
Patient: Thank you. Yes, doctor. That's correct. 
Doctor: Okay, walk me through this. So, you've seen doctor X Y Z before, correct? 
Patient: Yes, that's right. I saw him for low back pain and lumbar scoliosis post laminectomy syndrome, lumbar spinal stenosis, and symptomatic right L two radiculopathy.
Doctor: You were having right leg pain when you saw him? 
Patient: Yes. 
Doctor: Have you ever had surgery on your back? 
Patient: Yes, I had spinal stenosis, so they did, um, a laminectomy. 
Doctor: How did you respond to the procedure? 
Patient: Well, I had lower back pain and some arthritis in my spine after. 
Doctor: How have you been treated for these following the surgery? 
Patient: Um, Doctor X Y Z did some injections into my lower back. 
Doctor: Do you remember which side it was in?
Patient: It was in the right side, L2-L3.
Doctor: When was the last time you had these injections into the lower back?
Patient: The last one was in March of two thousand five. 
Doctor: How did your symptoms progress following the injections? 
Patient: Well, I went back to Doctor X Y Z, and then he thought that the symptoms I was having were coming from my right hip. 
Doctor: Did he do any imaging on this hip? 
Patient: Yes, I had some done when I saw him on, um, August fourth two thousand four. 
Doctor: Okay, the x rays we took today show marked degenerative changes, and a progression since the x rays taken back in August when you saw Doctor X Y Z. 
Patient: Oh no. Oh, he also did the injections into my right hip. 
Doctor: When was that?
Patient: Um, it was on April seventh two thousand five, and the last time I saw him was April fifteenth. 
Doctor: Is that when you had the last injections? 
Patient: Correct. 
Doctor: Has anyone talked to you about doing a hip replacement?
Patient: Yes, but right now I'm not sure if I want to do it. 
Doctor: Are you still having pain in that right hip today?
Patient: Yes, it still hurts. 
Doctor: What makes the pain worse? 
Patient: Well, anything that puts weight on this hip hurts really bad. 
Doctor: Okay, if it hurts that bad you should be using a cane. Did you ever get one?
Patient: Yes, I used one to come in here today, in fact. 
Doctor: Good. Do you have any other appointments scheduled?
Patient: Yeah, I made an appointment with an orthopedist in Newton. It's closer to my house. 
Doctor: That's fine. What medicines are you taking? 
Patient: Um, I take the generic for Ultracet. Sometimes I take as many as four times a day. 
Doctor: Does this help the pain?
Patient: No, I'm still in pretty significant pain, doctor."
1:51,1,51,only 2 turns (min 3),only 2 turns (min 3),51,MEDICATIONS,None.,"Doctor: So, just to confirm, no current medications? 
Patient: Yes, that's right."
1:52,1,52,doctor refers to prior patient (kimi),"Turn 2 consists solely of 'Okay.', a brief acknowledgment that refers entirely back to the previous patient answer and does not make sense on its own without that context.",52,ALLERGY,He has no known drug allergies.,"Doctor: Any allergies to medicine he might have? 
Guest_family: No, no allergies that we know of.
Doctor: Okay."
1:56,1,56,doctor refers to prior patient (kimi),"Turn 4 (""So, no loss vision, right?"") is entirely a confirmation/summary of the patient's immediately preceding answer (""Um, no."") and would not make sense on its own without it; it contains no separate standalone question or new topic.",56,ROS,"EYES: Negative visual changes, negative diplopia, negative scotomata, negative impaired vision.","Doctor: Any problems with your eyesight? Like blur or double vision?
Patient: Um, no.
Doctor: Any partial loss of vision or blind spot?
Patient: Um, no.
Doctor: So, no loss vision, right?
Patient: Right."
1:59,1,59,doctor refers to prior patient (kimi),Turn 2 ('Okay.') is entirely a backchannel/acknowledgment of the patient's immediately preceding answer and does not make sense as a standalone utterance without that context.,59,FAM/SOCHX,Mother and 2 maternal aunts with asthma. No history of renal or rheumatologic diseases.,"Doctor: Anyone have asthma at home?
Patient: Yes, my mother and her two sisters have long term asthma.
Doctor: Okay.
Patient: Yes.
Doctor: Any other diseases like kidney problems?
Patient: No kidney problems.
Doctor: Any rheumatological disorders?
Patient: Oh, no, no. Nothing like that."
1:60,1,60,same side twice at turn 3,same side twice at turn 3,60,LABS,"EKG is within normal limits, good sinus rhythm.  His axis is somewhat leftward.  CBC and BMP were normal and cardiac enzymes were negative x1.","Doctor: Your E K G looks good. Rhythm is normal. Your axis is somewhat leftward, but this is a normal variation. It is not an abnormal finding and in most cases does not need any further treatment.
Patient: How about blood tests?
Doctor: Your CBC and BMP came back normal and your cardiac enzymes were negative x1.
Doctor: Do you know what they are?
Patient: Yes, I can understand."
1:61,1,61,only 2 turns (min 3),only 2 turns (min 3),61,MEDICATIONS,None except the Amoxil and Aldex started on Monday.,"Doctor: What are your current medications?
Patient: None, except the Amoxil and Aldex that I started on Monday. "
1:62,1,62,no patient/guest patient turns,no patient/guest patient turns,62,GENHX,"The patient is a 17-year-old female, who presents to the emergency room with foreign body and airway compromise and was taken to the operating room.  She was intubated and fishbone.","Guest_clinician: How old is the patient? 
Doctor: She's seventeen years old. 
Guest_clinician: Did they determine what was obstructing her airways? 
Doctor: Yes, they found a two millimeter fishbone lodged in her throat. She had to be intubated and taken straight to the O R."
1:63,1,63,same side twice at turn 3,same side twice at turn 3,63,GENHX,"This is a followup dietary consultation for hyperlipidemia, hypertension, and possible metabolic syndrome.  The patient reports that she has worked hard for a number of weeks following the meal plan prescribed, but felt like she was gaining weight and not losing weight on it.  She is not sure that she was following it accurately.  She is trying to walk 1-1/2 to 2 miles every other day, but is increasing her time in the garden and doing other yard work as well.  Once she started experiencing some weight gain, she went back to her old South Beach Diet and felt like she was able to take some of that weight off.  However she realizes that the South Beach Diet is not a healthy diet for her and so is coming back for better instruction on safe weight loss and low-fat eating.","Doctor: Hello there, how are you doing? 
Patient: I'm doing good. Thank you. How about you? 
Doctor: Yeah, same old, same old. 
Doctor: So, looks like we're here to discuss your diet. Is that right? 
Patient: Yep. That's right. 
Doctor: Okay, let me look through your chart. It looks like you have high lipid levels, high blood pressure and a possibility for a metabolic syndrome. 
Patient: That looks like my chart. I'm kind of struggling here and I need your help. 
Doctor: Yeah, tell me did you follow the meal plan that we gave to you? 
Patient: I tried for many weeks to follow that meal plan that you gave me. 
Doctor: Okay, did it help? 
Patient: I don't know. I felt like I was still gaining weight instead of losing it. 
Doctor: Did you follow it exactly as you are, as you were asked to do?
Patient: I tried my best. But I feel like I am not doing it correctly or something. 
Doctor: Okay, tell me what kind of activities are you doing? How much physical activity are you doing on a regular basis? 
Patient: I try to walk around one and a half to two miles like every other day, but I'm spending more time in my garden and doing the yard work by myself. 
Doctor: That's good. Gardening gets-- can get hard and it helps you keep active. 
Patient: Oh yes, picking up all those pots from here to there and knowing that backyard of mine, it's a hard job. 
Doctor: Tell me what brings you here today? Like how can I help you? 
Patient: So, I think the meal plan that you gave was not working for me and there was definitely some weight gain, so I went back to my old South Beach Diet. 
Doctor: Okay. What were the results with your South Beach Diet then? Was it effective? 
Patient: I was able to get some pounds off. I felt pretty good about it. 
Doctor: That's good. Then what's the issue? 
Patient: Well, you see, deep in my heart I know this South Beach Diet is not a healthy diet for me and that's why I'm back to you. 
Doctor: I appreciate your honesty. You don't know how happy you made me by saying that. 
Patient: Yeah. You know, I'm here. So, tell me what to do to lose all this extra weight and how to enforce a low fat diet? What are your recommendations for that? 
Doctor: Let's set a plan for you."
1:69,1,69,same side twice at turn 3,same side twice at turn 3,69,PASTSURGICAL,None.,"Doctor: Have you ever had surgery, ma'am? 
Patient: What, like a joint replacement? 
Doctor: Well, it could be anything from a joint replacement to a C section.
Doctor: Oh, no. I've never had surgery. I had all of my children naturally."
1:71,1,71,no patient/guest patient turns,no patient/guest patient turns,71,EXAM,"GENERAL: Well developed, well nourished, in no acute distress.","Guest_clinician: Did you see that patient today? His general appearance looked good.
Doctor: Yeah, the patient was well developed and well nourished.
Guest_clinician: Was he in any acute distress?
Doctor: No."
1:72,1,72,only 2 turns (min 3),only 2 turns (min 3),72,FAM/SOCHX,noncontributory,"Doctor: Do you have any family medical history? 
Patient: No. I don't know of any family health problems."
1:73,1,73,same side twice at turn 9,same side twice at turn 9,73,ROS,"Positive for right upper quadrant pain.  He has occasional nausea, but no vomiting.  His appetite has decreased.  No joint pain, TIA, seizure or syncope.  Other review of systems is unremarkable. I reviewed his past medical history, past surgical history, and family history.","Doctor: Hi, how are you? 
Patient: I am okay, but I have this pain on my right side of the chest which is troubling me. 
Doctor: Where exactly do you have pain?
Patient: Ah, um it's kind of on the upper right side of my chest.
Doctor: Hm, do you have any nausea vomiting? 
Patient: Yeah, I have nausea sometimes but no vomiting.
Doctor: How is your appetite are you having a proper diet?
Patient: No not really. I don't feel hungry that much, my appetite has reduced a lot.
Doctor: Okay.
Doctor: Any fever, diarrhea headache or joint pain? 
Patient: No sir.
Doctor: Did you ever have any seizure or have loss consciousness or any stroke like symptoms?
Patient: Nothing of that sort.
Doctor: So, I just reviewed your past medical and surgical history. Tell me something, does anyone else in your family have this kind of chest pain? 
Patient: No, it's just me!
Doctor: Hm, okay."
1:76,1,76,only 2 turns (min 3),only 2 turns (min 3),76,EXAM,BREASTS: Normal male breast tissue.,"Doctor: That is just normal male breast tissue, nothing to worry about.
Patient: Oh okay."
1:77,1,77,doctor refers to prior patient (kimi),Turn 2 is entirely a reaction to the patient's immediately preceding answer about their diet. It contains no standalone questions or new topics; sentences like 'Keep doing whatever you're doing' and 'It's working for you' are anaphoric and only make sense in the context of that specific patient response. The whole turn functions as pure acknowledgment/feedback.,77,EXAM,"GENERAL: This is a well-developed and well-nourished, ??","Doctor: You look good? What are you eating these days? 
Patient: I've just started a protein rich diet. I am taking whey protein and have added a lot of greens as well. 
Doctor: You look great! Keep doing whatever you're doing. It's working for you."
1:79,1,79,doctor refers to prior patient (kimi),Turn 2 ('Anything else?') is entirely anaphoric and depends on the immediately preceding patient answer to be understood; it is not a standalone question or new topic and would not make sense on its own.,79,PASTMEDICALHX,"Positive for prostate cancer, intermittent urinary incontinence and left hip replacement.","Doctor: Did you have any medical issues in the past? 
Patient: I was found positive for prostate cancer. 
Doctor: Anything else? 
Patient: I also had on and off trouble holding my urine. 
Doctor: Any surgery in the past? 
Patient: I had my hip replaced on the left side."
1:80,1,80,only 2 turns (min 3),only 2 turns (min 3),80,EDCOURSE,RESTRAINTS: None.  She does have a palm protector in her right hand.,"Guest_clinician: Is the patient restrained? 
Doctor: No, but she does have a palm protector in her right hand."
1:81,1,81,doctor refers to prior patient (kimi),Turn 10 ('I am sorry to hear that.') is entirely a reaction to the patient's previous answer about being unemployed and would not make sense on its own without that context; it contains no standalone question or new topic.,81,FAM/SOCHX,"The patient lives with his wife.  He was an IT software developer, but he has been out of work for several months.  He smokes less than a pack of cigarettes daily. He denies alcohol or illicit drug use.","Doctor: Welcome to the clinic, sir! 
Patient: Thank you. 
Doctor: Do you use tobacco product, alcohol, or recreational drugs? 
Patient: I don't drink or do drugs. I do smoke cigarettes. 
Doctor: How much do you smoke per day? 
Patient: I probably smoke less then a pack a day. 
Doctor: Do you live at home with anyone? 
Patient: I live at home with my wife. 
Doctor: What do you do for work? 
Patient: I am currently unemployed. I have been out of work for several months now. I was working as an I T software developer. 
Doctor: I am sorry to hear that."
1:83,1,83,same side twice at turn 3,same side twice at turn 3,83,ROS,Review of systems is otherwise negative.,"Guest_clinician: I took her R O S, and everything looks normal except for mild soreness in her arm due to the vaccine.
Patient: In my left arm.
Doctor: Okay, thank you for updating the notes.
Guest_clinician: Sure, no problem."
1:85,1,85,only 2 turns (min 3),only 2 turns (min 3),85,PASTSURGICAL,None.,"Doctor: Did you ever have had any surgery? 
Patient: Not that I remember."
1:87,1,87,same side twice at turn 7,same side twice at turn 7,87,FAM/SOCHX,"There were possible illicit drugs.  Her family is present, and I have discussed her case with her mother and sister.","Doctor: Hi, how are you all?
Guest_family: We're good. Thank you. 
Doctor: How are you related to the patient? 
Guest_family: We are family. I am her mother and this is her sister.  
Doctor: Do you suspect any abuse of drugs?
Guest_family: we are not sure, but I guess she used to smoke or consume weed.
Doctor: I suspect there was some use of drugs as well. We can't tell which drug she was taking, but It looks like she was taking something.
Doctor: I hope you have understood her case very well and if there are any questions, please reach out to me."
1:90,1,90,doctor refers to prior patient (kimi),"Turn 2 (""And when was this?"") is entirely about the immediately preceding patient answer and would not make sense on its own without that context.",90,OTHER_HISTORY,None.,"Doctor: Have you ever been hospitalized for anything? 
Patient: No, thankfully. I was close to being hospitalized once, but it never actually happened. 
Doctor: And when was this? 
Patient: About two years ago. I got into a pretty brutal skateboarding accident.  
Doctor: Oh gosh. How long have you been skateboarding? 
Patient: Since I was a kid. Bout eight or nine years old. 
Doctor: Do you skate in your neighborhood or at a skatepark? 
Patient: Skatepark. I'll go with my friends every now and again.  
Doctor: Nice. I've never been skateboarding, but I've always been in awe of kids like you who know how to do cool skateboard tricks."
1:94,1,94,same side twice at turn 5,same side twice at turn 5,94,PASTSURGICAL,Includes a repair of a right intertrochanteric femur fracture.,"Doctor: Any past surgeries I should know of? 
Patient: Uh yes. I had a femur fracture repaired. 
Doctor: Do you remember which side? 
Patient: It was on the right. 
Doctor: Let me pull up your records. 
Doctor: Okay, I see. It looks like you had a repair of the right intertrochanteric femur."
1:95,1,95,same side twice at turn 37,same side twice at turn 37,95,GENHX,"This is a return visit to the renal clinic for this patient.  She is an 85-year-old woman with history as noted above.  Her last visit was approximately four months ago.  Since that time, the patient has been considerably more compliant with her antihypertensive medications and actually had a better blood pressure reading today than she had had for many visits previously.  She is not reporting any untoward side effect.  She is not having weakness, dizziness, lightheadedness, nausea, vomiting, constipation, diarrhea, abdominal pain, chest pain, shortness of breath or difficulty breathing.  She has no orthopnea.  Her exercise capacity is about the same.  The only problem she has is musculoskeletal and that pain in the right buttock, she thinks originating from her spine.  No history of extremity pain.","Doctor: Hello there!
Patient: Hi, how are you? 
Doctor: I am good. Do ypu mind stating your age and waht brings you in today? 
Patient: Oh, yes, I am 85 years old and I am having this weird muscle pain in my rightbuttocks region that I think it's radiating from my lower back or spine area I am not sure.
Doctor: Hm, what kind of pain is it? Like sharp pain or dull? 
Patient: It's kind of difficult to explain, but it's very irritating. 
Doctor: Okay! So, it's on the right side?
Patient: Yes.
Doctor: And when was your last visit to renal clinic? 
Patient: About four months back.
Doctor: Hm and you mentioned you are doing much better than before in terms of managing your high blood pressure with the current medication? 
Patient: Oh yes, absolutely I am doing so much better. I think earlier the nurse mentioned she has never seen my blood pressure this good. 
Doctor: Yes, it is much better than any of your previous visits. And no side effects, right?
Patient: No.
Doctor: Hm, and any other problem or any uneasiness?
Patient: Not really.
Doctor: Any nausea, vomiting or diarrhea?
Patient: No.
Doctor: Any weakness, dizziness or lightheadedness?
Patient: Nope.
Doctor: Any constipation or stomach pain?
Patient: No, I think just the hip pain.
Doctor: Any shortness of breath, chest pain or difficulty breathing?
Patient: I am fine no issues there.
Doctor: How bout any breathing issues while you sleep or when you lay down?
Patient: No.
Doctor: And do you exercise?
Patient: It is same as before not much difference.
Doctor: Okay.
Patient: Right now, it is just this hip pain which is bothering me.
Doctor: And you mention it is kind of radiating from your lower back.
Patient: Yeah, kind of like from my spine maybe, I am not sure.
Doctor: And no pain in your toes or lower legs?
Patient: No.
Doctor: Okay, did you try any medicines?
Patient: Yes, I did try some Tylenol but that's it. It does help a bit.
Doctor: Okay, let's try something stronger, I will write you a prescription for it. You can take it for a week and if your pain does not improve, we will take some x rays.
Doctor: How old are you again eighty-five? 
Patient: Yes.
Doctor: Okay. Overall, you do look better today and these medicines should take care of the pain. 
Patient: Thank you!
Doctor: Take care."
1:96,1,96,only 2 turns (min 3),only 2 turns (min 3),96,ALLERGY,No known drug allergies.,"Doctor: Do you have any known drug allergies? 
Patient: No.  None that I know of."
1:97,1,97,doctor refers to prior patient (kimi),Turn 4 ('Would you say you drink occasionally then?') is entirely contingent on the patient's immediately preceding answer and would not make sense on its own without it. It contains no separate standalone question or new topic; it is purely a request for confirmation of an inference drawn from that specific patient utterance.,97,FAM/SOCHX,She drinks alcohol occasionally.,"Doctor: Hello, miss. How was your weekend? 
Patient: It was fun. I went to a party, but now my back hurts. 
Doctor: I see. Did you drink alcohol at the party? 
Patient: Just a little. I only drink when I go to special occasions. 
Doctor: Would you say you drink occasionally then? 
Patient: I do."
1:99,1,99,only 2 turns (min 3),only 2 turns (min 3),99,ROS,Negative.,"Doctor: Are you experiencing any symptoms? 
Patient: Nope."
1:100,1,100,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,100,GENHX,"The patient is a previously healthy 2-month-old female, who has had a cough and congestion for the past week.  The mother has also reported irregular breathing, which she describes as being rapid breathing associated with retractions.  The mother states that the cough is at times paroxysmal and associated with posttussive emesis.  The patient has had short respiratory pauses following the coughing events.  The patient's temperature has ranged between 102 and 104.  She has had a decreased oral intake and decreased wet diapers.  The brother is also sick with URI symptoms, and the patient has had no diarrhea.  The mother reports that she has begun to regurgitate after her feedings.  She did not do this previously.","Doctor: I'm sorry to see that she's not doing well.  
Guest_family: I can't even begin to tell you how hard this past week has been for us. She has had so much congestion. She's also coughed more than she ever has before. She is only two months old and it breaks my heart to see her like this.
Doctor: Oh wow. We'll see what we can do for her. How's her breathing been? 
Guest_family: She's had some irregular breathing where she would breathe very quickly and retract.  
Doctor: Has she been running a fever? 
Guest_family: She's been running in the hundreds between one O two and one O four. 
Doctor: Has she been feeding well? 
Guest_family: No, not at all. She's been feeding less and I notice she hasn't had as many wet diapers as a result. 
Doctor: Is anyone else in the family sick? 
Guest_family: My son has an upper respiratory infection.  
Doctor: How long has he been sick? 
Guest_family: A day or two before our two month old. 
Doctor: You mentioned that she's been coughing a lot. Is she bringing anything up with her coughs?  
Guest_family: Yeah, I think her coughs trigger some sort of reflex response, causing her to spit up or throw up a few times. It comes on so suddenly, it takes me by surprise. 
Doctor: Does she happen to experience similar symptoms after her feedings? 
Guest_family: Yeah, that's new too. 
Doctor: Any diarrhea? 
Guest_family: None."
1:101,1,101,only 2 turns (min 3),only 2 turns (min 3),101,MEDICATIONS,Multivitamins and calcium.,"Doctor: Are you taking any medication? 
Patient: Just multivitamins and calcium."
1:102,1,102,doctor refers to prior patient (kimi),"Turn 2 ('Oops!') is entirely a reactive exclamation to the immediately preceding patient turn. It contains no standalone question, instruction, or new topic, and would not make sense on its own without that patient context.",102,CC,Buttock abscess.,"Doctor: Hey what you got there?
Patient: I got this boil type of situation going on on my butt.
Doctor: Oops!
Patient: I know.
."
1:106,1,106,only 2 turns (min 3),only 2 turns (min 3),106,ALLERGY,She has no known drug allergies.,"Doctor: Do you have any known drug allergies? 
Patient: No."
1:108,1,108,doctor refers to prior patient (kimi),"Turn 2 ('Both ears?') is entirely a backward-looking clarification about the patient's immediately preceding mention of ear pain. The word 'both' has no referent without that prior turn, so the line does not make sense on its own and contains no separate standalone question or topic.",108,ASSESSMENT,Ongoing purulent rhinitis.  Probable sinusitis and serous otitis.,"Doctor: How's she doing today? 
Guest_family: She's been blowing up green snot and complaing of ear pain. 
Doctor: Both ears? 
Guest_family: Both the right and left. 
Doctor: How long has she been bringing up green snot? 
Guest_family: Maybe six or so days? 
Doctor: Let's see. It looks like she may have sinusitis. After checking both ears, I noticed fluid buildup in the right middle ear. I'll go ahead and prescribe her some antibiotics and hopefully she'll be as good as new in a few days. I'd like her to come back for a follow up to make sure all the fluid in her ear is gone."
1:109,1,109,only 2 turns (min 3),only 2 turns (min 3),109,ALLERGY,None.,"Doctor: Do you have any allergies? 
Patient: I am not allergic to anything as far as I know."
1:110,1,110,doctor refers to prior patient (kimi),Turn 16 is entirely a synthesis of the patient's immediately preceding answer about episode duration ('thirty to forty seconds') and makes no sense as a standalone utterance without that prior context. It contains no new question or separate topic.,110,GENHX,"The patient is a 2-1/2-year-old female with a history of known febrile seizures, who was placed on Keppra oral solution at 150 mg b.i.d. to help prevent febrile seizures.  Although this has been a very successful treatment in terms of her febrile seizure control, she is now having occasional brief periods of pauses and staring, where she becomes unresponsive, but does not lose her postural tone.  The typical spell according to dad last anywhere from 10 to 15 seconds, mom says 3 to 4 minutes, which likely means probably somewhere in the 30- to 40-second period of time.  Mom did note that an episode had happened outside of a store recently, was associated with some perioral cyanosis, but there has never been a convulsive activity noted.  There have been no recent changes in her Keppra dosing and she is currently only at 20 mg/kg per day, which is overall a low dose for her.","Doctor: How old is the baby girl? 
Guest_family: She is two and a half years old. 
Doctor: And you both are her parents?
Guest_family: Yes. 
Doctor: Tell me what happened in detail.
Guest_family: She has a history of seizures. She used to have shakes and lose consciousness. 
Doctor: Was she taking any medications for that? 
Guest_family: Yeah, she was placed on Keppra solution one hundred and fifty M G for two times a day. It helped a lot and she was doing fine. Her seizures were improving a lot but recently we have noticed something similar again. 
Doctor: What kind of symptoms are showing now? 
Guest_family: She will just stop doing everything and stare blankly. We tried to shake her but during that period she just does not respond.
Doctor: Does she becomes floppy like can't control her body during that phase? 
Guest_family: No, we didn't notice that. 
Doctor: How long is that period? 
Guest_family2: I think it lasts somewhere around ten to fifteen seconds. 
Doctor: What are your thoughts on this? As a mother you might be spending more time with her. 
Guest_family: Yeah, I have noticed this too, but I think it stays for like three to four minutes. 
Doctor: So, it is somewhere around thirty to forty seconds.
Guest_family: One day I was outside the store and then I noticed that she had a similar event. Her skin around her mouth turned blue. 
Doctor: Was she having any kind of jerky motions?
Guest_family: No. 
Doctor: Have you changed her medications like the amount you are giving or anything like that? 
Guest_family: No, we haven't changed anything. She's still on the same dose. 
Doctor: I'm looking at the record and it says that she is supposed to take twenty M G per kilogram every day. It looks like a very low dose for her."
1:112,1,112,same side twice at turn 4,same side twice at turn 4,112,MEDICATIONS,"unknown anxiolytic, estrogen.","Doctor: Is she taking any medications? 
Guest_family: Um uh I wrote them down. Let me find the Post-it note. I had it right here. 
Doctor: Take your time. 
Guest_family: Ok uh found it. 
Guest_family: It looks like she's taking some type of anxiety medication and estrogen."
1:114,1,114,only 2 turns (min 3),only 2 turns (min 3),114,FAM/SOCHX,Reviewed and unchanged.,"Doctor: And we did review your family history last time. No one else suffers from heart problems in your family, right? 
Patient: Yeah, it's just me."
1:116,1,116,doctor refers to prior patient (kimi),"Turn 6 consists entirely of the acknowledgment 'Okay.', which only makes sense in reference to the patient's immediately preceding answer and cannot stand alone.",116,GENHX,The patient has had no help with the headaches from over-the-counter analgesics.,"Doctor: Have you ever taken any prescribed drug for your headaches. 
Patient: No. 
Doctor: What do you take when you get headaches. 
Patient: I try not to take to much medication but when they get really bad, I take Excedrin or ibuprofen. 
Doctor: So only over the counter medications? Do they work in providing you relief?
Patient: Yes, I have been using over the counter medications and they have been no help with my headaches . 
Doctor: Okay."
1:117,1,117,only 2 turns (min 3),only 2 turns (min 3),117,GYNHX,This is her first pregnancy.,"Doctor: Is this your first pregnancy? 
Patient: Yes. I'm so excited for the baby to arrive!"
1:119,1,119,doctor refers to prior patient (kimi),"Turn 4 ('Wonderful.') and Turn 8 ('Gotcha.') are entire utterances that serve only as acknowledgments of the immediately preceding patient answers. They cannot stand alone without that context, matching the examples to drop (e.g., 'That's good', 'Lucky you').",119,FAM/SOCHX,Divorced. Lives with boyfriend. 3 children alive and well. Denied tobacco/illicit drug use. Rarely consumes ETOH.,"Doctor: How many kids do you have? 
Patient: I have three kids, and I'm blessed to say that they're all healthy and well. 
Doctor: That's great to hear. Do they live with you or your ex husband? 
Patient: They live with my boyfriend and me. 
Doctor: Wonderful.  
Patient: It's a full house for sure. 
Doctor: Do you drink or smoke? 
Patient: I don't touch tobacco or any other drugs. I sometimes drink, but only on rare occasions. 
Doctor: Gotcha."
1:121,1,121,only 2 turns (min 3),only 2 turns (min 3),121,PASTMEDICALHX,She has an intolerance to Prevacid.,"Doctor: Are you still take Prevacid? 
Patient: No. I had to stop taking it.  It gave me diarrhea."
1:122,1,122,"starts with guest_family, not doctor|same side twice at turn 9","starts with guest_family, not doctor; same side twice at turn 9",122,EDCOURSE,"He also had a P-Bag placed, but did not have any urine.  Therefore, a straight catheter was done, which was done with ease without complication and there was no leukocytes noted within the urine.  There was a little bit of blood from catheterization but otherwise normal urine.  X-ray noted some stool within the vault.  Child is acting normally.  He is jumping up and down on the bed without any significant findings.","Guest_family: They just changed his P bag, that's why there is no pee in it.
Doctor: Okay. Yes, it looks empty. I think they did a straight cath.
Guest_family: Yeah, and they took out the urine to send it to the lab.
Doctor: Okay. Yes, there were no leukocyte seen. That means no infection.
Guest_family: But they said there was blood?
Doctor: Yes, during catheterization but the urine is normal.
Guest_family: Okay.
Doctor: In your x ray there was stool seen in the colon.
Guest_family: Okay.
Guest_family_2: He is fine?
Doctor: Yeah, he is fine. I can see that he is very active. Jumping up and down.
Doctor: Hi champ!
Patient: Hi."
1:124,1,124,no patient/guest patient turns,no patient/guest patient turns,124,ROS,Unobtainable secondary to the patient's condition.,"Guest_clinician: How's the patient doing? 
Doctor: In stable condition, but I'm not yet able to obtain a history from them. 
Guest_clinician: Please page me when they're awake and able to answer questions. I'll be on the eighth floor if you need me. 
Doctor: Will do."
1:125,1,125,"starts with patient, not doctor|same side twice at turn 11","starts with patient, not doctor; same side twice at turn 11",125,EDCOURSE,"1.  Serotonin syndrome.  After reevaluation of the patient including evaluation of the lab abnormalities it was felt that she likely had serotonin syndrome with obvious restlessness, increased bowel activity, agitation, and elevated white count and CPK.  She did not have fever, tremor or hyperreflexia.  Her CPK improved with IV fluids.  She dramatically improved with this discontinuation of her Prozac.  Her white count came back down towards normal.  At time of discharge, she was really feeling back to normal. 2.  Depression and anxiety with history of panic attacks exacerbated by her husband leaving her 2 weeks ago.  We discussed this.  Also, discussed the situation with a psychiatrist who is available on Friday and I discussed the situation with the patient.  In regards to her medications, we are discontinuing the Prozac and she is being reevaluated by Dr. X on Monday or Tuesday.  Cymbalta has been recommended as a good alternative medication for her.  The patient does have a counselor.  It is going to be difficult for her to go home alone.  I discussed the resources with her.  She has a daughter who will be coming to town in a couple of weeks, but she does have a friend that she can call and stay the next few days with. 3.  Hypertension.  She will continue on her usual medications. 4.  Diabetes mellitus.  She will continue on her usual medications. 5.  Diarrhea resolved.  Her electrolyte abnormalities resolved.  She had received fluid rehydration.","Patient: I just had few questions. Can you tell me about my diagnosis?
Doctor: Sure. It's called Serotonin syndrome, ma'am. After careful evaluation of your labs, we found out that your white count and C P K was high, and those abnormalities lined up with serotonin syndrome. What are you experiencing right now?
Patient: I have been very restless and easily agitated, I have diarrhea. But no fever or shakiness.
Doctor: These can match serotonin syndrome as well. You deny any fever, tremor or hypperflexia so we will give you some IV fluids and I will check on you in an hour or so.
Patient: Okay. 
Doctor: Looks like your C P K counts improved with I V fluids and after discontinuing Prozac.
Patient: How are the counts now? Are they normal? Because I feel normal.
Doctor: Yes, your C P K and white blood cell counts have come back down. Almost normal now.
Patient: My husband left me two weeks ago. My panic attacks are increasing day by day.
Doctor: Okay, I see that you have a history of panic attacks and you do have depression and anxiety, is that correct? Last Friday, I talked to psychiatrist about your issues, and he recommended Cymbalta as an alternative to Prozac. 
Patient: Yes, I stopped taking Prozac, and I am going to see him on Monday or Tuesday. I have a counselor too.
Patient: I do think it will be difficult to go home alone but my daughter is coming to visit me in two weeks.
Doctor: Oh wow.
Patient: Yeah.
Doctor: That's nice. Do you have someone who can drop you home and help you?
Patient: Yes, I have a friend who does that, I am staying with her for next three days.
Doctor: Okay that sounds good. Just continue with your medications for high blood pressure and diabetes as well. So, we treated your imbalance issues and gave you IV fluids, you do not have any more diarrhea, right?
Patient: Yes, that's right."
1:127,1,127,same side twice at turn 4,same side twice at turn 4,127,GENHX,The patient has NG tube in place for decompression.  She says she is feeling a bit better.,"Doctor: We have placed this nasogastric tube for decompression.
Guest_family: Okay.
Doctor: How are you feeling now?
Patient: Um.
Guest_family: She said that she feels better now."
1:128,1,128,doctor refers to prior patient (kimi),"Turn 10 ('Yes, we are looking at that at this point.') is entirely a backward-looking response to the patient's prior statement about palliative radiation/comfort care. It contains no standalone question or new topic and would not make sense on its own without the immediately preceding patient turn.",128,GENHX,"This is a 78-year-old male who has prostate cancer with metastatic disease to his bladder and in several locations throughout the skeletal system including the spine and shoulder.  The patient has had problems with hematuria in the past, but the patient noted that this episode began yesterday, and today he has been passing principally blood with very little urine.  The patient states that there is no change in his chronic lower back pain and denies any incontinence of urine or stool.  The patient has not had any fever.  There is no abdominal pain and the patient is still able to pass urine.  The patient has not had any melena or hematochezia.  There is no nausea or vomiting.  The patient has already completed chemotherapy and is beyond treatment for his cancer at this time.  The patient is receiving radiation therapy, but it is targeted to the bones and intended to give symptomatic relief of his skeletal pain and not intended to treat and cure the cancer.  The patient is not enlisted in hospice, but the principle around the patient's current treatment management is focusing on comfort care measures.","Doctor: We are following up with you for your prostate cancer which has metastasized to your bladder and in several locations throughout your body including the spine and shoulder.
Patient: Yes, you remember I had blood in my urine in the past, but I think it is coming back. I started noticing that from yesterday, and today I saw a lot of blood with very little urine.
Doctor: Oh okay, we will have to evaluate that then. Let me ask you few other questions to get this out of the way. How about your back pain, how's it? Also any incontinence?
Patient:  Okay sure. No, there is no change in my chronic lower back pain, and no, no incontinence, urinary or stool. 
Doctor: All right. How about fever, belly pain, nausea or vomiting?
Patient: No to everything.
Doctor: Are you able to pee noramally and pass urine, you aren't retaining? How about blood in stools?
Patient: Yes, I am passing everything well. No blood in stools.
Doctor: Okay. Can you tell me if you have finished your chemo?
Patient: Yes, I have already completed chemo. Now they started me with radiation therapy, but it is only targeted to the bones. They told me I will feel well as in there won't be any pain. It's not supposed to treat or cure the cancer, but just to make me comfortable.
Doctor: Yes, we are looking at that at this point.
Patient: Okay. 
Doctor: Do you have any hospice care facility listed?
Patient:  No, I haven't looked at it yet, but I would love to look at hospice facilities.
Doctor: That treatment management we are focusing on-
Patient: I know only comfort ha!"
1:130,1,130,only 2 turns (min 3),only 2 turns (min 3),130,DIAGNOSIS,Foreign body OS.,"Doctor: Looks like he has a foreign body in his left eye. 
Guest_family: Does he need to see an eye doctor after this?"
1:131,1,131,same side twice at turn 1,same side twice at turn 1,131,ASSESSMENT,I feel that this patient has a febrile seizure.,"Doctor: His fever is running very high, I think he is having a febrile seizure.
Guest_clinician: Yeah, I think so too.
Guest_family: Is he going to be okay? 
Doctor: Ma'am, let us have a look."
1:132,1,132,only 2 turns (min 3),only 2 turns (min 3),132,FAM/SOCHX,"No tobacco, alcohol, or drug abuse.","Doctor: Do you have any history of tobacco, alcohol, or drug use? 
Patient: I have a glass of wine with dinner every once in a while, but no other than that."
1:133,1,133,doctor refers to prior patient (kimi),Turn 4 ('Excellent!') is entirely a backward-looking reaction to the patient's 'No!' and has no standalone meaning without that prior context. Turn 2 is acceptable because it contains a separate standalone question after a brief acknowledgment.,133,FAM/SOCHX,"No history of any smoking, alcohol or drug abuse.","Doctor: Do you have a history of alcohol or drug abuse? 
Patient: I have had a drink on special occasions, but I don't drink. And I have never ever done drugs. 
Doctor: Okay. Do you smoke or have you ever in the past? 
Patient: No! 
Doctor: Excellent!"
1:134,1,134,doctor refers to prior patient (kimi),"Turn 2 ('Yes, sir.') is a direct confirmation of the patient's clarifying question with no standalone content beyond that response. Turn 8 ('Okay great.') is a purely backward-looking acknowledgment of the patient's answer, functionally identical to the example 'That's good'. Both doctor turns consist entirely of material about the immediately preceding patient answer and would not make sense on their own.",134,MEDICATIONS,"He is currently on several medications, a list of which is attached to the chart, and was reviewed.  He is not on any blood thinners.","Doctor: What are you taking? 
Patient: You mean meds?
Doctor: Yes, sir.
Patient: Actually, that nurse asked me already and reviewed it with me. Do you want me to tell you again?
Doctor: No let me check the chart then.
Patient: Okay.
Doctor: You are not on any blood thinners right?
Patient: No I am not.
Doctor: Okay great.
Patient: Yeah."
1:136,1,136,doctor refers to prior patient (kimi),Turn 2 ('What do they say?') is entirely anaphoric and depends on the immediately preceding patient turn mentioning reports; without that context the line is incomplete and would not make sense on its own. It contains no separate standalone question or new topic.,136,GENHX,"School reports continuing difficulties with repetitive questioning, obsession with cleanness on a daily basis, concerned about his inability to relate this well in the classroom.  He appears confused and depressed at times.  Mother also indicates that preservative questioning had come down, but he started collecting old little toys that he did in the past.  He will attend social skills program in the summer.  ABCD indicated to me that they have identified two psychologists to refer him to for functional behavioral analysis.  There is lessening of tremoring in both hands since discontinuation of Zoloft.  He is now currently taking Abilify at 7.5 mg.","Doctor: Can you tell me more about your son, ma'am? 
Guest_family: Well, I have his reports from his school right here.
Doctor: What do they say? 
Guest_family: Well, in summary, he's having a lot of problems at school. 
Doctor: What kind of problems is he having? 
Guest_family: Well, he has been asking an unusual number of questions, and he's been obsessed with cleaning and cleanness. 
Doctor: What about his interactions with his classmates? 
Guest_family: According to the reports from his school, he doesn't relate well in the classroom. 
Doctor: How is his mood? 
Guest_family: Well, he seems to be confused and depressed sometimes. 
Doctor: Is he still asking a lot of questions in class? 
Guest_family: It's come down a little bit recently. 
Doctor: Are there any other unusual behaviors you've seen? 
Guest_family: Um, he used to collect old little toys when he was younger, and he's started doing that again. 
Doctor: I see, what are his plans for the summer, will he be in classes? 
Guest_family: He'll be in a social skills program this summer, doctor. 
Doctor: I see here as well that A B C D has referred him to two psychologists for functional behavioral analysis, is that correct?
Guest_family: Yes, doctor, that's correct. 
Doctor: Good, be sure to follow up with them please. 
Guest_family: Yes, we will, doctor. 
Doctor: Has he been taking his Zoloft? 
Guest_family: No, he's taking, um, seven point five M G of Abilify. 
Doctor: I see, how has he responded to stopping taking the Zoloft? 
Guest_family: Actually, the tremors in his hands have been a little better."
1:139,1,139,same side twice at turn 18,same side twice at turn 18,139,GENHX,"This 1+ year, black female, new patient in dermatology, sent in for consult from ABC Practice for initial evaluation of a lifelong history of atopic eczema.  The patient's mom is from Tanzania.  The patient has been treated with Elidel cream b.i.d. for six months but apparently this has stopped working now and it seems to make her more dry and plus she has been using some Johnson's Baby Oil on her.  The patient is a well-developed baby.  Appears stated age.  Overall health is good.","Doctor: Hello, ma'am. I see you brought your baby daughter in today. Is she a new patient? 
Guest_family: Hello, I am her mother. She is a new patient. 
Doctor: Before we begin, could you verify her age and ethnicity, please? 
Guest_family: She is a little over one years old, and we identify as black. 
Doctor: Thank you. How did you hear about our dermatology office? 
Guest_family: Well, we just came from Tanzania, my birthplace. I have been seeing this odd skin issue with my baby, so I took her to the A B C Practice. After, they sent me here so that you can check her skin problem. 
Doctor: I see. Do you have a report from the A B C Practice? 
Guest_family: I do. Here you go. 
Doctor: Thank you. It looks like she has a history of this atopic eczema, correct? 
Guest_family: Yes, she has. 
Doctor: Did they provide you with any medication? 
Guest_family: I have the bottle with me. Here you go. 
Doctor: It looks like they gave you an Elidel cream. How often do you apply it to her rashes? 
Guest_family: I've been putting it on my daughter twice a day for six months now. 
Doctor: Is it effective? 
Guest_family: It was, but now it doesn't work. Her skin is just dry now. I've been putting this oil on her now.
Doctor: Do you know the name of the oil? 
Guest_family: No, I don't. It starts with a J. I can find a picture. 
Guest_family: Here it is. It's this oil. 
Doctor: Oh, I see. The Johnson's Baby oil. That's a good brand. Well, your daughter seems to be well-developed and has good health. She looks her age. We can see what else can help with her rashes."
1:140,1,140,only 2 turns (min 3),only 2 turns (min 3),140,ALLERGY,No allergies.,"Doctor: Did you have any known allergies?
Patient: Not that I know."
1:141,1,141,"starts with patient, not doctor|same side twice at turn 1","starts with patient, not doctor; same side twice at turn 1",141,ASSESSMENT,"The patient presents for evaluation after a contaminated needlestick to the index finger. The source patient was tested and found to be negative for HIV. However, he did test positive for hepatitis C. He was described as a carrier without active disease. The patient has been followed with periodic evaluation including blood testing. He has completed a 3 shot series for hepatitis B and had titers drawn that showed protected antibodies. He also was up-to-date on his immunization including tetanus. The patient has been well during this time except for the onset of a intestinal illness being investigated with some squeakiness and vomiting. He had no other symptoms that were suggestive of acute hepatitis. His abdominal exam was normal. He had no generalized lymphadenopathy and no fever. Blood tests were drawn on 02/07/2005. The results of which were reviewed with the patient. His liver function test was normal at 18. His hepatitis C and HIV, both of which were negative. He had no local signs of infection, and otherwise has been doing well except for his acute intestinal illness as described above.","Patient: So, as you remember I was working with a patient and I accidently jammed that needle inside me.   
Patient: I am coming for regular screening.
Doctor: Yes, thank you for that, sir. Did they screen patient?
Patient: Yes, he got negative H I V but positive hep C, they said he is a carrier only, never will show disease symptoms. 
Doctor: Okay.
Patient: I am scared. 
Doctor: Don't worry, we will do what we can okay. Firstly, let me check if they did some hepatitis B shots on you. Okay looks like you had three shots of hep B and Tetanus is up to date with all others. Antibodies are showing, which is good. 
Patient: They did the tests on February seven two thousand and five. Have you seen my liver test results? And maybe some other?
Doctor: Yes, I can see that your liver function test were normal at eighteen and hepatitis C and H I V, both were negative. We took these labs on February seventh. You do not have any local signs of infection, right?  Except acute intestinal problem?
Patient: Nothing local, but I do have intestinal squeakiness and vomiting.
Doctor: Let me look at your exam.
Patient: Okay.
Doctor: Abdomen is fine, no fever and no swellings. That's great.
Patient: Okay."
1:142,1,142,doctor refers to prior patient (kimi),Turn 2 ('Oh I am so sorry.') is entirely a reaction to the immediately preceding patient answer and does not make sense on its own without that context; it contains no standalone question or new topic.,142,CC,Weak and shaky.,"Doctor: How are you feeling?
Patient: I am feeling very weak and shaky.
Doctor: Oh I am so sorry.
Patient: It's okay."
1:145,1,145,same side twice at turn 3,same side twice at turn 3,145,FAM/SOCHX,"Mother with breast CA, MA with ""bone cancer."" AODM both sides of family.","Doctor: Lets talk about your family history, does anyone else in your family have cancer?
Patient: Yes, my mother had metastatic breast cancer and my mother's sister was dealing with bone cancer. 
Doctor: Oh, I am sorry to hear that!
Doctor: Anything else? 
Patient: Yeah, both sides of my family has diabetes.
Doctor: Were your family members young when they were diagnosed, or did they develop it later in life?
Patient: I believe they all were adults when they were diagnosed with diabetes.
Doctor: Ah, yes. They had adult onset diabetes mellitus.
Patient: Yeah."
1:146,1,146,doctor refers to prior patient (kimi),"Turn 8 ('We'll have to, even though its early.') is entirely a response to the patient's preceding question and cannot stand alone. Turn 14 ('Yes, he won't feel a thing.') is entirely an answer to the immediately preceding yes/no question and is non-sensical without it. Both are fully dependent on the previous patient turn.",146,GENHX,"The patient is a 5-year, 5-month-old male who sustained a both-bone forearm fracture in September 2007.  The fracture healed uneventfully, but then the patient subsequently suffered a refracture one month ago.  The patient had shortening in arms, noted in both bones.  The parents opted for surgical stabilization with nailing.  This was performed one month ago on return visit.  His ulnar nail was quite prominent underneath the skin.  It was decided to remove the ulnar nail early and place the patient in another cast for 3 weeks. Risks and benefits of the surgery were discussed with the mother.  Risk of surgery incudes risks of anesthesia, infection, bleeding, changes in sensation in most of the extremity, need for longer casting.  All questions were answered and mother agreed to above plan.","Doctor: Good morning, young man. Is this your mother?
Patient: Yes, doctor.
Doctor: Good, nice to mee you. Can you tell me more about your son, please? 
Guest_family: Good morning to you too, doctor. Well, he's about five and a half now, and he broke both the bones in his forearm in September of two thousand seven. 
Doctor: How did the fracture heal? Generally, children heal very well. 
Guest_family: Well, yes, until he also rebroke it about a month ago. 
Doctor: Yes, I see now, there's an ulnar nail pretty prominently visible under the skin, did he have surgery for this? 
Guest_family: Yes, about a month ago now. Should we remove the nail?
Doctor: We'll have to, even though its early.
Guest_family: What will we do after the nail is removed? 
Doctor: After that, we'll put him back in a cast for about another three weeks. We'll evaluate him and see how he's doing.  
Guest_family: Okay. What are the risks of infection for this surgery?
Doctor: The risk of infection is overall very low, honestly its less than one percent. We use antibiotics to control for infection the entire time. Other risks include bleeding, changes in sensation in most of the extremity, or need for longer casting. I would not worry too much about these risks. I have not seen anything bad happen before.
Guest_family_1: Will he be asleep for the surgery?
Doctor: Yes, he won't feel a thing."
1:147,1,147,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,147,MEDICATIONS,"In Spanish label.  They are the diabetic medication, and also blood pressure medication.  She also takes aspirin a day.","Doctor: Does she take any medicine? 
Guest_family: Um, let me check. She usually keeps them in her purse. Okay, so here we have three medicine bottles. The labels are all in Spanish, but I can translate for you. She takes one Aspirin a day along with her blood pressure and diabetes medicine. 
Doctor: Do you mind if I take a look as well? 
Guest_family: Sure, here you go."
1:148,1,148,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,148,GENHX,"A 2-week-old who at this point has otherwise been doing well.  He has a relatively unremarkable foreskin.  At this point in time, he otherwise seems to be doing reasonably well.  The question is about the foreskin.  He otherwise has no other significant issues.  Severity low, ongoing since birth two weeks.  Thank you for allowing me to see this patient in consultation.","Doctor: How is your two week old newborn son doing today?
Guest_family: He's been doing very well. 
Doctor: Great, what brings you in for a visit today?
Guest_family: We just have a question about his foreskin. It's not a severe issue, but we are still concerned. 
Doctor: Other than the foreskin, which appears to not be out of the ordinary upon exam, does he have any other problems? 
Guest_family: No, not really, he's been doing pretty well. "
1:150,1,150,"starts with guest_family, not doctor","starts with guest_family, not doctor",150,GENHX,"This is an 18-month-old white male here with his mother for complaint of intermittent fever for the past five days.  Mother states he just completed Amoxil several days ago for a sinus infection.  Patient does have a past history compatible with allergic rhinitis and he has been taking Zyrtec serum.  Mother states that his temperature usually elevates at night.  Two days his temperature was 102.6.  Mother has not taken it since, and in fact she states today he seems much better.  He is cutting an eye tooth that causes him to be drooling and sometimes fussy.  He has had no vomiting or diarrhea.  There has been no coughing.  Nose secretions are usually discolored in the morning, but clear throughout the rest of the day.  Appetite is fine.","Guest_family: My baby is sick.
Doctor: Don't worry, I will help you.
Guest_family: He has had a fever for five days.
Doctor: How old is he?
Guest_family: Just eighteen months. He is a Swedish American. 
Doctor: You gave him medication?
Guest_family: Yes, he finished Amoxil several days ago for sinus infection.
Doctor: He takes Zyrtec as well right?
Guest_family: Yes. For allergies.
Doctor: Okay. Is the fever constant throughout the day or it fluctuates?
Guest_family: It is higher at night.
Doctor: Have you checked it?
Guest_family: Yes, it was one o two point six for two days. I have not checked it since then. But isn't it strange just when I thought to bring him to the doctor, he is better.
Doctor: Ha, that tends to happen? 
Guest_family: Yeah.
Doctor: His tooth is coming out.
Guest_family: No wonder! Maybe that's why he is fussy and drooling so much.
Doctor: Yeah. How about any diarrhea or vomiting?
Guest_family: No, he doesn't have that.
Doctor: Cough?
Guest_family: No coughing.
Doctor: Have you seen any change in the color of his mucous that is coming out of his nose?
Guest_family: Yes, his snots are discolored in the morning but not so much in the day.
Doctor: Is he eating well? He seems hungry?
Guest_family: Yeah, yeah."
1:152,1,152,doctor refers to prior patient (kimi),Turn 10 ('Does this make the pain worse?') is entirely about the immediately preceding patient answer (playing instruments) and would not make sense on its own without it; the referent of 'this' is supplied only by the patient's hobby statement in turn 9.,152,GENHX,"XYZ was seen by Dr. ABC for an FCR tendinitis.  We do not have his reports, but by history she has had two cortisone shots.  She plays musical instruments, and it does bother her from time to time.  She was considering surgery, but she takes ibuprofen and it seems to be well-controlled.  She is here now for consultation.","Doctor: Good morning, Miss XYZ.
Patient: Good morning, Doctor.
Doctor: So, I hear from my nurses you have F C R tendinitis. Have you seen another doctor for this?
Patient: Yes, I saw Doctor A B C, but what is F C R tendinitis? I don't have his notes with me today. 
Doctor:  That stands for flexor carpi radialis, it's a tendon in your forearm that has become inflamed. 
Patient: Okay, thank you for explaining that for me. 
Doctor: You're very welcome, my dear. So, you don't have his reports, but do you remember how this has been treated in the past? 
Patient: So far, I've had two cortisone shots. 
Doctor: I see. So, what do you do for fun? Do you have any hobbies?
Patient: Actually, I play a few instruments. 
Doctor: Does this make the pain worse?
Patient: Yes, but only from time to time. 
Doctor: I see. Do you take anti-inflammatories when the pain gets bad?
Patient: Yeah, I do. I was thinking about having surgery, but if it's managed with the anti-inflammatories would I even need it? I'd like your opinion on that."
1:153,1,153,doctor refers to prior patient (kimi),Turn 2 ('I am sorry.') is entirely a sympathetic reaction to the patient's statement that their father has passed away. It does not introduce a new question or topic and would not make sense on its own without the preceding patient answer.,153,FAM/SOCHX,"Positive for diabetes mellitus in his father, who is now deceased.","Doctor: And does diabetes run in your family? 
Patient: Actually yes, my dad had it. He is no more.
Doctor: I am sorry."
1:154,1,154,"starts with patient, not doctor","starts with patient, not doctor",154,PASTMEDICALHX,"Remarkable for chronic pain.  He has had multiple stab wounds, gunshot wounds, and a variety of other injuries that resulted him having chronic pain and he states that is what triggers of him getting on heroin to try to get out of pain.  He has previously been followed by ABC but has not seen him for several years.","Patient: I am in pain! You have to help me. 
Doctor: Where is the pain? 
Patient: It is all over. My whole body hurts. I have been stabbed, shot, and injured multiple times that I have chronic pain and am in pain all the time. 
Doctor: I have your chart notes from Doctor X Y Z from several years ago. I see that you have been treated for heroin use. Are you using heroin again, sir? 
Patient: Yes! I have been trying to cope with the pain and I just keep going back. When the pain hits me hard the cravings start."
1:156,1,156,same side twice at turn 3,same side twice at turn 3,156,PASTSURGICAL,None.,"Doctor: Have you ever had surgery in the past? 
Patient: No, not that I know of.
Doctor: So, there's no history of gallbladder or appendix removal, or joint replacements?
Doctor: No, I've never had any of that done."
1:158,1,158,doctor refers to prior patient (kimi),"Turn 4 ('Yes, it is normal.') is entirely an answer to the patient's immediately preceding question ('Is that normal?') and would not make sense on its own without that context. This matches the examples to drop (e.g., 'Yes, I do.', 'Yes mostly').",158,IMAGING,Two view x-rays were taken of the shoulder.  There are no osseous abnormalities or significant degenerative changes.,"Doctor: So, I am looking at your x ray here.
Patient: Oh yes please tell me if everything is fine.
Doctor: Yes so, we have a two view of you shoulder. I am not seeing any bone abnormalities or any degenerative changes, so no wear and tear.
Patient: Is that normal?
Doctor: Yes, it is normal.
Patient: That's good."
1:160,1,160,only 2 turns (min 3),only 2 turns (min 3),160,PASTMEDICALHX,Parkinson disease.,"Doctor: Welcome to the clinic.  Let start with your medical history. 
Patient: I was diagnosed with Parkinson disease by Doctor Johnson five years ago."
1:161,1,161,only 2 turns (min 3),only 2 turns (min 3),161,PASTMEDICALHX,Remarkable for tonsillectomies.,"Doctor: Can you tell me if you ever had chronic issues? Like any illnesses?
Patient: Let me think, um, yeah they took my tonsils out for recurrent infections."
1:166,1,166,no patient/guest patient turns,no patient/guest patient turns,166,GENHX,"This 58 y/o RHF was in her usual healthy state, until 4:00PM, 1/8/93, when she suddenly became blind. Tongue numbness and slurred speech occurred simultaneously with the loss of vision. The vision transiently improved to ""severe blurring"" enroute to a local ER, but worsened again once there. While being evaluated she became unresponsive, even to deep noxious stimuli. She was transferred to UIHC for further evaluation. Upon arrival at UIHC her signs and symptoms were present but markedly improved.","Doctor: We have a fifty eight year old female who was allegedly in her typical healthy state until four o'clock P M on January eighth, nineteen ninety three when she suddenly became blind.
Guest_clinician: Did she experience any slurred speech or other neurological symptoms?
Doctor: She complained of tongue numbness and slurred speech in conjunction with vision loss. She explained that her vision improved slightly on her way to the local E R. She noticed severe blurring right before arrival, but the vision problems worsened shortly after.
Guest_clinician: Is this the first time she had experienced any of these symptoms?
Doctor: Yes. While being evaluated, she became unresponsive. She wasn't responding to deep noxious stimuli. 
Guest_clinician: Did they transfer her?
Doctor: Yes. She was transferred to U I H C. Her symptoms improved markedly upon her arrival."
1:167,1,167,doctor refers to prior patient (kimi),"Turn 2 consists solely of the acknowledgment ""I see."", which refers entirely to the patient's previous answer and does not introduce any standalone question or new topic. It would not make sense on its own without the prior patient turn.",167,FAM/SOCHX,"The patient had a second-degree relative with a history of depression and ""nervous breakdown"".","Doctor: So tell me something, does depression or depression like symptoms run in your family?
Patient: Hm, not in my immediate family, but I have a second cousin who had depression. He later had a nervous breakdown. 
Doctor: I see."
1:168,1,168,doctor refers to prior patient (manual review),Manually reviewed — drop per prior-patient criterion (doctor lines depend on earlier patient wording).,168,GENHX,"The patient presents today for followup, recently noted for E. coli urinary tract infection.  She was treated with Macrobid for 7 days, and only took one nighttime prophylaxis.  She discontinued this medication to due to skin rash as well as hives.  Since then, this had resolved.  Does not have any dysuria, gross hematuria, fever, chills.  Daytime frequency every two to three hours, nocturia times one, no incontinence, improving stress urinary incontinence after Prometheus pelvic rehabilitation. Renal ultrasound, August 5, 2008, reviewed, no evidence of hydronephrosis, bladder mass or stone.  Discussed. Previous urine cultures have shown E. coli, November 2007, May 7, 2008 and July 7, 2008.","Doctor: Has your E coli improved since your last visit, ma'am?
Patient: Yes, but I had some complications with the medicine.
Doctor: You were taking the Macrobid, correct?
Patient: Yes, I took it once a day at night for about seven days. 
Doctor: What complications did you have?
Patient: Well, I had a skin rash and hives, so I discontinued the medicine.
Doctor: Since stopping the medicine, have these symptoms gone away?
Patient: Yes, since I stopped taking the medicine.
Doctor: Do you have any pain with urination or blood in your urine?
Patient: No, nothing to report there.
Doctor: What about fever or chills?
Patient: No, nothing there either.
Doctor: Good, how many times a day do you urinate?
Patient: Well, it's about every two or three hours, and then maybe once at night.
Doctor: Are you controlling your urine well?
Patient: Yes, I'm having no problems there. It's getting better under stress too, with the pelvic exercises and rehab.
Doctor: Are you familiar with the results of this renal ultrasound from August fifth two thousand eight?
Patient: It was normal, right?
Doctor: Basically, yes. There's nohydronephrosis, masses, or stones.
Patient: That's good to hear. 
Doctor: I hear that you've had E coli few times, once in November of two thousand seven, and then in May and July of two thousand eight.
Patient: Yes, that sounds familiar."
1:170,1,170,same side twice at turn 1,same side twice at turn 1,170,GENHX,"This 37y/o LHM was seen one month prior to this presentation for HA, nausea and vomiting. Gastrointestinal evaluation at that time showed no evidence of bowel obstruction and he was released home. These symptoms had been recurrent since onset. At presentation he complained of mild blurred vision (OU), difficulty concentrating and HA which worsened upon sitting up. The headaches were especially noticeable in the early morning. He described them as non-throbbing headaches. They begin in the bifrontal region and radiate posteriorly. They occurred up to 6 times/day. The HA improved with lying down or dropping the head down between the knees towards the floor. The headaches were associated with blurred vision, nausea,vomiting, photophobia, and phonophobia. He denied any scotomata or positive visual phenomena. He denies any weakness, numbness, tingling, dysarthria or diplopia. His weight has fluctuated from 163# to 148# over the past 3 months and at present he weighs 154#. His appetite has been especially poor in the past month.","Doctor: Hello nurse, who do we have here today?
Guest_clinician: This is a thirty-seven-year-old, left-handed male. He visited us one month ago for headaches, nausea, and vomiting. His exams from that time showed no evidence of bowel obstruction and he was released home.
Doctor: Was there any improvement after your discharge, sir?
Patient: No, I had the same symptoms on and off after that. 
Doctor: What problems are you facing now?
Patient: I am seeing things blurred and having difficulty concentrating. My headaches are worse when sitting up. I notice them first thing in the morning. 
Doctor: How would you describe your headaches? 
Patient: They're dull, constant, and it feels like as if my head is wrapped in a tight band. 
Doctor: Your headache starts from which part of your head? 
Patient: It normally starts on the forehead and then it kind of goes to the back. It happens like six times a day. Lying down or putting my head down between my knees helps.
Doctor: What else do you feel along with your headaches? 
Patient: Like I told the Nurse here before, I get blurry eyesight, nausea and there is vomiting. Any kind of bright light hurts. I'm just afraid of loud sounds. 
Guest_clinician: I discussed with him about any blind spots, positive visual phenomena, weakness, numbness, tingling or double vision or any speech disorder, but he denies everything.
Doctor: How about your weight? 
Patient: It has been going up and down like for over past three months. I was one hundred and sixty three and then I know it was one hundred and forty eight at a point. 
Guest_clinician: Today his weight is one hundred and fifty four pounds.
Doctor: How are you eating habits in the last, let's say, one month? 
Patient: It has been bad. I don't feel like eating anymore. Looks like I have lost my appetite."
1:171,1,171,doctor refers to prior patient (kimi),"Turn 14 ('Why aren't you still doing this?') and turn 18 ('What does this entail?') are entirely anaphoric follow-ups that refer back to the immediately preceding patient answers. Without those patient turns, the referent of 'this' is missing and the utterances do not make sense on their own.",171,FAM/SOCHX,"The patient states she lives in a single-level home with her husband, who is in good health and is able to assist with any tasks or activities the patient is having difficulty with.  The patient rates her general health as excellent and denies any smoking and reports very occasional alcohol consumption.  The patient does state that she has completed exercises on a daily basis of one to one and a half hours a day.  However, has not been able to complete these exercise routine since approximately June 2008, secondary to back pain.  The patient is working full-time as a project manager, and is required to do extensive walking at various periods during a workday.","Doctor: Good morning, ma'am. Are you married? 
Patient: Good morning, doctor. Yes, my husband and I have been married for a while now. 
Doctor: That's great, do you have stairs in your home?
Patient: No, we don't. It's a single level home. 
Doctor: Great, well, how are you feeling today? 
Patient: I'm feeling well, doctor. I'm in good health.
Doctor: What about your husband? 
Patient: He's doing well too, he helps me around the house and with things I need help with. 
Doctor: That's great, do you smoke? 
Patient: Absolutely not. 
Doctor: What about alcohol, do you drink?
Patient: Yeah, I have the occasional glass of wine with dinner. 
Doctor: Do you exercise? 
Patient: I used to daily and for an hour or an hour and a half.
Doctor: Why aren't you still doing this? 
Patient: Well, I haven't been able to do this since about June of two thousand eight, because of this back pain. 
Doctor: I see. What do you do for a living? 
Patient: Right now, I work full time as a project manager. 
Doctor: What does this entail?
Patient: I have to walk a lot for long periods of time throughout the day."
1:172,1,172,doctor refers to prior patient (kimi),Turn 4 ('That's great.') is entirely a back-reference to the patient's previous answer and does not make sense as a standalone utterance.,172,FAM/SOCHX,Denies any recent travel overseas,"Doctor: Do you like to travel?
Patient: I do. In fact, I have been to more than six countries.
Doctor: Have you travelled outside the country recently?
Patient: No not recently, it's been couple years now, but I plan to.
Doctor: That's great.
Patient: Yeah."
1:173,1,173,doctor refers to prior patient (kimi),Turn 6 ('Oh.') is entirely a backchannel acknowledgment of the patient's previous answer and does not make sense as a standalone utterance; it refers completely to the prior patient turn without introducing any new question or topic.,173,ROS,He denies any chest pain.  He does admit to exertional shortness of breath.  He denies any GI or GU problems.  He denies any bleeding disorders.,"Doctor: Any chest pain or shortness of breath?
Patient: No chest pain, but I tend to have shortness of breath after any type of exertion.
Doctor: How about bladder and bowel issues?
Patient: No, that is fine.
Doctor: Any excessive or unstoppable bleeding issues?
Patient: No, I do not have any bleeding issues.
Doctor: Oh.
Patient: Yeah."
1:174,1,174,doctor refers to prior patient (kimi),Turn 2 ('Do you know what kind of cancer she passed from?') is entirely a follow-up about the mother's cancer mentioned in the immediately previous patient turn and does not make sense on its own without that context.,174,FAM/SOCHX,The patient's mother died from gastric cancer.  She had a brother who died from mesothelioma.  He did have a positive asbestos exposure working in the shipyards.  The patient's father died from motor vehicle accident.  She had a sister who succumbed to pneumonia as a complication to Alzheimer disease.,"Doctor: Tell me about your family medical history.  
Patient: My mother died from cancer.   
Doctor: Do you know what kind of cancer she passed from?  
Patient: She had cancer in her stomach. My sister had Alzheimer and she passed away for complication after getting pneumonia. 
Doctor: What about your fathers' medical history?  
Patient: He died in a car accident when I was a teenager.
Doctor: Any other siblings or just your sister?
Patient: My brother died from mesothelioma. He had positive asbestos exposure from working in the shipyards."
1:175,1,175,same side twice at turn 2,same side twice at turn 2,175,ALLERGY,To cephalexin.,"Doctor: Any allergies to any drugs?
Patient: Ah, yes, what is called, cepro-
Guest_family: Oh, you are allergic to Cephalexin mother! 
Patient:  Yep, thank you honey."
1:176,1,176,doctor refers to prior patient (kimi),"Turn 4 ('Never?') is entirely a backward-looking follow-up to the patient's immediately preceding answer ('No, I do not drink.') and does not make sense as a standalone utterance without that context.",176,FAM/SOCHX,Negative for smoking and drinking.,"Doctor: Do you smoke cigarettes?
Patient: I did way back in the past when I was young, but not now.
Doctor: How about alcohol?
Patient: No, I do not drink.
Doctor: Never?
Patient: Nope."
1:178,1,178,only 2 turns (min 3),only 2 turns (min 3),178,PASTMEDICALHX,Asthma.,"Doctor: Do you have any medical conditions or illnesses?
Patient: I have asthma."
1:181,1,181,doctor refers to prior patient (kimi),"Turn 10 is entirely a backchannel acknowledgment ('Okay.') that refers back to the immediately preceding patient turn and lacks standalone meaning without it. Turn 8 contains a backward-referring phrase but also includes a separate standalone question ('What about your brothers?'), so it does not qualify as an offending turn per the instructions.",181,FAM/SOCHX,Strong family history for Huntington disease as per the HPI.  Mother and grandmother died of Huntington disease.  Two young brothers also had Huntington disease.,"Doctor: How are you doing today? 
Patient: I am doing okay. 
Doctor: I see in your note that you told the nurse that you have a strong family history of Huntington disease. 
Patient: Yes, I do. 
Doctor: Who in your family had Huntington disease? 
Patient: My mother, grandmother, and my two younger brothers. 
Doctor: How is everyone doing? 
Patient: My grandmother and my mother both died of Huntington disease. 
Doctor: I am so sorry to hear that. What about your brothers? 
Patient: My brothers are doing okay. One of my brothers just started a neurological treatment. I am not sure what it is called. 
Doctor: Okay."
1:182,1,182,no patient/guest patient turns,no patient/guest patient turns,182,ALLERGY,No known drug allergies.,"Guest_clinician: Does the patient have any drug allergies? 
Doctor: None that I'm aware of. Let me check his chart again to confirm.  
Guest_clinician: Thanks. 
Doctor: Yeah, it looks like he's not allergic to anything."
1:183,1,183,doctor refers to prior patient (kimi),"Turn 2 ('Good, great.') is entirely an acknowledgment of the patient's previous confirmation and does not make sense on its own without that context.",183,ALLERGY,No known drug allergies.,"Doctor: So, let's see what we have here. I have down that you're not allergic to any medications. 
Patient: Correct, no drug allergies.  
Doctor: Good, great."
1:187,1,187,same side twice at turn 5,same side twice at turn 5,187,CC,This is a 66-year-old patient who came to the emergency room because she was feeling dizzy and was found to be tachycardic and hypertensive.,"Doctor: Ma'am, are you feeling okay?
Patient: No not really, I feel dizzy.
Doctor: Who brought you to emergency?
Patient: My husband, he is trying to find parking outside. 
Doctor: Okay.
Doctor: Let me check your blood pressure and this will monitor your heartbeat. 
Doctor: Well, your blood pressure looks quite high and so does your heartbeat. Do you have a history of hypertension or tachycardia, how old are you?
Patient: I am sixty six."
1:190,1,190,same side twice at turn 9,same side twice at turn 9,190,EXAM,"HEENT: Eyes:  EOMI.  PERRLA.  Sclerae nonicteric.  No lesions lids, lashes, brows, or conjunctivae noted.  Funduscopic examination unremarkable.  No papilledema, glaucoma, or cataracts.  Ears:  Normal set and shape with normal hearing and normal TMs. Nose and Sinus:  Unremarkable.  Mouth, Tongue, Teeth, and Throat:  Negative except for dental work.","Doctor: Let me quickly examine your eyes nose and ears. 
Patient: Sure.
Doctor: Well, eyes look fine no lesion seen on lids, brows or corner of the eyes. Extra ocular movements are intact. Sclerae look great. Pupils look fine. Can you open your eyes wide for me I am going to check with this instrument. Everything looks fine here.
Patient: Okay.
Doctor: I don't see any swelling or glaucoma. No cataracts. Let me check your ears, Looks perfectly normal. Ears normal set and shape with normal hearing and tympanic membrane. No hearing problem or tinnitus or anything?
Patient: Nope. 
Doctor: No cough or cold or sinus congestion, right?
Patient: No. 
Doctor: Open your mouth for me, stick your tongue out, say ""ahhhhh"" for me. Everything looks normal here. 
Doctor: Do you regularly visit your dentist?
Patient: Yes, I recently got some dental work done.
Doctor: Okay."
1:192,1,192,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,192,ASSESSMENT,"A 2-year-old with chronic lung disease, doing the sprints, some bowel difficulties, also just weight gain issues because of the high-energy expenditure with the sprints that she is doing.","Doctor: How has she been since the last time we saw you both?  
Guest_family: She has been in good spirits.  She has so much energy. She has had some constipation issues lately.  
Doctor: How has her breathing been? Any changes?  
Guest_family: No. Everything is the same.  
Doctor: According to her chart she has not gained any weight since her last visit. I am sure it is due to her high energy level, but it is something we need to keep a close eye on.  
Guest_family: What can I do to help her gain weight? 
Doctor: I would like you to focus on making sure she is getting enough protein in her daily diet. Here is a handout on meal suggestions and tips for keeping meal times on a consistent schedule.  
Guest_family: Thank you."
1:195,1,195,doctor refers to prior patient (kimi),"Turn 12 ('Great.') is entirely a reaction to the patient's preceding answer ('Everything's well') and would not make sense on its own without that context. This matches the examples to drop (e.g., 'That's good' when it is the whole line).",195,GENHX,"Briefly, the patient is a very pleasant 72-year-old female with previous history of hypertension and also recent diagnosis of C. diff for which she was admitted here in 5/2009, who presents to the hospital on 6/18/2009 with abdominal pain, cramping, and persistent diarrhea.  After admission, she had a CT of the abdomen done, which showed evidence of diffuse colitis and she was started on IV Flagyl and also on IV Levaquin.  She was also placed on IV Reglan because of nausea and vomiting.  In spite of the above, her white count still continues to be elevated today.  On questioning the patient, she states the nausea and vomiting has resolved, but the diarrhea still present, but otherwise denies any other specific complaints except for some weakness.","Doctor: Hi there, I love that dress, very pretty! 
Patient: Thank you for complementing a seventy-two-year-old patient.
Doctor: No, I mean it, seriously. Okay, so you were admitted here in May two thousand nine. You have a history of hypertension, and on June eighteenth two thousand nine you had bad abdominal pain diarrhea and cramps.
Patient: Yes, they told me I might have C Diff? They did a CT of my abdomen and that is when they thought I got the infection.
Doctor: Yes, it showed evidence of diffuse colitis, so I believe they gave you IV antibiotics?
Patient: Yes they did. 
Doctor: Yeah I see here, Flagyl and Levaquin. They started IV Reglan as well for your vomiting.
Patient: Yes, I was very nauseous. Vomited as well.
Doctor: After all this I still see your white blood cells high. Are you still nauseous? 
Patient: No, I do not have any nausea or vomiting, but still have diarrhea. Due to all that diarrhea I feel very weak.
Doctor: Okay. Anything else any other symptoms?
Patient: Actually no. Everything's well.
Doctor: Great.
Patient: Yeah."
1:198,1,198,doctor refers to prior patient (kimi),"Turn 2 ('Well, anything from depression, to cancer.') is entirely a clarification/elaboration in direct response to the patient's request for explanation in turn 1. It would not make sense as a standalone utterance if the patient had answered the original question instead, violating the requirement that doctor lines be independent of the specific previous patient answer.",198,PASTMEDICALHX,Past medical history is unremarkable.,"Doctor: Are there any major medical conditions that you know of that I should be aware of?
Patient: What do you mean by that, doctor?
Doctor: Well, anything from depression, to cancer.
Patient: No, none of that rings any bells."
1:199,1,199,only 2 turns (min 3),only 2 turns (min 3),199,IMMUNIZATIONS,"Immunizations were up to date for influenza, negative for Pneumovax.","Doctor: Have you had your flu or Pneumonia vaccination this year? 
Patient: I got my flu shot this year, but I did not get the one for Pneumonia."