[
{
"source": "primock57",
"dialogue": "[Doctor] Hello? Hi. Um, should we start? Yeah, okay. Hello how um. Good morning sir, how can I help you this morning?\n[Patient] Hello, how are you?\n[Patient] Oh hey, um, I've just had some diarrhea for the last three days, um, and it's been affecting me I need to stay close to the toilet. And, um, yeah, it's been affecting my day-to-day activities.\n[Doctor] Sorry to hear that. Um, and and when you say diarrhea, what'd you mean by diarrhea? Do you mean you're going to the toilet more often? Or are your stools more loose?\n[Patient] Yeah, so it's like loose and watery stool, going to the toilet quite often, uh and like some pain in my, like, lower stomach?\n[Doctor] \n[Doctor] Okay. And how many times a day are you going, let's say, in the last couple of days?\n[Patient] Um, probably like six or seven times a day? Yeah.\n[Doctor] Six, seven times a day. And you mention it's mainly watery. Have you noticed any other things, like blood in your stools?\n[Patient] No, no blood, yeah, just watery and loose stool.\n[Doctor] Okay. And you mentioned you've had some pain in your tummy as well. Whereabouts is the pain, exactly?\n[Patient] Yep. So in my lower abdomen, so, uh, like, um...yeah, just to one side.\n[Doctor] One side. And what side is that?\n[Patient] Uh, on the left side.\n[Doctor] Left side. Okay, and can you describe the pain to me?\n[Patient] Yeah, it feels, um, like a cramp, like a muscular cramp, and, um, yeah i feel a bit uh weak and shaky.\n[Doctor] Okay. And is the pain, is that, is it there all the time, or does it come and go?\n[Patient] Uh, it comes and goes.\n[Doctor] Come and go. Does the pain move anywhere else, for example towards your back?\n[Patient] Uh...no, just maybe my stomach.\n[Doctor] Okay, fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh have you been feeling feverish, for example?\n[Patient] Yeah.\n[Patient] Um, yeah, it doesn't feel like -- yeah, it just makes me feel weak. I haven't had a fever, um, at the moment, but I did notice um a temperature when the symptoms started, so, um, yeah around about three or four days ago.\n[Doctor] \n[Doctor] You measure your temperature then?\n[Patient] Yeah, I uh I didn't mention my temperature, no, but I felt, um, just a bit hot. And, y'know.\n[Doctor] Okay. Okay. Any other symptoms like sweating, or um, night sweats? No? And, uh, any vomiting at all?\n[Patient] Uh, no.\n[Patient] Yeah, so um, I vomited at the start of the symptoms but now um I've stopped vomiting.\n[Doctor] You stopped vomiting, okay. And was your vomit, I know it's not a nice thing to talk about, but was it just normal food colour Yeah. And there was no blood in your vomit, is that right?\n[Patient] Yeah, yeah, just normal vomit, yeah. No no blood, no. Yeah.\n[Doctor] No, okay. Um, and um, any any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned your vomiting, uh, anything else that comes to mind?\n[Patient] Yep. Um, I had a loss of appetite, um, so I haven't been eating as much, but I've been able to hold down fluids.\n[Doctor] Okay.\n[Doctor] Okay, so you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n[Patient] Yep.\n[Patient] Um, just soups, and, uh, yeah, light foods. Like smoothies and, yeah, liquid foods mainly.\n[Doctor] Okay. Fine. Um, and sir these started three days ago the symptoms. Are you aware of any triggers which may have caused the symptoms uh to kick on. So for example, think like takeaway foods or eating out or being around other people with similar symptoms.\n[Patient] \n[Patient] Yeah, so I had takeaway about four days ago, um, uh, but other than that I've, yeah, been, uh, eating normally. Nothing unusual here.\n[Doctor] Okay. Do you remember where you ate?\n[Patient] Um, yeah, I ate at a Chinese restaurant with friends. Yeah.\n[Doctor] Okay. Anyone else unwell with similar symptoms?\n[Patient] Um, so no one else in the family, so a wife and two kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n[Doctor] Okay, okay. Fine. Um, alright. And uh, in terms of your , your overall health, are you normally fit and well? Or, uh\n[Patient] Um, yeah, I mean, other than um athsma, um I use an inhaler, everything uh else is fine.\n[Doctor] Okay. And, is your asthma well-controlled?\n[Patient] Uh, yeah, that's fine. I just, yeah, use an inhaler, and uh that's under control.\n[Doctor] Fine. And you don't have any other tummy problem, bowel problems I should be aware of?\n[Patient] No.\n[Doctor] No, okay. Um, and apart from the inhalers, do you take any other medications?\n[Patient] Uh, no, no other medications.\n[Doctor] Okay, fine. And in terms of just your day to day life, you said it's been affecting your life, um, in what way has it been affecting your life?\n[Patient] Yeah.\n[Patient] Uh, so, I need to stay close to the toilet 'cause I go quite frequently during the these past three days. Um, yeah, other than that, it's uh, yeah, the main concern.\n[Doctor] Okay.\n[Doctor] Yeah. And have you, are you currently working at the moment? \n[Patient] Uh, yes, yeah. I I work, er. Um, I'm an accountant.\n[Doctor] Would, would work.\n[Doctor] Okay. Have you been going into work the last three days, or have you been at home?\n[Patient] Uh, yeah, I've been going to work. Yeah. Yeah, it's been quite difficult.\n[Doctor] okay. That must be difficult for you then. fine. And you said, you mentioned you live with your wife and two children, is that right?\n[Patient] Yes, yeah.\n[Doctor] Right, alright. Um, just a couple of other question we need to ask, sir. Um, do you smoke at all?\n[Patient] Uh, no, I don't smoke.\n[Doctor] And do you drink much in the way of alcohol?\n[Patient] Uh, no, I I don't drink alcohol, no. \n[Doctor] Okay. so um, er normally at this stage I like to um, examine you if that's okay, but um, um, but but having listened to your story, sir, I think uh, um, just to recap for the last three days you've been having loose stool, diarrhea, a bit of tummy pain uh mainly on the left-hand side, um and vomiting and fever and you're quite weak and lethargic um, you mentioned you had this Chinese takeaway as little as three days ago and I wondered whether that might be the cause of your problems.\n[Patient] Yeah.\n[Patient] \n[Patient] Okay.\n[Doctor] Um, it seems like you may have something, uh, called gastroenteritis, which essentially just a tummy bug or infection of your uh of your tummy.\n[Patient] \n[Doctor] Uh, mainly caused by viruses but there can be a possibility of bacteria uh causing its symptoms. Um.\n[Patient] Yeah.\n[Patient] Yeah.\n[Doctor] At this stage, uh, what, what we'd recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated, so drinking fluids.\n[Patient] \n[Patient] Mm-hmm.\n[Doctor] Um, there are things like Dioralyte you can get from the pharmacy, which uh it's um it helps helps replenish your minerals and vitamins.\n[Patient] Okay.\n[Doctor] Um, and if you are having vomiting diarrhea I would say recommend that in the first, you know, first couple of days.\n[Patient] Yep.\n[Doctor] If you are feeling feverish and weak, eh taking some paracetamol, uh, two tablets up to four times a day for the first few days can also help.\n[Patient] Yep.\n[Doctor] I will certainly advise you to take some time off work, actually I know you're quite keen to work but I would say the next two, two to three days as the infection clears from your system to take some time off and rest.\n[Patient] Okay.\n[Patient] Yeah.\n[Doctor] Um, I'll admit if your symptoms haven't got better, you know, in in three to four days, I'd like to come and see you again. \n[Patient] Okay, sure.\n[Doctor] Because if it is ongoing then we have to wonder whether something else caused your symptoms.\n[Patient] Yep.\n[Doctor] Uh, and we may need to do further tests like um taking a sample of your stool so we can test that.\n[Patient] \n[Doctor] Um, etcetera etcetera.\n[Patient] Yep, sure, yep.\n[Doctor] How's that sound?\n[Patient] That sounds great, yeah. Yeah.\n[Doctor] Do you have any questions for me?\n[Patient] Um, no, no further questions, no.\n[Doctor] Okay, and is uh is the treatment plan clear?\n[Patient] Uh, yes, yeah, that's that's very clear. Thank you.\n[Doctor] Great. Well, I wish you all the best.\n[Patient] Okay, thank you. Bye.\n[Doctor] Thank you. Bye bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I've been having really bad diarrhea for the last 3 days. 3/7 hx of diarrhea, mainly watery. No blood in stool. Opening bowels x6/day. Associated LLQ pain - crampy, intermittent, nil radiation. Also vomiting - mainly bilous. No blood in vomit. Fever on first day, nil since. Has been feeling lethargic and weak since. Takeaway 4/7 ago - Chinese restaurant. Wife and children also unwell with vomiting, but no diarrhea. No other unwell contacts. Nil smoking/etOH hx\n\nPAST MEDICAL HISTORY: Asthma\n\nMEDICATIONS: Inhalers\n\nSOCIAL HISTORY: works as an accountant. Lives with wife and children. Affecting his ADLs as has to be near toilet often.\n\nASSESSMENT:\ngastroenteritis\n\nPLAN:\n1. Conservative management - rest, push fluids, paracetamol if feverish. 2. Recommend OTC diarolyte. 3. To review in 3-5d if symptoms not improving. 4. To see earlier if feeling more unwell."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hello. Can you hear me well?\n[Doctor] Uh uh yes. I think. It's a bit better. It's a bit, it's a bit, it's not very clear. But let's continue anyway.\n[Patient] OK.\n[Doctor] Uh, OK. Let's start again. So how can I help you sir?\n[Patient] Yes. So, it's been a few days now. I have like a sore, and a red skin. It's kind of, it's really itchy, and it's like super annoying. So I'd like to find something quick to solve it.\n[Doctor] OK.\n[Doctor] No, no problem. I'm happy to help. Um whereabouts in your skin is it affected?\n[Patient] Uh, mostly like my chest, my, my hands, my arms. Like, like really, it's it's super annoying. Like it's itching a lot, like all the time. And I can't even sleep at night. I really need something quickly to, to solve it. Because even at work I, I can, when I'm in a meeting and I have to, like uh think about my work, I can't focus, I can't actually focus on my work. It's really annoying because I can't actually think about, uh, what I have to say. I'm always like, uh, disturbed by this disease.\n[Doctor] Yeah.\n[Doctor] \n[Doctor] No no, OK. I'm certain this is obviously affecting you. And uh we'll try our very best to get get this sorted out for you. Um, have you had anything like this before in the past?\n[Patient] Um so yes. Uh earlier I was like prescribed for my eczema.\n[Doctor] OK.\n[Patient] And they gave me like some cream, and something to, uh when I like shower, when I was in the shower, had to put something. But um\n[Doctor] OK.\n[Doctor] Did it help?\n[Patient] Um I mean, at that time yes. That's, those symptoms, like these symptoms appear like, when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like I bought a, a steroid cream at the pharmacy last night. But it apparently didn't help, because it's still itching a lot today. Uh, yeah.\n[Doctor] OK. OK. Do you remember the name of the cream you bought?\n[Patient] A steroid cream.\n[Doctor] OK, steroid, OK. um would you say these symptoms are very similar to your eczema symptoms, or different?\n[Patient] Um it's much more like itchy. And my eczema was more like only in the arm. But now it's also on the chest. And in the on the, on the hands as well.\n[Doctor] OK.\n[Patient] Like pretty, yeah when, like I like, for instance hiking, during the weekend. And\n[Doctor] \n[Patient] I am, I can't really do it anymore, because it's like very like I wanted to do that last weekend. And because super painful, and I I have to take like showers every day to be able to, cannot uh ease this itching part, which is very very annoying.\n[Doctor] Yes.\n[Doctor] No. Well OK. That's so you mentioned the itchiness. Um you also mentioned it's been quite sore.\n[Patient] Yeah.\n[Doctor] Um have you, have you noticed any uh bleeding or discharge from your skins?\n[Patient] . OK.\n[Patient] No. Um so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. But uh, yeah.\n[Doctor] OK. You've not, haven't uh seen any other uh pus or blood, coming out of your skin.\n[Patient] No.\n[Doctor] No. And you mentioned it all started three days ago. Are you, four days ago. Are you aware of any triggers, or anything that you may have done, that may have caused your symptoms to start?\n[Patient] Four days ago.\n[Doctor] So for example, have you changed your uh shower gel, any clothing? Have you been around anyone else?\n[Patient] No I . It's actually like, it's really annoying, because I'm thinking about, maybe I should change something. Because I I haven't, and I don't understand I cannot, um afraid of asking people around me because it's cannot you know um, I don't feel really comfortable asking about these questions. It's kind of intimate that. So I your help now.\n[Doctor] Mm. Mm. No no, OK. That's OK. Um Fine, so just to resummarize. For the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well?\n[Patient] Yeah.\n[Patient] Uh, no. Just the chest, hands and like, like inside the elbows. Yeah.\n[Doctor] \n[Doctor] OK. anything on your face at all?\n[Patient] Am I what?\n[Doctor] On your face?\n[Patient] On my face? No.\n[Doctor] No, OK. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n[Patient] No. just very itchy. Nothing else.\n[Doctor] Itchy. OK. So your, your bowels are working OK? Your chest is OK? No cough, no breathing difficulties?\n[Patient] No.\n[Doctor] You're passing urine OK.\n[Patient] I I think so.\n[Doctor] OK, alright. Um It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n[Patient] Any what?\n[Doctor] Any ideas, as to what could be causing your symptoms?\n[Patient] Um so I had eczema before. So maybe it's disease, but it seems like more uh, like uh my eczema was only on the arms. So, I'm I'm not sure. I I really have no idea.\n[Doctor] OK. That's OK. So um, normally at this stage I like to examine you. Um To see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's, you've got some dry skin and some, uh cracked skin as well. Uh and has been very itchy. And so would your um\n[Patient] Yeah.\n[Doctor] Uh your your background of eczema. Um So Sorry to say, there's a couple of questions I wanted to ask you, which I completely forgot, my apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n[Patient] Uh, no. I just had asthma in the past. But not anymore.\n[Doctor] OK. Not anymore, OK. And do you take any regular medications at the moment?\n[Patient] Uh no.\n[Doctor] No, OK. Do you have any allergies to anything?\n[Patient] I like some , sorry? Yeah?\n[Doctor] sorry I said do you have any allergies to anything?\n[Doctor] Hello?\n[Patient] Hello? Yes.\n[Doctor] can you hear me? That's alright I think it . Uh do you have any allergies at all?\n[Patient] Ohh, allergies. Uh, no.\n[Doctor] No, OK. Um and tell me about your um uh your situation at home. Who do you live with?\n[Patient] Uh so, I live with a few flatmates. I'm a, so you know I'm thirty one. Uh I, yeah I'm I have a full time job. And so I'm living with a few people to save money.\n[Doctor] OK. And what do you do for work?\n[Patient] Uh I work uh at a pharmaceutical company. So it's been a, it's been a few years now. Uh it's uh, it's kind of interesting. We're working I'm a, like a kind of project manager. Uh I mean, do you want to, to know more about it?\n[Doctor] OK. Uh no no no that's , that's absolutely fine. Um just a couple of questions I want to ask you, which can sometimes affect your symptoms, is, do you smoke at all?\n[Patient] No.\n[Doctor] No. And do you drink much in the way of alcohol?\n[Patient] \n[Patient] Uh you know, once in a while I can, I like hanging out with people once in a while. So yeah I'd say a few, a few beers per week. Something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger. But it's been, it's been a while. \n[Doctor] OK. OK. OK I've got to say, at this stage I've got to say this sound quality is not uh great. But I will continue because we've come this far. Um So um, based on everything you mentioned Sarah , I do wonder whether this is a flare-up of your eczema. Um\n[Patient] \n[Doctor] The reason being that you said it was quite itchy. Um it's mainly affecting your chest and your back. Um and uh, having looked at your skin, uh the the the rash does appear quite familiar. Um you mentioned using steroid creams, yesterday.\n[Patient] \n[Doctor] Um from the pharmacy. I wonder whether giving you a stronger prescription of a of a steroid may be beneficial. Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something, some emollients, which helps to moisturize the skin.\n[Patient] OK.\n[Patient] OK.\n[Doctor] Um which use in the bath and shower. And it's definitely worth um using that for the first seven to ten days.\n[Patient] OK.\n[Doctor] Uh before we make the decision on whether it's working or not.\n[Patient] OK.\n[Doctor] Um it's also worth um using antihistamines, which you can sometimes buy over counter. Things like Loratadine or Piriton, which can help the itchiness of your skin.\n[Patient] OK.\n[Doctor] And uh, um it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use, in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about an eczema CU.\n[Patient] OK. Yes, I have tried antihistamines, uh lately, but it didn't really help.\n[Doctor] Ohh, could you say that again, sorry?\n[Patient] I have tried uh antihistamines, but uh but it didn't really help.\n[Doctor] OK.\n[Doctor] OK. So it's something for you to think about. you can get different types of antihistamines. I can give you something a little bit stronger today as well. Um, something like Fexofenadine, which I can give to you today. It's definitely worth trying, and it's not going to do you any harm.\n[Patient] OK.\n[Doctor] Um but I think using the steroids and the emollients, um on a regular basis Uh over the next week to ten days, should hopefully control your symptoms. But do come back and see me next week, if things don't get better.\n[Patient] That sounds good.\n[Doctor] OK? Um do you have any questions for me?\n[Patient] Uh, no that's it. Thank you very much. Bye. Thank you as well. Bye.\n[Doctor] OK. Well I wish you all the best. Thank you. Have a good day.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have sore, red skin. 4/7 hx of dry itchy skin, mainly on chest and back. Skin is also sore and cracked. No bleeding or discharge. No spread elsewhere. Not aware of any triggers. Used steroid cream OTC last night with minimal effect. Pt has also tried antihistamines. Systemically well otherwise - no fevers, no vomiting, no SOB/cough. No bowel sx. DHx: Nil regular NKDA ICE: pt thinks might be related to eczema. No concerns\n\nPAST MEDICAL HISTORY: Eczema, Asthma\n\nSOCIAL HISTORY: lives with flatmates, works as a pharmaceutical manager. Non-smoker, social EtOH.\n\nASSESSMENT:\nflare up of eczema\n\nPLAN:\n1. Steroid cream - Betnovate BD 2. Emollients - cetraben - use up to QDS 3. Trial antihistamines 4. Keep trigger diary 5. Review in 10-14d if symptoms no better, or earlier if any concerns/worsening sx"
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hello.\n[Doctor] Hello there. It's uh Doctor here. How can I help you this afternoon?\n[Patient] Ohh, I just got a terrible headache since mid-day. Um on the left side. It's just making me feel so ill. I just feel like I need to vomit.\n[Doctor] I'm sorry to hear that. Um can you tell me a bit more about the headache?\n[Patient] Well you know, I noticed some zig-zag lines in my vision a few minutes before the headache started.\n[Doctor] \n[Doctor] Mm-hmm.\n[Patient] My vision blurred. Um, you know, it just I, yeah. Pain's just horrible. Just making me feel so unwell. Um\n[Doctor] Mm, OK. And \n[Patient] just want you to do something.\n[Doctor] Well, let's try our best. Let's try and get you, let's try and get you well, soon. Um you mentioned it's on your left hand side. Is that right? And it started at mid-day, a few hours ago.\n[Patient] Yeah.\n[Doctor] OK. Um did the pain come on quite suddenly? Or was it more of a gradual build up?\n[Patient] Don't know, really. It just happened.\n[Doctor] OK. And are you able to describe what kind of headache it was? For example, was it throbbing, or was it more of a sharp pain?\n[Patient] Yeah, I guess it's, yeah I guess it's throbbing, um on that left side.\n[Doctor] And is it moving anywhere else, at all?\n[Patient] No, but it's worse when I move.\n[Doctor] Uh OK. Is that when you move your neck?\n[Patient] Well, like if I lean forward, or like move my head or neck, yeah, headache gets worse.\n[Doctor] OK. Um\n[Patient] I'm just really worried. Like I've just been googling and like I've read, you know if your headache gets worse if you move, it could be a sign of brain cancer.\n[Doctor] OK. Is that all you're worried about?\n[Patient] cancer.\n[Doctor] Is that, is that all your main worries today?\n[Patient] Ohh yeah, yeah and I'd like, you know My, my friend's mum, she she recently died of a brain tumor. So, it's really concerning me actually.\n[Doctor] Oh dear, I'm sorry to hear that. I can, I can understand why it's affecting you. Um But why don't we, why don't we take a good history first, and let me examine you. And then we can have a little chat afterwards, and see what's going on here.\n[Patient] \n[Doctor] Um so you mentioned a few things. You mentioned a headache. You also mentioned some disease, like Lyme's, uh before the headaches came on. And your vision has been blurry as well. Is that right? Is that , is that on both eyes, or just in left, left eye?\n[Patient] Yeah.\n[Patient] Eh, feels like it some days.\n[Doctor] Both eyes, OK. Have you any difficulty with seeing bright lights, at all?\n[Patient] Yeah well I'm , wearing sunglasses right now. It's just, you know, the light's really hurting my eyes.\n[Doctor] Ohh, I see OK. Um and you mentioned that you felt quite nauseous. Have you vomited at all?\n[Patient] Yeah. I vomited twice.\n[Doctor] Twice, OK. Um earlier today, OK. Um, any temperatures or fevers?\n[Patient] Um, no I don't feel feverish.\n[Doctor] OK. Um, any other funny skin rashes that you may have noticed?\n[Patient] No, I haven't noticed anything like that.\n[Doctor] OK. Um fine. Um, and do you normally get headaches?\n[Patient] Um, I'm not really prone to them, no. No but I did, I did have a similar headache a few weeks ago.\n[Doctor] OK. And what happened then?\n[Patient] Just similar.\n[Doctor] How long did it last for?\n[Patient] Couple of days.\n[Doctor] Did you do anything that made it better?\n[Patient] Um yeah I had to take painkillers, and had to go go to bed and rest and\n[Doctor] Yeah.\n[Patient] couple days off work, and I work in the fashion industry. And you know, they're wondering what's going on, like I have to take sick days.\n[Doctor] \n[Doctor] Yeah. Yeah.\n[Patient] I need to get back to work today. But you know, what if it is a brain tumour? What's gonna happen with my future and my career?\n[Doctor] Yeah. Yeah. \n[Patient] You know, really about this. never had headaches like this before. Like why should I get them now?\n[Doctor] Yeah, sure. I mean I can see your concern obviously is a lot, there's a lot of worry there. Um but you know let let let, as I said let's take it step by step, um to see exactly what the cause of these headaches are first. Um, I'm just going to ask you some, um very uh yes no questions if that's OK, ma'am. Um Um have you noticed any problems with your speech at all, any difficulties with your words?\n[Patient] No.\n[Doctor] Any problems with your arms and legs? For example numbness or weakness?\n[Patient] No.\n[Doctor] Any difficulty with balance, your balance or coordination?\n[Patient] No.\n[Doctor] OK. And have you had any injuries to your head? Have you had a fall recently, or been knocked on the head?\n[Patient] No.\n[Doctor] OK, alright. Um and and you're feeling otherwise OK. So, for example your um Uh your your breathing's OK? You're not feeling breathless, or\n[Doctor] No, OK. Um do you have any other medical history I should be aware of?\n[Patient] No, nothing.\n[Doctor] No. So for example, have you had, has anyone told you you've had migraines in the past?\n[Patient] No.\n[Doctor] No, OK. Do you \n[Patient] No. My mum, my mum has, has migraines. But I've, I've not been diagnosed.\n[Doctor] OK. Right, my next question was that of family history. Is there anything in the family? So apart from migraines, is there anything else? Is there anything related to brain, for example?\n[Patient] as well.\n[Doctor] What was that, sorry?\n[Patient] My mom has an underactive thyroid as well.\n[Doctor] thyroid as well. OK. Um OK any other problems with for example, the brain, or? Um you mentioned brain cancer. Any other family history of ?\n[Patient] \n[Patient] No.\n[Doctor] No, OK. Um in terms of medications, do you take anything on a regular basis?\n[Patient] Um I take the pill, Microgynon.\n[Doctor] OK. And how long have you been on that for?\n[Patient] three months.\n[Doctor] Three months, OK. And is that mainly for contraception, or is that for something else?\n[Patient] it's for contraception.\n[Doctor] OK, alright. That's something you meant to have a little discussion about today as well. Um Uh well my next question was about um your social, your situation at home. You mentioned you work in the fashion industry. And your work, is your job quite stressful at the moment?\n[Patient] Yeah it's really stressful, actually.\n[Doctor] Have you been\n[Patient] having problems at like work, you know managers like putting a lot of pressure on me to deliver and, uh yeah it's not a good time.\n[Doctor] . Is it getting you down?\n[Patient] I don't feel down, just a little bit stressed.\n[Doctor] OK, alright. And what kind of things do you do to alleviate your stress, normally?\n[Patient] Nothing really.\n[Doctor] OK. Do you do much in the way of exercise?\n[Patient] No.\n[Doctor] No, OK. Um who's at home with you?\n[Patient] Um, I live on my own.\n[Doctor] OK. Um are you coping OK at the moment?\n[Patient] Fine.\n[Doctor] Yeah? OK. Um do you smoke at all? and do you drink much in the way of alcohol?\n[Patient] No.\n[Patient] No.\n[Doctor] OK, alright. Um, so normally at this I'd like to kind of proceed to examination. Um That's um based on your story, um I wonder whether you may, uh may have a migraine, uh migraine type headache. Uh it sounds Um, very classical of that, of that nature, the the the headache on one side, throbbing nature, the nausea, vomiting, um sensitivity to bright lights. Uh, I'm reassured that you don't have anything more serious, such as meningitis, or indeed Brain cancer, I know that was a big worry of yours initially. Um\n[Patient] thank you, uh thanks so much. I was so worried that I had cancer. And, ohh now you say migraine. Yeah I guess my mum has similar symptoms to me and yeah, it does make sense.\n[Doctor] yeah. Yeah. Well, I hope that puts your, you know, mind at ease. Um, certainly this is the second migraine you've had in the space of a month. Um, So I think, moving forwards, there's a couple of options. I think keeping a headache diary would be quite important, uh to see exactly what's triggering these headaches. And in terms of trying to treat your headaches today, some strong painkillers would be advisable. So, think about Paracetamol, or even Co-codamol. Um, and some anti-inflammatories, such as Ibuprofen and Naproxen. How's that sound to you?\n[Patient] K that sounds good.\n[Doctor] Um and uh, you know if your headaches were to become more persistent, then we could maybe think about giving you some medications that will stop your headaches from happening in the first place, something prophylactic medicines. then we could have a discussion next time I see you next week, perhaps.\n[Patient] OK.\n[Patient] OK.\n[Doctor] OK. Um, now a couple of things I want you to think about is, you know if your symptoms aren't getting better next two three days, or indeed they're getting worse. I'd like you to come back and see me, um straight away if possible. So if your headache's getting worse, not responding to medications Or your um neck pain is getting worse, or you develop any weakness in your arms and legs, or your vision, then I want you to come back and see me straight away. OK?\n[Patient] OK.\n[Doctor] Does that sound all OK?\n[Patient] Doctor, that's great.\n[Doctor] Great. Any questions for me?\n[Patient] No. Thank you.\n[Doctor] OK. Have a good day!\n[Patient] K thanks. Bye!\n[Doctor] Right.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have terrible headache. Headache on left side. Started few hours ago, gradual onset. Throbbing in nature. Nil radiating. Had visual aura before onset of headaches - zigzag lines in field of vision. Also associated photophobia and blurred vision. Feels nauseous and has vomited twice today. Also reports some neck pain. Nil neck stiffness. No speech disturbances No limb weakness or numbness No coordination/balance issues No recent head injury No fever No rashes Similar episode 2/52 ago - resolved with analgesia. Pt worried about brain Ca. NKDA\n\nMEDICATIONS: microgynon\n\nSOCIAL HISTORY: lives alone, works in fashion industry. Feeling stressed ++. Nil mood sx. Nil smoking/etOH hx. Family history: mother - migraine\n\nASSESSMENT:\nmigraine\n\nPLAN:\n1. Change COCP to POP 2. Keep headache diary 3. Regular paracetamol/NSAIDs 4. Review in 1w to discuss prophylactic Rx, or earlier if worsening sx (headaches, vomiting, vision sx) or any concerns"
},
{
"source": "primock57",
"dialogue": "[Doctor] Alex. Ohh. Hello? Hi, can you hear me?\n[Patient] \n[Patient] Yeah.\n[Doctor] OK great. Um how can I help you this morning, sir?\n[Patient] Alright, so I've been feeling, I've been feeling kind of uh under the weather for the past four days.\n[Doctor] \n[Patient] Um it started with the um, uh sore throat and runny nose, and It's sort of, um, it's sort of going into a cough now. Um, the sort throat is kind of going away, but, um, I'm starting to cough.\n[Doctor] Mm-hmm. OK.\n[Patient] And uh kind of uh bad and tired.\n[Doctor] Sorry to hear that .\n[Doctor] Mm. OK. I'm sorry to hear that. Seems like there's a lot going on there. Um so let's start with your, your sore throat first. Um tell me a bit more about that, if you can.\n[Patient] Um ,so I, I , you know I think I, it all started with, uh, this colleague of mine, she just kept sneezing next to me, all the time. I think her kids are catching something from the uh from their kindergarten or something. And uh, you know the it it started as normal sore throat, and uh was quite painful for a couple days, but then it was past.\n[Doctor] OK.\n[Doctor] OK. OK. And did you have any uh difficulty or pain on swallowing?\n[Patient] Um yeah. Yeah it was uh, it was quite painful to swallow, for one or two days.\n[Doctor] OK. You , did you manage to have a look at the back of your throat in the mirror?\n[Patient] Um no, not really.\n[Doctor] No. OK you didn't, you didn't notice any abnormal white spots, redness at the back of your throat?\n[Patient] Um No. Um I I didn't think about uh .\n[Doctor] \n[Doctor] that's OK. That's OK. And you mentioned a runny nose. Um again what kind of discharge is coming out? Is it clear, or is it a bit more coloured?\n[Patient] Yeah yeah, it's uh it's clearing up . Sort of um, sort of getting my nose stuffed all the time. It's very had to, uh to get it free.\n[Doctor] OK. You feel quite congested, do you?\n[Patient] Yeah, quite congested.\n[Doctor] OK, fine. Um you also mentioned a cough as well. Can you tell me a bit more about that?\n[Patient] Um yeah that started recently, like just uh um maybe yesterday. And um it's uh, it's dry for now, it's it's not very painful but it's sort of there, all the time.\n[Doctor] OK.\n[Doctor] OK. And is it worse any particular time of the day?\n[Patient] Sorry?\n[Doctor] Is it, is it worse any particular time of the day? For example in the evenings, night time, mornings?\n[Patient] Um\n[Doctor] throughout the day.\n[Patient] No it's it's um, it's sort of, it's sort of constant. Um I forgot to mention, that um I'm also having uh night sweats.\n[Doctor] OK.\n[Doctor] Night first, OK.\n[Patient] That's, that's very odd actually. makes me a bit tired, um makes my uneasy.\n[Doctor] Mm. \n[Doctor] I can imagine, yes. Uh and this has again, been going on for last uh three four days, has it?\n[Patient] Yeah, yes.\n[Doctor] OK. Um right, OK. Have you noticed any fevers or temperatures at all?\n[Patient] Um I I had some some fever in the beginning, but it's now sort of uh going down. I I've been taking some Paracetamol and Ibuprofen for that, and uh they, they help.\n[Doctor] OK.\n[Doctor] That's very sensible. Um very good. Um in terms of your chest otherwise, have you any difficulty breathing, or any pain in your chest?\n[Patient] Um so no pain in chest, but uh I noticed that I um um so I feel a bit winded on exertion. So if I I I haven't been going, going to the gym thus uh, because of that.\n[Doctor] When you say winded, do you feel, uh do you feel more short of breath would you say, on exertion? Is that when you, OK. Um and and that's mainly on exercise. But when you're resting, there's no problem.\n[Patient] yeah. \n[Patient] Yeah, yeah. When when when I'm resting it's OK. So I've been actually going to work, um sort of managing.\n[Doctor] OK. OK, fine. Just a couple other questions , if you don't mind. Any pain in, in your ears at all?\n[Patient] Um no.\n[Doctor] No, you don't feel blocked, or any discharge coming out of your ears?\n[Patient] \n[Patient] No, I don't think so.\n[Doctor] OK, fine. Um what I'm gonna do, I'm just gonna run through a few uh yes no questions, if you if you don't mind, just a review of your systems. Any, any headaches at all?\n[Patient] Um, yeah, yeah. That that's still, that's still there.\n[Doctor] Whereabouts are the head, headaches?\n[Patient] Um it's sort of general. Uh and uh they're not, they're not always there, but you know every now and then they will come and go.\n[Doctor] OK. And with those headaches have you had any problems with your, with your eyesight, your vision?\n[Patient] Um no.\n[Doctor] Uh any difficulty with seeing bright lights?\n[Patient] No, I don't think so.\n[Doctor] No, OK. Um and just moving down now, in terms of any, any feeling nausea or any vomiting?\n[Patient] No, none of that.\n[Doctor] OK. Tell me about your bowels. Are your bowels working OK?\n[Patient] Uh yeah, yeah. Think so.\n[Doctor] You're passing urine OK?\n[Patient] Yeah, yeah.\n[Doctor] How's your appetite, sir?\n[Patient] Yeah I've been, I've been drinking a lot more than the usual. But uh so other than that, so \n[Doctor] OK. Um and you're eating and drinking, uh you're eating OK otherwise.\n[Patient] Um maybe a bit less than uh than what I, I would usually have.\n[Doctor] OK. Um have you noticed any, any funny rashes at all, on your skin?\n[Patient] Um no, no.\n[Doctor] No. And any general muscle pain or aches, joint pain, ?\n[Patient] Yeah, yeah. Yeah that's, that sort of started in the past couple days.\n[Doctor] Yeah, OK. Alright um and uh just having a look at the rest of your history, are you otherwise fit and well? Or do you have any other medical problems I should be aware of?\n[Patient] Um, so otherwise that, uh, I'm I'm fine. There's um, there isn't anything that I'm taking or, I'm being treated for.\n[Doctor] OK. Um\n[Patient] Um\n[Doctor] So you are otherwise fit and well. Uh any, any allergies at all to any medications, I should be aware of?\n[Patient] Um, no \n[Doctor] No, OK. Um Any family history at all? So anything relevant in the family that I should be aware of? Anything like diabetes, high blood pressure?\n[Patient] Um, yeah my grandma has diabetes. Um, and, my grandma.\n[Doctor] \n[Doctor] Your brother?\n[Doctor] you say grandma, sorry my apologies. Grandma, OK. Uh do you know what type of diabetes it is? Is it type one, type two?\n[Patient] \n[Patient] I think , I think it's type two.\n[Doctor] OK. Um anything else which you think is significant?\n[Patient] Yeah, I, I think um, one of my uh, great grandads had an eczema.\n[Doctor] Excellent, OK. OK. Um just moving on to what we social history, just to get to know you a bit more as a person. Tell me, who do you live with at home?\n[Patient] Ohh um, I live alone.\n[Doctor] OK. And you said you're working at the moment?\n[Patient] Yeah, yeah.\n[Doctor] What do you do for work?\n[Patient] I'm an, I'm an accountant.\n[Doctor] OK, and how's your work going at the moment? Uh over the last, has it, has it been affecting your work?\n[Patient] Um, a little bit. I've been a bit slower. And you know, it's uh, it's, it's a bit of a stressful period just around the um, end of the year. Right.\n[Doctor] Mm, OK. Is that stress, is that affecting your um, your mood at all any, in any way?\n[Patient] Um, no I think I think it's, it's the, you know it's the good kind of stress. It's um, it's good work.\n[Doctor] OK. Well if there's anything you want to talk to me about, you can always come see me about your mood, um stress, anxiety. happy to help.\n[Patient] I don't know. I, I like my job. It's just you know, it's a bit more work than usual.\n[Doctor] OK. OK. And just very briefly, just in terms of smoking uh, do you smoke at all?\n[Patient] Um, yeah occasionally, you know, cigars and things on company parties.\n[Doctor] OK so not, not regular. Um and what about alcohol?\n[Patient] No.\n[Patient] Um, occasionally yeah I would have some. I'm, I'm not a very big drinker.\n[Doctor] socially with work.\n[Patient] Yeah.\n[Doctor] Um OK. Um so um just having listened to your story, um uh really just to summarize you know since the last four days you've been feeling generally quite unwell, sore throat, runny nose, bit of a dry cough, bit of muscle pain, weakness. Um had initial fever, but now settled. Um I don't think there's a lot to worry about. I think you probably have, you know a bit of a viral, what we say viral illness, maybe a viral upper respiratory tract infection, or maybe early signs of a flu. Um these normally last about seven to days and just gets better really, um over time. But things you can do to really help yourself, um is get plenty of rest. I'd probably advise you taking a day or two off work if you can. Um Making yourself, pushing fluids and make yourself well-hydrated. Continue with the regular Paracetamol, Ibuprofen. Um and and you should see how things go, really. Um if next week you're still not better, I'd like you to come back and see me. Um is that clear? Does that, does that make, does that make \n[Patient] Yeah, yeah, that's that's , it makes sense. Uh, I think I'll take a couple days off, and see how it goes.\n[Doctor] Yeah, yeah. and things to look out for if you're really not getting better, if you if you have a high fever, or your breathing is becoming a bit more labored, or chest pain, I'd like you to come back and see me much sooner, give me a call. Um and we can help you out. OK?\n[Patient] Yeah.\n[Patient] Yeah, yeah I understand. Uh, I'll uh, I'll take care.\n[Doctor] Great. Have a great day. Good luck with your work. Thank you. Bye bye. Bye bye.\n[Patient] Thank you. Thank you. You too. Bye bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I don't feel well, I have a cough and runny nose. 4/7 hx of generally unwell, mainly sore throat, runny nose, fatigue, myalgia and general joint pain. Sore throat is improving. Also has nasal congestion. Now developed a cough -mainly dry, constant. Night sweats for the past 4/7. Initially had fever, but now settling with paracetamol/ibuprofen. No chest pain. Feels more SOB on exertion. Associated headaches - generalized, intermittent. No visual sx/photophobia. No nausea/vomiting. No bowel or urinary sx. Drinking fluids, reduced appetite. No rashes NKDA\n\nSOCIAL HISTORY: lives alone, works as an accountant. Occasional smoker/etOH. Finding work slightly stressful. No mood sx.. Family history: Grandmother - type 2 diabetes\n\nASSESSMENT:\nviral URTI/influenza\n\nPLAN:\n1. Conservative mx - rest, push fluids, regular paracetamol/ibuprofen, monitor temp 2. Review in 5-7d INB 3. Discussed red flag sx (SOB, chest pain, fevers)- if present, for urgent review with Dr"
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] \n[Doctor] . Good morning, Tim. Um, how can I help you this morning?\n[Patient] Um, so I'm Having some, some pain, uh, in my tummy, like the lower part of my tummy. Um and I've just been feeling, quite, hot and sweaty.\n[Doctor] OK.\n[Doctor] Right, I'm sorry to hear that. When, when did your symptoms all start?\n[Patient] About two days ago.\n[Doctor] OK. And whereabouts in your tummy is the pain, exactly?\n[Patient] Uh, like below my belly button, it's like quite, sore when I press on it.\n[Doctor] OK. Did the pain come on quite suddenly, or was it more gradual?\n[Patient] , it hasn't been, it's more gradual and it's just, it is getting a bit worse now.\n[Doctor] OK, OK. And can you describe the pain to me?\n[Patient] Uh, it's kind of like a, a, I guess a burning pain. Uh, and it's just right there yeah, in that spot, like uh, that's mostly where I'm feeling it. It hasn't spread anywhere else.\n[Doctor] Just in, just below your belly button you uh, mentioned.\n[Patient] Yeah.\n[Doctor] OK. Um, and is the pain constant, or does it come and go?\n[Patient] It's pretty constant, it's like getting worse. Um, it's not like, I , I can still move and walk around. Uh, I mean I'm still kind of functioning, it's just uh, I'm aware of it time.\n[Doctor] \n[Doctor] . Mm-hmm. OK. Um, and with the pain have you noticed any other symptoms, at all? So, for example, let's, let's focus first on your bowels. Are your bowels working OK?\n[Patient] Yeah, I had a bit of constipation, but that's better, now. That was like, since last week.\n[Doctor] OK. So you've got no other symptoms, like diarrhea or loose stools?\n[Patient] No, I'm , I'm, my bowel movements are normal now.\n[Doctor] No.\n[Doctor] OK. And, what about your waterworks? Are you passing urine OK?\n[Patient] Yeah, I'm fine, that's fine, that's. I did notice that I was a little, the urine was a little pink, in colour. But I haven't like, it hasn't really been burning, specifically or hurting when I pee and uh. And I did notice I was going to the, I was peeing more, regularly, but I have been drinking lots of fluids. So I wasn't sure, um, I wasn't sure, um, like you know, if that was related to the pain.\n[Doctor] Mm.\n[Doctor] And when you mentioned pink urine, do you, was there any blood at all in your urine? Or was it difficult to say?\n[Patient] I can't say, I mean maybe.\n[Doctor] OK, alright. But otherwise, it doesn't hurt, uh, or or or sting, when you pass urine?\n[Patient] And I haven't noticed that it really burns or anything like that. Um, just that I'm, peeing more than , more regularly.\n[Doctor] OK.\n[Doctor] OK. Um, OK. And um, moving on to other symptoms, have you noticed any vomiting, or feeling nauseous at all?\n[Patient] Just a little nauseous, um, but no vomiting.\n[Doctor] No vomiting. Any temperatures or fevers?\n[Patient] I haven't , I felt a bit hot and sweaty, but I haven't really measured it, so I can't really say.\n[Doctor] OK, fine. Um, uh, uh, and Kim, have to ask um, uh all all all patients. This this question is about your cycle, if you don't mind me asking. Um, are you currently um, are you currently sexually active?\n[Patient] Yes.\n[Patient] Uh, yeah I've, I have had the same partner, I am, we were last sexually active about four days ago. Um, my last STD screen was normal, which was about six months ago.\n[Doctor] OK. So you've had no other partner since then.\n[Patient] No, the .\n[Doctor] OK. Um, uh, and do you use any contraception at all?\n[Patient] Uh, I'm, on the Implanon. I had the Implanon inserted about a year ago.\n[Doctor] At the moment, OK, fine. Um, are you still having periods?\n[Patient] Yes.\n[Doctor] When was your last period?\n[Patient] Uh, my last period was about, three weeks ago. I mean, two weeks ago.\n[Doctor] Two week scare, OK. So, is there any chance you could be pregnant? I know you've got an implement in there, but is there any chance you could potentially be pregnant? It's something for us to think about \n[Patient] Well, we don't use any other barrier, method so, we just use the , I just have the Implanon and the same partner. Um. Theoretically, if the Implanon, hasn't been working then I could be pregnant, but I don't suspect .\n[Doctor] Yeah, OK. Well it's something for us to think about. Um, uh, maybe worth taking a pregnancy test later on, just to confirm that. Um OK. And, and so, just to summarize so far, if you don't mind, it's really for the last couple of days, it's tummy pain that's really affected you, mainly lower down towards your belly button. It's quite burning, you said. It's getting worse. Um, you noticed some pink urine. Um, but no burning or stinging pain when you pass urine. Your bowels are working OK. You've felt a little bit nauseous, um, and feeling hot and sweaty. Have I got that all right?\n[Patient] Yeah, that sounds, very accurate.\n[Doctor] Is there anything else, perhaps, that you feel like you should share with me at this stage, anything that might be important?\n[Patient] I don't think so, I think I've, you , we've covered everything that's really bothering me.\n[Doctor] Yeah, OK. Um, tell me, tell me a bit more about your um, medical history otherwise. Are you normally fit and well?\n[Patient] Yeah, , well, I haven't had any, surgical, I don't have any surgical history. I don't have any previous, I haven't had any operations before, or, and I'm not on any other medication, I just have the Implanon.\n[Doctor] \n[Doctor] OK. Um, have you had anything like this before in the past? Any similar symptoms?\n[Patient] I've never , I've never had these symptoms before.\n[Doctor] No, OK. Um\n[Doctor] Fine. Um, any other family history I should be aware of? Anything relevant, family, uh related to bowels, maybe related to history?\n[Patient] No, not that , not that I'm aware of, no.\n[Doctor] OK. Alright. Um, and socially, just tell me a bit more about your home situation. Who's at home with you?\n[Patient] Uh, I live in a share house, and with two other, two other room-mates.\n[Doctor] OK. Um, and uh, are you currently working?\n[Patient] Yeah, I currently, I am currently .\n[Doctor] What do you do for work?\n[Patient] I am an accountant.\n[Doctor] OK. Um\n[Doctor] OK. Um, Do you smoke at all, Kim?\n[Patient] No.\n[Doctor] No. And do you drink much in the way of alcohol?\n[Patient] Uh , socially I drink, but uh, I don't think more, more than normal. .\n[Doctor] No, OK.\n[Doctor] OK. Um, just before I go to the examination, I just want to go through just some few screening questions if that's OK, yes or no. Uh, we've, we've covered the majority of them already. Uh, but I just want to make sure I'm not missing anything else.\n[Patient] All right.\n[Doctor] Um, how's your, how's your chest? How's your breathing? Um, any \n[Patient] I don't feel short of breath uh, or, I'm not having any problems, or I don't have a cough or anything that's , worrying me.\n[Doctor] OK. Any uh, funny heartbeats or rhythms, palpitations?\n[Patient] Not that it, no.\n[Doctor] OK. Any headaches? Any problems with your vision?\n[Patient] No.\n[Doctor] No, OK. Alright. Um, Fine, OK. Um, So really just uh, moving on, um, And so based, based on your story really, uh, uh Kim it's, it's it's difficult. it's it's um, you know you've got some tummy pain. You don't exactly know what's causing it. It could be a few different things that could be causing your pain. Could just be a, you know, could just be a urine infection, for example. Could just be something related to your gut. Um, could just be something related to your, you know, a pregnancy-related cause. Um, and so it's probably worth doing some tests initially. to try and rule out um, what's going on here. Um, which I can organize for you today.\n[Patient] OK.\n[Doctor] Um, and basically those tests, we, we'll have a better idea in terms of how we should proceed. But certainly, it if it's been going on for the last couple of days, um, Uh, you know, it's probably maybe worth empirically treating you for a maybe urine infection. And, so it's an \n[Patient] . Yeah, I , can we do that instead of me, going for tests, and then seeing how that goes?\n[Doctor] Yeah, absolutely. So, um I think it's certainly worth, you know covering you with some antibiotics today. Uh, but i still want you to bear in mind, you know, have a pregnancy test done to make sure we're not missing anything else here. And, um, and I want you to kind of really come back and see me in a few days time, if your symptoms are not getting any better, or indeed if they're getting worse. So, things to look out for would be, you know, worsening tummy pain, um, if you're feeling really hot or sweaty, your temperature's not coming down um, vomiting et cetera. Does that make sense?\n[Patient] Yeah, I think I'm happy with that plan.\n[Doctor] OK. Um, you can try just regular painkillers, uh, Paracetamol would be advisable. Um, make sure you drink plenty of fluids. You can try some cranberry juice as well, which uh, can sometimes help with your urine symptoms. Um, take the antibiotics, uh, and give me a call, you know, if you are worried about anything else.\n[Patient] Uh, sure. That sounds great. Thank you very much. Um, should I just collect the script at my pharmacy?\n[Doctor] \n[Doctor] Yeah, if I send it straight to your pharmacy, start the antibiotics today, something called Trimethoprim. Um, you can take two tablets, uh, one tablet twice a day for three days.\n[Patient] OK.\n[Patient] OK, , that sounds great.\n[Doctor] Uh, , let's see how you get on.\n[Patient] OK. Thank you very much.\n[Doctor] Great. All the best!\n[Patient] Bye.\n[Doctor] Bye bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: Lower abdominal pain. 2/7 ago developed lower abdo pain/suprapubic pain, gradual onset, burning pain, constant, progressively worsening No bowel sx. Urinary sx - noticed some pink coloured urine, no frank haematuria, nil dysuria. Some nausea, no vomiting Feeling hot and sweaty Currently sexually active with regular partner. Last STD 6/12 ago. Unprotected SI 2/7 ago. LMP 2/52 ago No chest pain/SOB/palpitations No headches/visual sx PSH: nil\n\nMEDICATIONS: implanon , otherwise nil\n\nSOCIAL HISTORY: roomshare with 2 flatmates, works as an accountant. Nil smoking, social EtOH\n\nASSESSMENT:\n?UTI. also need to exclude pregnancy\n\nPLAN:\n1. Pregnancy test 2. Urine dip and MSU 3. Rx empirically with Abx for UTI 4. Regular paracetamol for pain 5. Review in 24-48 hours if sx not improving, or earlier if worsening sx (fever, abdo pain, vomiting)"
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hello there.\n[Doctor] Uh, hello. Can you hear me OK?\n[Patient] Yes, I can hear you.\n[Doctor] OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n[Patient] Are you the doctor?\n[Patient] Um, I'm, contacting you because I've been, quite short of breath lately.\n[Doctor] OK. Do you want to tell me a bit more about it? When did it all start?\n[Patient] Uh, well it seems to have been, slowly getting worse over the last couple of weeks. Um, now it's, become quite troublesome, in the last few days. Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n[Doctor] \n[Patient] And uh, it's got me kind of worried, don't really know what's going on.\n[Doctor] OK.\n[Doctor] OK. OK. Is there anything you're particularly worried about?\n[Patient] Um, well, I've, I've uh, I've got um, heart failure.\n[Doctor] OK.\n[Patient] Uh, I was told that, uh, a while ago. Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n[Doctor] OK.\n[Doctor] Right.\n[Doctor] Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse. Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n[Patient] No pain in my chest.\n[Doctor] OK. And have you found yourself coughing, coughing at all?\n[Patient] Um.\n[Patient] Uh, I've got a bit of a dry cough, but it's not too troublesome.\n[Doctor] OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n[Patient] Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n[Doctor] OK.\n[Patient] I've noticed my ankles have got a bit bigger.\n[Doctor] OK. And what do you mean by that?\n[Patient] Uh, it's just like, it's sort of swollen up a bit.\n[Doctor] OK. Um, is that, is that both ?\n[Patient] Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n[Doctor] Both ankles?\n[Doctor] OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n[Patient] Um, I kind of noticed it the last few days.\n[Doctor] Past few days, OK. And is this something that you've had before, in the past?\n[Patient] Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n[Doctor] OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n[Patient] No, not really.\n[Doctor] OK. And any temperatures or fevers?\n[Patient] Uh, no.\n[Doctor] OK. And how about your appetite? Are you eating and drinking OK?\n[Patient] Yeah, I, , I'm, that's fine.\n[Doctor] OK. And your waterworks? Are you passing urine OK?\n[Patient] Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n[Doctor] Yeah. Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n[Patient] Uh, well I was told I had like a, they called it like a small heart attack. About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n[Doctor] OK.\n[Patient] And um, they, uh, but then I just got better.\n[Doctor] OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n[Patient] Um.\n[Patient] Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n[Doctor] It's more hard to say. OK. Was it like angina or, um,\n[Patient] Um.\n[Patient] Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n[Doctor] OK.\n[Patient] Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n[Doctor] OK.\n[Doctor] OK.\n[Patient] And yeah, I've been OK since then.\n[Doctor] You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n[Patient] Uh, no, I think I'm otherwise, I'm OK.\n[Doctor] OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n[Patient] Uh, yeah, I take something called Furosemide.\n[Doctor] . Do you know which dose you're taking?\n[Patient] I can't remember, I'm sorry doctor. I have to check.\n[Doctor] That's OK. No problems. Um, Any other medications?\n[Patient] Uh, yeah. I take Aspirin.\n[Doctor] OK.\n[Patient] And uh, Bisoprolol.\n[Doctor] The Metoprolol, was it? Or?\n[Patient] Uh, Bisoprolol.\n[Doctor] Sorry, the connection's not very good. OK. Thank you, yeah.\n[Doctor] \n[Patient] Um, .\n[Doctor] And a thousand, OK. Alright. Any allergies at all? Any medications?\n[Patient] Uh, no, no allergies.\n[Doctor] No. OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n[Patient] Uh , my, my father died of a, uh, of a heart attack.\n[Doctor] I'm sorry to hear that. And, um, how old was your father when he passed away?\n[Patient] Uh, he was, um, early sixties.\n[Doctor] Early sixties, OK. Alright. Anything else I should be aware of?\n[Patient] Um, my mother had osteoporosis.\n[Doctor] OK. Is your mother still with us?\n[Patient] Uh, yeah, she's still living.\n[Doctor] OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n[Patient] Uh, I live on my own. Well, I got two cats.\n[Doctor] You've got two cats. OK, great. Do they have names?\n[Patient] They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n[Doctor] OK. Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n[Patient] Uh, I work part-time as, a, uh, lorry driver.\n[Doctor] OK. And how is that? Is that quite stressful, long hours?\n[Patient] Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n[Doctor] Mm.\n[Patient] Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n[Doctor] Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n[Patient] No.\n[Doctor] Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving? \n[Patient] Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n[Doctor] OK. OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n[Patient] Not any more.\n[Doctor] So, you used to smoke?\n[Patient] Yeah.\n[Doctor] And how many did you smoke a day, on average?\n[Patient] Ooh it was about, about a pack a day, back in the day.\n[Doctor] Um, and how many, how many years was that for?\n[Patient] Ohh that was, oof, good twenty five years.\n[Doctor] OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n[Patient] I don't drink alcohol.\n[Doctor] OK. Do you do much in the way of exercise, sir?\n[Patient] Uh, I try and walk to the shops, at least once a day.\n[Doctor] OK.\n[Patient] Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n[Doctor] OK.\n[Doctor] Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said. Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, Which can sometimes happen. Um, um, and uh,\n[Patient] Mmm. That.\n[Doctor] It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n[Patient] What's going on.\n[Doctor] Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n[Patient] Mmm.\n[Doctor] Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK, I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days. Um, and see, and see how you're getting on.\n[Patient] OK. If you think that'll be better.\n[Doctor] Uh, I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n[Patient] OK.\n[Doctor] Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n[Patient] What does that?\n[Patient] Ohh yes, I remember now.\n[Doctor] Sorry?\n[Patient] Uh, yeah, I remember now. .\n[Doctor] You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um, Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function. Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day. But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n[Patient] I think that sounds like a good plan.\n[Doctor] And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n[Patient] OK. I'll see how I get on.\n[Doctor] OK? Do you have any questions for me?\n[Patient] Uh, I think that's all pretty clear. Thank you very much Doctor.\n[Doctor] Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n[Patient] OK. See you soon.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: hard to breathe. 2/5 hx of SOB, worsening over the past 2/7. Feeling more SOB on minimal exertion, nil SOB at rest. No chest pain/palpitations. Assoc cough - mainly dry. No fevers. Has also noticed ankle odema bilaterally over past few days extending to shins. Diagnosed with heart failure previously and currently on diuretics. Urinary - Polyuria, nil else NKDA FH - father died of MI early 60s , mother - osteoporosis\n\nPAST MEDICAL HISTORY: Heart failure, ?unstable angina\n\nMEDICATIONS: furosemide, aspirin, bisoprolol, simvastatin\n\nSOCIAL HISTORY: lives alone, 2 cats , works part time as a lorry driver. Ex-smoker - a pack/d for 25 years. No etOH\n\nASSESSMENT:\nexacerbation of heart failure\n\nPLAN:\n1. Increase furosemide BD 2. Blood tests, inc U+Es, FBC, BNP 3. Arrange echo 4. Review in 7d, or earlier if worsening sx (chest pain, SOB, dizziness, etc)"
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hello?\n[Doctor] Hello? Uh, can you hear me OK?\n[Patient] Yes, yeah I can, I can, cheers.\n[Doctor] . Great. Right, how can I help you this afternoon sir?\n[Patient] Uh, I am not feeling, very well.\n[Doctor] I'm sorry to.\n[Patient] And I haven't been feeling well, for, a good few days, now, and, I'm really hoping you can do something about it, because it's been, bugging me, for a while now.\n[Doctor] Well I will certainly try my best, for you. Um, can you tell me a bit more about what's been going on?\n[Patient] Uh, I just feel a bit, run-down, you know I've got, a cough, a cold.\n[Doctor] . Mm-hmm.\n[Patient] You know, my wife's been nagging me. I just, it's just all, yeah, it's just, that, that, that's it, that's it.\n[Doctor] Mmm. OK, well let's start with your cough first. Tell me a bit more about your cough. Is it, for example are you, coughing up anything at all, or is it mainly dry?\n[Patient] Uh, yeah, yeah, mean, mostly, dry it's a , you know it's a wee bit in the morning it's a bit worse uh, but , and you know it's, it's fairly, fairly dry, aye.\n[Doctor] \n[Doctor] So you're not bringing up any mucky, flem?\n[Patient] Yeah, yeah, yeah, yeah, yeah, yeah. I don't like to admit that it's, you know it's talk about but, yeah it's , aye, aye. It's a wee bit, wee bit uh, yeah.\n[Doctor] OK, all right.\n[Doctor] Yeah, I can certainly hear you've got the sniffles. So, bit of a runny, bit of a runny nose, you mentioned.\n[Patient] Yeah, yeah, yeah, aye, aye you're right. Is that, is that coming through loud and clear on the phone yeah the, the sniffling, yeah, .\n[Doctor] . Yeah, sorry to hear that, yeah no . Um, and uh, any other symptoms, so for example have you any, uh, any sore throats, any ear pain?\n[Patient] Yeah, ugh, yeah, yeah. I've, I've had a bit of a sore throat. I mean, I, you know, , I'm doing a lot of uh, you know I'm, , watching the, watching the football as well. So I do a lot of shouting at that, but uh, uh, uh, I'm not sure if that's related or not.\n[Doctor] \n[Doctor] Ah OK. Who do you support?\n[Patient] Uh, well it's a team, called, Partick Thistle. And they're in the, they're not even in the top division, uh, of the Scottish, league. They're actually in the, the, the championship, which is the league below that, and they're, bottom of the table.\n[Doctor] Right.\n[Patient] So I've been, shouting myself a wee bit hoarse, 'cause their performance has been, uh, pretty shite, if I'm being honest with you. .\n[Doctor] Well, all sounds fascinating, well I wish them all the best. nothing table. Um, so, so you mentioned sore throat. Um, and have you had a chance to look in the, in the mirror? Have you had a look at the back of your throat?\n[Patient] , yeah, yeah, yeah.\n[Patient] , aye, I mean aye, I, I shave, every day so I'm, I'm looking at myself, it's not, not, not a pretty sight to be honest at the best of times but it's been a, wee bit, a wee bit rough, uh, the last few days for sure.\n[Doctor] Yeah, now, I mean have you any, have you noticed any kind of, white spots on the back of your, back of your throat, or redness?\n[Patient] Ohh right, right aye. , sorry you mean I'm looking ah right yeah uh. , no I, I don't, I don't really like to look, you know to look at it so I, I, I haven't, haven't tried to do any of that.\n[Doctor] .\n[Doctor] .\n[Doctor] . I understand it's not pretty but as I say it's not, it's not something we, we always um, uh, recommend but um, moving on. In terms of your ears , any dullness or blocked ears, pain in your ears.\n[Patient] \n[Patient] Uh, yeah, , a, a wee bit I mean . You know, I'm fit, I'm , I'm fifty years old now and my, my hearing's, you know it's not as good as it used to be but, you know I , I, I think, I think it's all right, it's all right.\n[Doctor] OK, OK. Fine. Um, moving down to your chest. Um, how's your breathing been? So do, you feel more breathless or tight in your chest?\n[Patient] Uh.\n[Patient] Uh, no. No, no it's, it's not. No, no, no, .\n[Doctor] . So your breathing is ?\n[Patient] , sorry, what was that?\n[Doctor] Uh, your, your breathing is fine is it? your, it's not laboured, or?\n[Patient] No it's, it's, it's, it's not, it's not good. It's not good.\n[Doctor] OK. It's not good?\n[Patient] No. No, no.\n[Doctor] No, OK, OK. So you're , you're, you're feeling more short of breath?\n[Patient] Yeah, yeah.\n[Doctor] OK, OK, , OK. Um, any pain in your chest at all?\n[Patient] No, no it's, it's, it's weird, it's, it's just, you know it's just a wee bit, it's just a wee bit shortness of breath, but it's not, , it's, it's not, it's not pain, you know, as such.\n[Doctor] No pain, OK, OK. Have you noticed yourself, any, any, any temperatures or fevers? Um, feeling hot and cold? Sweaty?\n[Patient] Yeah, yeah that's, that's, that's, that's definitely something I've noticed. Like, you know in, in bed with the wife and having to, you know get out and, get the blanket off, and put it back on again it's, it's not, it's not pleasant. I mean, I'm keeping her up at night as well, which is a, bloody nightmare but, I mean, you know how these things are.\n[Doctor] .\n[Doctor] .\n[Doctor] Yeah, .\n[Doctor] Seems, seems very difficult at the moment. Um, , have you measured your temperature at all? Have you, got a ?\n[Patient] \n[Patient] But uh, no I mean, no you know, you know, I can, I just feel it in my forehead but, I mean, I haven't, haven't, you know, used a thermometer or anything.\n[Doctor] Mmm, OK.\n[Doctor] Sure, OK. Um, and just moving on, just very quickly. Um, any other symptoms? Any nausea? Any vomiting? Any tummy pain?\n[Patient] Uh, the, the first, the first day I had, you know a wee bit, of uh, , you know uh, you know the rot like, a wee bit of diarrhoea.\n[Doctor] .\n[Patient] You know but, but that, that's, that's fine, now. Um, and, , yeah but, but apart from that, , no.\n[Doctor] .\n[Doctor] OK. And how's your appetite? Are you eating and drinking OK?\n[Patient] Uh, yeah I mean I'm, I'm, I'm trying to and I think what, what is you , you starve, a cold and you, feed the. I, can't remember what it is, but I think I've, uh, my appetite's been, been all right yeah, yeah. I'm trying to, trying to keep, keep the fluids up as well you know, I hear that's what you should do.\n[Doctor] .\n[Doctor] Yeah, absolutely, , completely uh, recommend that, so keep, keep doing what you're doing. Um, and just lastly, you know any, any, any kind of muscle pain, joint pains?\n[Patient] \n[Patient] Yeah.\n[Patient] Yeah it's, it's, it's just been a wee. I mean again, you know I'm , I'm getting a just a wee bit older now so it, it's, it's not something that I, I was thinking about but, I have, I have noticed like when I, you know, when I'm bending down and. Know moving about, it's just, a wee, a wee bit stiffer than, than normal. , you know and I'm, I think that might be to do with whatever this.\n[Doctor] Mmm.\n[Patient] Thing is, but, again it's, you know, I'm just getting on.\n[Doctor] And where do you, where do you feel the stiffness?\n[Patient] It it's, just kinda, like you know when you're, when you're bending like, elbows and knees and just, just a wee bit, kinda stiff, you know?\n[Doctor] , all over, OK. And just remind me sir, when did your symptoms all start? , you say a few days ago?\n[Patient] Yeah.\n[Patient] Yeah I would say what day is it today? It's uh, , Wednesday, so it would have been, what is it Saturday, 'cause I was out.\n[Doctor] It's Wednesday.\n[Doctor] OK.\n[Patient] Yeah I was out having dinner, and then, yeah I, I came, yeah, yeah, yeah it would have been that. 'Cause I was out, for my wife's, uh she's, she was, doing this wee thing, we had a wee bit of a celebration, so we were out for that.\n[Doctor] .\n[Patient] And I remember saying to her, it was like you know what? I'm, I'm, I'm not feeling, great. You know I , I stuck it out with her but, aye, it would have been that, Saturday. So, what's that about five, five days ago? Yeah, yeah, yeah, yeah.\n[Doctor] Four, five days ago, yeah. OK. Are you aware of anything that might have set your symptoms off/\n[Patient] No I haven't been, haven't been , I mean, as I said, I was out with my wife. I don't know whether it's like, you know, the restaurant we went to was like, it was like, pretty good, so I wouldn't have expected them to be serving me anything. Dodgy or anything like that but, I , I, I, I don't know, you know. So, , nothing that I can see.\n[Doctor] , OK.\n[Doctor] And , without prying too much, what were you celebrating?\n[Patient] Well, my wife, has just been, uh, promoted. So, she's now going to be, uh, a head teacher, of, of primary school. So, just took her out.\n[Doctor] .\n[Doctor] .\n[Patient] . Yeah, wee, a wee night on the tiles, for that, so uh, it was good, . Yeah, yeah.\n[Doctor] , very nice.\n[Doctor] , good, excellent. So just moving on sir. Uh, regarding your, um, what we say, past medical history. Are you, do you have any other medical problems I should be aware of? So anything to do with your heart, lungs?\n[Patient] Uh, I mean, I'm a , I'm a wee bit, on the chunky side. You know, uh, you know I've, I've got a wee bit, a wee bit round the midriff, the spare tyre's, definitely there. Uh, and I've, I've got the uh, I've got the diabetes.\n[Doctor] Diabetes, right. What type of , is it type one or type two?\n[Patient] Uh, it's, it's uh, type, two, two. Aye, type one, , aye, aye. 'Cause he said, the doctor I spoke to, he was sort of saying like, you know, as a bigger guy, it's, it's kinda, it's kinda like, yeah, and.\n[Doctor] OK, OK.\n[Doctor] And what.\n[Doctor] . Yeah, OK. .\n[Patient] And uh, aye, when I was speaking to uh, it was this, it was other, another doctor I spoke to a while ago but. Aye when he, took the, when he was telling me this as well he, took my blood pressure and that said that was, that was high, uh, high, higher than it should be.\n[Doctor] .\n[Doctor] .\n[Doctor] You've been diagnosed with high blood pressure, uh, or . OK, all right. So um, moving on. Come to your medications, , which medications do you take on a regular basis?\n[Patient] . Yeah, yeah.\n[Patient] Uh, give me, I'm just gonna check. It's, it's, let me know if I'm pronouncing this correctly 'cause I haven't got, I haven't got my glasses with me. So, it's , Metformin?\n[Doctor] , that's correct, OK.\n[Patient] and, and there's another one, , Lisinopril? Is that? Yeah, . I mean that's those two, I had, I've got them written down a wee bit of paper so.\n[Doctor] OK. Lisinopril, yeah. That sounds like.\n[Doctor] No problems, no problem, that's fine. Anything else sir?\n[Patient] Uh, no, no, just, just, just those two. Yeah, I mean a wee bit of like , a wee bit of Aspirin or whatever every now and again, but you know nothing long-term.\n[Doctor] Right.\n[Doctor] OK, all right. And just moving on swiftly sir. Do you have any allergies at all?\n[Patient] Uh, not that I'm, not that I'm aware of. You know, I mean, what, what are the, what are the allergies you get? Just, you know, nah, not.\n[Doctor] Just allergies to , medications really, I'm, I'm asking not, as opposed to um, other things.\n[Patient] Right ah, yeah. No, nothing, nothing that, nothing that I'm aware of, doctor's never said nothing to me, so.\n[Doctor] .\n[Doctor] OK. And just very briefly, socially sir, just it's very important to ask. Uh, you said you live, with your wife. Anyone else at home with you?\n[Patient] Uh, no, no, kids, the kids have uh, they've flown the nest. So uh, now it's just me and the missus, you know, good life.\n[Doctor] OK.\n[Doctor] OK, OK. And are you, yep, and are you working at the moment? Uh, yourself?\n[Patient] Uh, I am. Yep, yeah, yeah um, .\n[Doctor] What, what do you do at work?\n[Patient] Uh, well I'm, it's one of the, there's a wee factory, just uh, down the road, um, so we just you know, we just manufacture like uh. Uh, it's like, kind of steel, steel parts, uh, things like that. You know, so it's a, good wee job, you know, keeps us, a roof over the, over us.\n[Doctor] \n[Doctor] \n[Doctor] . Pays the bills, really. Um.\n[Patient] Yeah, yeah, aye, exact, exactly.\n[Doctor] What, what about smoking and alcohol, sir? Do you, you do either?\n[Patient] Uh.\n[Patient] I, I do, I do like a wee drink. Uh, aye the doc, the old, doctor I had, he, he, he did say I was drinking just a wee, a wee bit too much. I mean I'm not like, you know I'm not, not an alky or anything, but just, just uh, yeah, do like a few, a few pints every now and again.\n[Doctor] roughly on average, how many you would drink a week?\n[Patient] Uh, pints?\n[Doctor] Well, whatever you drink. Is it , beer, lager, wine, spirits?\n[Patient] . You know, maybe, maybe what like four, four pints on like Saturday and then, you know on, Sunday as well, , maybe like. Nine, nine pints in a week, I would say.\n[Doctor] OK, OK. And what about smoking, sir?\n[Patient] Uh, ugh, , a wee, every now and again, but I'm, I, I am trying to cut that down. I've got a wee uh, what are those wee things called? The wee vaporisers.\n[Doctor] Ohh OK, OK.\n[Patient] Yeah I've got, I got, I got myself one of those, so I've been, I've been cutting down on the cigarettes. Uh, and I just got this wee, this wee thing, it's great, it is, it's actually like amazing, by the way.\n[Doctor] Well, I wish you , all the best on your journey to quit, I , I highly recommend it. Um, if you can, it'll certainly help your health as well. Um, so just to , just to summarise, I think you know, uh, based on your story.\n[Patient] Thank you.\n[Doctor] Um, yeah I'm not, worry. I think you know what you essentially have is a bit of a, a bit of a viral illness perhaps, a bit of a, maybe early signs of a flu, um.\n[Patient] Mm-hmm.\n[Doctor] Which I think should, settle down, um, really on it's own, uh, over time. Um, things to you know, you, you can do, help yourself you know, , stay rested, drink plenty of fluids.\n[Patient] Right.\n[Patient] Yes, aye.\n[Doctor] Um, if you are, if you are feeling hot and cold and sweaty, taking regular Paracetamol would be beneficial. Um, you mentioned feeling a bit short of breath. Um, I'm a little bit on the edge about giving you antibiotics. I don't think you've got a chest infection, but what we could think about is giving you a.\n[Patient] Aye.\n[Doctor] A script for antibiotics, which maybe use in next, twenty four to forty eight hours, if your symptoms don't get better.\n[Patient] Right, so , so if, so if I'm, I just , just lie down and take it easy. If I'm still, feeling a bit rubbish then, I go in, I .\n[Doctor] Yeah.\n[Doctor] Yeah, , I will, yeah, I'll, I'll give you a script today, give it about twenty four to forty eight hours. If you feel like you're still feeling breathless and, run-down, I think there's no harm in starting a course of antibiotics, something like Amoxicillin. One tablet, three times a day. Um, uh, and , if you're still not better by next week, come back and see me, we can have another look.\n[Patient] \n[Patient] All right, OK. OK, so I just, plenty of rest, lots of water, hopefully this thing pass.\n[Doctor] Exactly.\n[Doctor] Yes, absolutely.\n[Patient] Right, that is, that's perfect, that's just what, , what I wanted to hear.\n[Doctor] Great, well, I'm, glad I could help. And um, I wish you and your football team all the best.\n[Patient] Cheers.\n[Patient] Aye, I hope so, I hope so. It's not, not looking too good, but uh, aye. Right, cheers, cheers, .\n[Doctor] OK. , all the best. Bye bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have a cough and cold. 5/7 hx of generally unwell with cough and cold sx. Mainly dry cough. No chest pain. Feeling more SOB. Feeling hot/cold and sweaty. No fevers. Sore throat and blocked ears. Also myalgia and arthralgia - mainly stiffness in joints. No unwell contacts No nausea/vomiting No bowel symptoms NKDA\n\nPAST MEDICAL HISTORY: obesity, diabetes - type 2 , hypertension\n\nMEDICATIONS: metformin, lisinopril , aspirin,\n\nSOCIAL HISTORY: lives with wife, works in factory/manufacturing, smoking socially, etOH - >14 units/week\n\nASSESSMENT:\nviral URTI/? LRTI\n\nPLAN:\n1. Conservative mx - rest, fluids, regular paracetamol 2. Delayed script for amoxicillin abx - to start in 24-48 hours if sx not improving 3. Review in 1/52 INB, or earlier if worsening sx (chest pain, SOB, fevers)"
},
{
"source": "primock57",
"dialogue": "[Patient] OK. Ohh, OK.\n[Doctor] Hello?\n[Patient] Hello, can you hear me?\n[Doctor] Hello. Uh, just before we go any further, can I confirm your name and, age please?\n[Patient] Uh, my name's Itha, and I'm twenty six.\n[Doctor] Twenty six, OK. And how can I help you this afternoon?\n[Patient] Um, so basically, I've been really stressed at work for the past few days. And, I've realised that I've got, really dry itchy skin.\n[Doctor] OK. Um, sorry to hear work's been so stressful. Um. Tell me more about your skin first, Lou. Tell me uh, you mentioned it's been dry and itchy. Um, whereabouts on your skin?\n[Patient] All over my arms, um, and my hands mainly.\n[Doctor] OK. Um, and is this something you've had before?\n[Patient] Uh, no. Never had .\n[Doctor] So, uh, did it, did it come about quite suddenly, or was it more, kind of a gradual thing?\n[Patient] I think it started a few days ago.\n[Doctor] OK. And, has this spread anywhere else? Has it spread to your, to your chest, your legs, your face?\n[Patient] \n[Doctor] No, OK. So apart from being dry and itchy, um, any other symptoms? Has it been sore? Has it been, uh, have you noticed any cracked skin?\n[Patient] Um, so my skin's quite red, um, and I'm using coconut butter for the past few days.\n[Doctor] OK. Has that.\n[Patient] I don't have any spots, and no fever , and I'm not sweating either.\n[Doctor] OK.\n[Doctor] Thank you, for mentioning all those. Um, OK. Uh, so the coconut butter hasn't helped, with the itch?\n[Patient] No, .\n[Doctor] OK. And, uh, you mentioned work's been quite stressful. What do you do for work?\n[Patient] Um, I work as a teacher.\n[Doctor] OK. And, uh, in what way has work been stressful?\n[Patient] I think the kids have been really annoying these days.\n[Doctor] OK. .\n[Patient] And, I've been working really long hours.\n[Doctor] OK, all right. Well I'm sorry to hear that, and I hope it gets better. Um, going back to your skin. I mean is it anything you've done perhaps, uh, which may have triggered your symptoms? Anything you've touched or, you know, for example shower gels, soaps, fabric , fabric cleaners?\n[Patient] , I went swimming a few days ago.\n[Doctor] OK. Is that the first time in your life or have you been before?\n[Patient] Uh, no, I've been before.\n[Doctor] OK. And did your symptoms start after you went swimming?\n[Patient] Uh, yes, .\n[Doctor] OK, all right. Um, you mentioned you've had no other fevers, is that right? No fevers? No vomiting?\n[Patient] No.\n[Doctor] No. How's your health otherwise?\n[Patient] It's pretty good, yeah. I'm not on any medication.\n[Doctor] And all , we'll get to medication in just a second. Um, , do you, do you feel generally run-down? Do you feel tired?\n[Patient] Uh, yeah, I think I have been, quite tired.\n[Doctor] OK, OK. Are you eating and drinking OK?\n[Patient] Yeah, I've been drinking, and eating as normal.\n[Doctor] Your appetite's fine is it? OK. And your bowels, are your bowels working OK?\n[Patient] Yeah.\n[Doctor] Uh, no, no problems with vomiting, or loose stools?\n[Patient] No.\n[Doctor] OK. And your waterworks are uh, all OK? You're passing urine OK?\n[Patient] Yep.\n[Doctor] OK, all right. Um, so just moving on. In terms of your other medical history, is there anything else I should be aware of?\n[Patient] I'm currently taking .\n[Doctor] Microgynon.\n[Patient] Yeah.\n[Doctor] OK. Do you know what that is?\n[Patient] Uh, no.\n[Doctor] OK. , it's a contraceptive pill\n[Patient] \n[Doctor] Does that make sense? Is that something you're, is that, does that ring a bell now?\n[Patient] Ohh yeah.\n[Doctor] OK. Is there, any other medications that you take?\n[Patient] Uh, no.\n[Doctor] No. So, in terms of your medical history, there's no, problems of skin problems in the past, things like eczema or, um, dermatitis?\n[Patient] Uh, no, I think it might just be the weather.\n[Doctor] Sorry what was that? You think it's. The .\n[Patient] I think it might just be the weather.\n[Doctor] The weather?\n[Patient] Yeah, .\n[Doctor] Ohh, you think the , OK. You think the weather, OK. OK. No that's OK, no, no problems. Well um, uh, move . Do you, do you suffer from allergies? Are you someone who suffers from allergies?\n[Patient] Um.\n[Doctor] Food allergies? Medication allergies?\n[Patient] I think, um, I might be lactose intolerant.\n[Doctor] Lactose intolerant, OK, that could be helpful to know. Um, fine. And tell me of family history, is there anything in the family that you're aware of?\n[Patient] Um, yeah, so um, my dad has asthma, and, my mum has hayfever.\n[Doctor] Hayfever, OK. Um, fine, but any, again, any skin problems that you're aware of?\n[Patient] Yep.\n[Patient] Uh, no.\n[Doctor] No, OK, all right. Socially, who do you live with at home?\n[Patient] Ohh, it's just me.\n[Doctor] Live alone?\n[Patient] Yep.\n[Doctor] And, uh, do you smoke at all? Do you, can I ask? Do you smoke? Are you a smoker?\n[Patient] Uh, no, I don't smoke.\n[Doctor] Do you drink much in the way of alcohol?\n[Patient] Uh, no.\n[Doctor] Recreational drugs?\n[Patient] No.\n[Doctor] OK. And you said you , you work as a primary school teacher?\n[Patient] Yes, that's right.\n[Doctor] Uh , the reason I ask is sometimes stress can be a , contributing factor. Um, you felt, you noticed yourself, find, uh, , life's been more stressful recently. Is that right? Do you think that might have any correlation to your symptoms?\n[Patient] I don't. I certainly think so.\n[Doctor] OK, all right. Um, fine. Um. OK, well, normally at this stage I like to proceed to examination, but um, based on your uh, story. Um, it's difficult. I think that, you know, , you've, essentially the story is you've got a dry itchy rash on your, mainly your hands. you mentioned. Um and your arms which started, perhaps after swimming a few days ago. Um, but no other symptoms, you're feeling otherwise, well, no fevers, no bleeding or discharge from skin.\n[Patient] Yep.\n[Doctor] I wonder whether you may have something called dermatitis. Um, have you heard of that condition before?\n[Patient] I have, yeah.\n[Doctor] OK. Um, great. Well I can give you a patient information leaflet about that, which gives a bit more information about the disease, but, um, it, it's something that we can readily treated. Um. With couple options, we have steroid creams I can give you, um, which will help with the inflammation. And, uh, something called emollients, which can help with the dry, dry skin. And that's something you just need to kind of paste on, uh, on to your skin, uh, , throughout the day for the next few days. Um, and hopefully that helps your symptoms.\n[Patient] OK, it's cool. Thank you very much.\n[Doctor] Um, , you can also try antihistamines, so you can get things over the counter, Piriton, Loratadine, they can sometimes help with the itchiness.\n[Patient] Yeah, that sounds good.\n[Doctor] OK. And um, that's probably what I recommend. Paracetamol on this occasion, wouldn't be helpful. Um, uh, uh, painkillers wouldn't be helpful , on this occasion, but let's, let's, let's see how the next few days go. And if it's still not getting better, come back and see me next week, and we can have another look again, at your symptoms.\n[Patient] OK, perfect. Thank you very much.\n[Doctor] Right. Do you have any questions for me?\n[Patient] Uh, no.\n[Doctor] OK. Well, I wish you all the best. Have a good day.\n[Patient] Well, thank you very much. Bye.\n[Doctor] Thank you. Bye bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have dry, itchy skin. 3/7 hx of dry itchy skin, mainly on the hands and palms. No spread elsewhere. No bleeding/discharge. No cracked skin. Sx started after going swimming. No prev skin problems. No fevers. No vomiting. Appetite maintained, nil nausea/vomiting Nil bowel/urinary sx NKDA\n\nPAST MEDICAL HISTORY: Lactose intolerance\n\nMEDICATIONS: microgynon\n\nSOCIAL HISTORY: - lives alone, nil smoker/etOH/recreational drugs , works as primary school teacher. Recent stress ++. Family history: Father - asthma, Mother - hayfever\n\nASSESSMENT:\ndermatitis\n\nPLAN:\n1. Steroid cream BD 2. Emollients - regular use QDS 3. Antihistamines 4. Review sx in 1/52, or earlier if worsening sx/any concerns"
},
{
"source": "primock57",
"dialogue": "[Patient] Hello?\n[Doctor] Hello?\n[Doctor] Hello? I can hear you, can you hear me? . Excellent, just before I go any further, can you confirm your name and your age, please?\n[Patient] Hi. Can you hear me? Yeah, I can hear you now.\n[Patient] Uh, yeah. My name is Jessica Smith, and I'm nineteen years old.\n[Doctor] OK. And how can I help you Mrs Smith?\n[Patient] Um, yeah so uh, I mean this is, this is a bit embarrassing, but it's, it's uh, hurting when I, , when I use the bathroom, when I pee. And um, it's been going on for a few days, so I'm a, I'm a little bit worried about it. Uh, not sure what to do.\n[Doctor] Right, well , I, thank you for coming in, so hopefully we can help with your symptoms. Um, so you mentioned it started a few days ago. Um, so, can you tell me a bit more about that, what kind of pain it is, that you're experiencing?\n[Patient] Um, it's, it's not too bad, it's sort of like a stinging kind of pain. Um. It's not like unbearable, but uh, it's , it's definitely uh, it definitely bothers me when I pee. Um. And uh, yeah I also maybe sometimes get some like, pain kind of lower down in my tummy, when I, when I go to the bathroom. Uh, yeah.\n[Doctor] \n[Doctor] , OK. And, and, uh, the pain in your tummy, is it, can you describe the , the pain to me? Is it cramping, burning, sharp?\n[Patient] , yeah, I don't know maybe uh, sort of, sort of cramping. I'm not really sure, but it's not like, it's not like cramping like when I get, when I have a period or something. It's like, I don't know, .\n[Doctor] Right, right, OK, OK. Um, fine. And, have you found yourself going to the toilet more often than normal?\n[Patient] Um, not, I don't think so, I haven't noticed that.\n[Doctor] No, OK, fine. Have you noticed any, any funny colour to your urine? So, has there been, uh, , any blood in your urine? Have you noticed any other darkening of urine?\n[Patient] Um, there was a little bit of blood earlier today, um, but besides that, not at all, no. Um. It does kind of, it, it kind of like, doesn't smell very, it smells a bit weird I guess, um, but, no, not really anything uh, anything drastic.\n[Doctor] Yes.\n[Doctor] \n[Doctor] OK, fine, OK. Um, right, let me just , write a few notes down as well. Um. , and you mentioned a tummy pain, that also started a few days ago. Does the pain move anywhere else? Does it move towards the back, or towards your flank, the sides?\n[Patient] No, not really, no.\n[Doctor] No, OK, fine. With those symptoms, have you noticed any other symptoms like nausea, vomiting?\n[Patient] Uh, no, not , not at all.\n[Doctor] OK. Any fevers, or temperatures?\n[Patient] think so.\n[Doctor] , sorry, was there any, any fevers or temperatures? Sorry, I didn't hear you.\n[Patient] No, no, no fever, no.\n[Doctor] No fever, OK, fine, sorry. Um, OK. Um, in terms of your bowel, are your bowels working OK?\n[Patient] Um, uh, I think so, yeah, it seems .\n[Doctor] So, uh, by that I mean, um, any, any diarrhoea, loose stool?\n[Patient] Uh, no, not that I've, not that I've noticed at all.\n[Doctor] OK, all right. And um, Jessica, sometimes we have to ask very private sensitive questions, uh, just to , get a full history. Um, hope you don't mind me asking, but are you currently sexually active?\n[Patient] \n[Patient] Uh, yeah I am.\n[Doctor] OK, is that with a regular, partner?\n[Patient] Ohh, yeah, so I, I've had a boyfriend for about a, a couple of months now, yeah.\n[Doctor] Fine, OK. Um, have you noticed any other discharge from, from down below?\n[Patient] I haven't noticed anything.\n[Doctor] No, OK. When was your last um, uh, last STD screen? If, if ever?\n[Patient] Don't think I've ever, I don't think I've ever had one.\n[Doctor] No, OK, fine. And, and um. Do you use any form of contraception, at all?\n[Patient] Uh, yeah, we use condoms.\n[Doctor] You use condoms, OK. And when was your last, period?\n[Patient] Uh, couple of weeks ago.\n[Doctor] Three weeks ago, OK. Is there any chance you could be pregnant perhaps?\n[Patient] Say again.\n[Doctor] Is there any chance you could be pregnant?\n[Patient] Uh, I don't think so, I don't.\n[Doctor] No, no. , it's always worth asking uh, young females like yourself, um. Uh, um, so if that obviously you are worried about the pain.\n[Patient] Yeah.\n[Doctor] Um, not getting any better, uh, then I'd always , advise getting a pregnancy test, to rule out pregnancy. OK? Um, fine. So just moving on, moving on. Are you otherwise fit and well?\n[Patient] Uh-huh.\n[Patient] Um, yeah, I think I'm, I'm feeling OK, otherwise, yeah.\n[Doctor] And so by that I mean, do you have any other medical problems, medical , medical history?\n[Patient] Um, so, in the past I've had some uh, some IBS. Um. But, other than that I think no like uh, real serious medical problems that seem, yeah.\n[Doctor] OK. Do you take any regular medications?\n[Patient] Uh, no, I did uh, I did uh, a little bit ago, or a couple of days ago, try some uh, over the counter bicarbonate, to try and help with the pain but it wasn't, it wasn't really helping.\n[Doctor] OK. So you've tried that and it didn't help? OK, all right. Um, do you have any allergies to any medications?\n[Patient] Uh, yeah, I'm allergic to, Clindamycin.\n[Doctor] And what happens when you take Clindamycin?\n[Patient] Um, I, I get some like a, a, a swelling, basically.\n[Doctor] Right then, OK. So it's quite a, seems like a quite severe allergy to it, is , is that right? Um, OK. Fine. In terms of your family history, is there anything I should be aware of, um, related to kidneys, bladder, bowels, guts?\n[Patient] Yeah.\n[Patient] Uh, no I don't think so, not that I, not anything I know about.\n[Doctor] OK, all right. And tell me a bit more about your home situation. Who's lives, who's at home with you?\n[Patient] Um, so I live in a, live in a flat near my college, with a, a couple of like friends of mine. Uh, so I'm, I'm not like living at home or anything. Um.\n[Doctor] OK, and what .\n[Patient] about sorry.\n[Doctor] OK, and are you a, are you working at the moment, or are you a student?\n[Patient] I'm a student.\n[Doctor] OK, and what are you studying?\n[Patient] Uh, I'm studying biology.\n[Doctor] And how's that going?\n[Patient] Um, it's good yeah, it's really, it's really interesting uh, learning about, learning about how uh, how the world works, yeah.\n[Doctor] great. Do you have any aspirations for the future, in terms of careers?\n[Patient] Uh, I don't know, maybe a doctor someday, you never know.\n[Doctor] , recommend it, we need doctors. Um, what about smoking and alcohol? Do you drink much in the way of, , do you, do you smoke, or do you drink much in the way of alcohol?\n[Patient] Uh, I don't, I don't smoke, uh, I do drink, like on the weekends, yeah.\n[Doctor] , so socially, OK. All right. Um, right, excellent. So, um, at this stage I , I would proceed to examination.\n[Patient] Yeah.\n[Doctor] But um, based on your story, um, just to summarise really. So, last three days, you've been having bit of burning pain on passing urine. A bit of, crampy tummy pain lower down. Um, , essentially but, but no other fevers or back pain, uh, if I, if I understand correctly.\n[Patient] \n[Doctor] I think probably do have what we call a simple UTI or urinary tract infection, bladder infection, um, which can be readily treated. So, I'll give you a course of antibiotics today.\n[Patient] Mm-hmm.\n[Patient] OK.\n[Doctor] Something, called either Nitrofurantoin, or Trimethoprim. Uh, and it's normally a three day course. Uh, so, one tablet, twice a day, for three days.\n[Patient] OK.\n[Doctor] And , that should hopefully help your symptoms, but I also advise you to drink plenty of fluids. Let's try and flush that, you know, that infection out of your body, if you can.\n[Patient] OK.\n[Doctor] Um, you can try, cranberry juice, that can sometimes help with your symptoms. Um, and if you're still not better, by the end of this week, I want you to give me a call or come back and see me. And uh, we can have another look at your symptoms.\n[Patient] \n[Patient] OK, so three days of the medication, and then wait a little bit, if it still doesn't go away, call back, that OK?\n[Doctor] OK.\n[Doctor] Yeah, yeah absolutely. And things to look out for would be, you know, if you are having kind of, high temperatures, a back pain, um just , generally feeling more unwell. Uh, you know, I do want you give me a call back, 'cause then we do worry whether your infection may be spreading up towards your kidneys, which is something we wanna avoid. So, do, do give me a call if you're having any concerns, OK.\n[Patient] OK.\n[Patient] OK, is there, is there anything like, like, should I be worried about? Like, like, not having sex or anything within the next week, or anything like this?\n[Doctor] Yeah I mean if you can try and avoid it, I think that'd be sensible. Um, uh, it's great that you're using barrier contraception. I would recommend you to continue using barrier contraception, but if you can avoid it while your symptoms clear up. That'd probably be the best for you and your boyfriend,.\n[Patient] OK, OK. Uh, that, that makes sense. Ohh, OK, thank you so much.\n[Doctor] All right. Great. Thank you very much. Wish you all the best.\n[Patient] Yeah, thank you. Take care.\n[Doctor] ",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: It hurts when I pee. 3/7 hx of dysuria and suprapubic pain. Nil frequency. Brief episode of haematuria, now resolved. Foul smelling. Abdo pain - cramping, nil radiating Nil nausea/vomiting. Nil fever. Nil bowel sx Currently sexually active - with regular partner for 2/12. No previous STD screen. Nil PV discharge. LMP 2/52 ago.\n\nPAST MEDICAL HISTORY: IBS\n\nALLERGIES: clindamycin\n\nSOCIAL HISTORY: lives in a flat with friends, student in Biology, nil smoking, social EtOH at weekends. Family history: Nil regular\n\nASSESSMENT:\nUTI/cystitis\n\nPLAN:\n1. Nitrofurantoin abx for 3/7 2. Push fluids 3. Trial cranberry juice 4. Pregnancy test to exclude pregnancy 5. Review in 3d if no better, or earlier if worsening sx (fevers, back pain, vomiting, more unwell)"
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hello?\n[Doctor] Hello? Can you hear me OK?\n[Patient] Hello.\n[Patient] Uh I can hear you, but I can't really see you.\n[Doctor] That's perfect. Um\n[Patient] Is, is that OK? Am I meant to\n[Doctor] this audio. And then it's absolutely fine.\n[Patient] Just connection on the screen.\n[Doctor] Uh, now before I go any further, can I confirm your name and your age?\n[Patient] OK.\n[Patient] Um so, um my name is uh Dan Choudhry. I am seven, twenty seven.\n[Doctor] Twenty seven, OK. And how can I help you this afternoon, Dan?\n[Patient] Um so I've just um, been having some troubles, basically in the uh, I guess it's been a little while now. And I've just been feeling not so great. And It's all come from like, uh it's like basically I think it's diarrhoea. And it's like just coming out, like loads of it. Like I go to the toilet and it's just super watery and it Yeah it doesn't feel very solid. It so, it just, it's just pouring straight from my bum, and like just coming out. And it's, uh, Yeah it's just uh not, not been very pleasant. And like I just, it just kind of hasn't, doesn't feel like it's getting better. So\n[Doctor] Wow, no. Sorry to hear. Seems like there's a lot going on there. Well, when did it all start, your symptoms?\n[Patient] Um, so I think it was a few, when I think about it So Monday, Tuesday, I I, so I think it was about three, it's been about three days now.\n[Doctor] OK. And is it mainly diarrhoea? So, you mentioned watery stools. Um How many times are you going a day, would you say?\n[Patient] Um so I , I feel like it's like almost every hour, when I'm awake. Um, so . Sorry?\n[Doctor] Alright, wow. OK. So you're losing a lot of, a lot of, you're using a lot of fluid there.\n[Patient] Yeah, so I mean I'm , I'm trying to drink a lot of water. But um, yeah it's just quite a lot and Uh it's, yeah I I, I think I I feel like it's just, just fluids coming out.\n[Doctor] OK. Have you got any blood in your stools?\n[Patient] Um So I, no I don't, I don't remember anything, like, no I , I think it's just I, nothing like that. There's nothing like that.\n[Doctor] OK. And any, any tummy pain? Any, any, any pain in your tummy? \n[Patient] Yeah. I mean I, it, I feel, I feel a cramp. and then, and then I know it's time to go right? So, around every hour I just feel something come up. And then I have to go. So, yeah I mean that's, that's the , kind of the first sign.\n[Doctor] \n[Doctor] Where is this crampy pain? Which part of your tummy?\n[Patient] It's kind of, . If I think about it, it's like, it's like at the bottom. Uh, I don't know if that makes sense. Um\n[Doctor] . Well why don't we start with, is it, is it in the middle, or is it to one particular side?\n[Patient] Um I I think it it , it feels pretty , like in the middle, to me. Not on any side, left or right.\n[Doctor] OK. And does the pain come and go, or is it there constantly?\n[Patient] Um, it it comes and goes. It comes and goes.\n[Doctor] . Fine, OK. And if I was to ask you on a scale of one to ten, ten being the worst pain you ever had, how bad is this pain?\n[Patient] OK so like Um\n[Patient] So What do you mean by, uh pain? So I, I think it's maybe a\n[Doctor] Is it, is this pain as in making you double over? Is it ten, is it ten out of ten, the worst pain you ever had? Or is it more of a kind of a mild pain, like a three out of ten?\n[Patient] I I guess so. I'm, when I think about it, like when I get it, I can pretend that I don't feel it. So I can still sit down and Uh I can still like cover it up, and people don't really notice. So I, I don't know what that means. But maybe is that like a six, or a seven? \n[Doctor] solid six. OK, OK. Alright, good. Um, and apart from the pain and diarrhea, any other symptoms like nausea, vomiting?\n[Patient] OK.\n[Patient] Um, yeah I definitely, I definitely feel kind of nauseous. Um Like I and, like I've have vomited. And when I like, I think it's maybe something to do with like, whenever I have like milk or something like that, I just feel like I want to vomit. And actually, yeah one time I just like had some milk, and I just completely vomited it.\n[Doctor] Not sleeping. OK, alright. Uh\n[Patient] Um, I've been, I've been trying to avoid it. But um, yeah.\n[Doctor] And the vomiting is not as pronounced as the diarrhea. Is that right?\n[Patient] Um, sorry could you repeat that?\n[Doctor] and the vomiting is not as, uh, prominent as the diarrhea. Is that right?\n[Patient] Uh no, no it's not.\n[Doctor] OK. OK, alright. Um, any other symptoms, like fevers or temperatures?\n[Patient] Um so I, yeah I think I am pretty, I feel kind of really hot all the time. And uh I'm pretty sure I'm burning up. I haven't actually done any temperature reading, or anything like that. But it's, I, yeah I've, I've sure I'm, I'm not a, like not a normal temperature.\n[Doctor] OK.\n[Doctor] OK, so you're feeling hoarse. OK. And in terms of your waterworks, are you passing urine OK?\n[Patient] Um yeah a bit, I guess less frequently maybe. Um but yeah, it seems to be OK.\n[Doctor] OK, alright. Um, fine. And, and you said that, you mentioned, three days ago was when it all kicked off. Are you aware of any triggers? I mean, have you for example gone out, had some takeaway food? Have you been around anyone else, um with diarrhea, for example?\n[Patient] Um so I , so my um my brother has had, actually had something like this for um he has it as well for five days, as well. Um and I I've, I'm not, yeah I I can't think of what, what the trigger is for me. I mean, my brother normally can deal, deals with this stuff a lot better than me. But , yeah I, that's why\n[Doctor] Is your, is your brother now better?\n[Patient] Um He, so he's been like this for five days. I think he's getting better, but I'm not, I'm not really sure. He said, he said he had, he's had something for a little while as well.\n[Doctor] OK, alright. Are you having anything to eat or drink? Have you, I can see you're drinking a coffee, but are you keeping it down? Are you keeping your fluids down?\n[Patient] Um so it just feels like the, the fluids do go down. But it just feels like it's going straight through. It just feels like it's going straight through.\n[Doctor] OK, alright. Fine. When was the last time you had anything solid to eat? And which , which uh which you kept in?\n[Patient] Um so, I had some, I mean I had some lunch today. Um But again it just it just came, come out pretty loose.\n[Doctor] OK, alright. Um and and Dan, moving forwards, are you otherwise fit and well, or do you have any other medical history?\n[Patient] Um, so I um, yeah I think, I think otherwise I'm fit and well. I um Yeah I mean I, I'm an OK weight. And um, I I can't think of any related medical history. Um, I mean like my, yeah I no I I don't think so.\n[Doctor] Good.\n[Doctor] I'll take it you don't take any regular medications, then.\n[Patient] So I Um\n[Patient] No I mean I, I've been taking some like Paracetamols and stuff like that lately. But uh, I haven't been, I'm not on any regular medication or anything like that.\n[Doctor] OK. And do you have any allergies to any medications?\n[Patient] Um, so I don't have any allergies that I know of.\n[Doctor] OK. And what about any family history? Do you have any family history of bowel problems? \n[Patient] Um bowel, so would, would bowel like, is is the colon like something that\n[Doctor] Yeah, yeah. So what I mean by bowel is the whole gut. So it could be anything from the mouth anus.\n[Patient] So my, yeah my, my dad actually has um colon cancer at the moment.\n[Doctor] Ohh dear. I'm very sorry to hear that. How is he?\n[Patient] So um, from what I heard he's kind of, So I don't I don't speak to him that often. So I don't, I don't know the exact details. And I, I don't exactly know the full things of like the steps of cancer, and all that kind of thing. But um, he's sort of in his third stage. Uh, I'm not sure what that means exactly.\n[Doctor] \n[Patient] Um, and yeah. So yeah it's, it's um, he's, yeah you can, yeah I can see he's kind of weaker, and it's affecting him a lot. And um, that's it's quite, I I guess he's um, had it for a little while now.\n[Doctor] Yeah, OK.\n[Doctor] \n[Doctor] Yeah I'll make a not of that 'cause uh, important to know these kind of details. Um, and socially, tell me more about your home situation. Who's at home with you, Dan?\n[Patient] Um so, uh not my brother. He doesn't live with me. I'm, I live with my, um sister and my mum.\n[Doctor] OK. And, uh, how are things at home?\n[Patient] Um, I think, I mean in what sense do you mean that?\n[Doctor] Don't . in general day-to-day life are you managing OK? Any particular ?\n[Patient] I mean uh I think uh, yeah it's been, it's been tricky. Um Going to work with all of this. Um I dislike um, taking time off work. I feel like I I just want to go, um when I can. So I I try and go um I think at, at home, uh yeah I just haven't really um I I don't normally actually um, eat with my family. I normally am buying stuff and that kind of thing. So, I don't think it's affected them. And I haven't really been, haven't really gone into detail with my sister and my mom about it. Um Yeah. I'd, I'd just rather deal with these things. Um so \n[Doctor] Sure. you mentioned work. You mentioned work. What is it you do for work?\n[Patient] Um So I work at a, I I work at um an office, um in Central London. Um it's uh, so I work in government.\n[Doctor] , OK. So , OK right. And just a couple last final couple, uh couple questions. Uh, smoking and alcohol, do you do either? Do you smoke, or do you drink much in the way of alcohol?\n[Patient] Um so I I smoke um, I smoke uh, uh for like socially, but not like regularly. Um So normally if if it's a, a Friday or something like that I might, I might have a cigarette or something like that. But um not .\n[Doctor] \n[Patient] Sorry?\n[Doctor] And alcohol?\n[Patient] So alcohol, um uh you know I might have a a beer during the weekdays, maybe uh not that many, maybe um . On Fridays I have more um alcohol um\n[Doctor] But not .\n[Patient] But yeah uh, I'll have my units um\n[Doctor] \n[Patient] Uh, honest, I suppose um, not every week, but maybe I'll once or twice a month, that yeah, I'll go out with my friends and drink a lot so that that's um, yeah um\n[Doctor] \n[Doctor] Well thank you for me. That's really helpful to know. So um, Dan, just as a a conclusion, uh um, just to wrap it all up, I think your symptoms are suggestive of something called gastroenteritis.\n[Patient] OK.\n[Doctor] bit of a basic infection of your tummy. . There's nothing to worry about. Uh um uh uh I suspect this will just settle down in the next few days.\n[Patient] OK.\n[Doctor] Just like you did for you brother. Drink, make sure you drink plenty of fluids, OK? And you can \n[Patient] Uh-huh.\n[Patient] Should I just drink like normal water? I just feel like every time I drink it's just coming out. Um \n[Doctor] Right. fluid is probably best. But I am obviously worried about the fact that you are losing minerals and vitamins. Um so, you can get things like Diarolyte, which is um, a fluid replacement you can get from the pharmacy. It's probably worth uh recommending that.\n[Patient] Do i need like a prescription for that?\n[Doctor] no, you can just get that over the counter.\n[Patient] OK.\n[Doctor] Um, you can try just you know regular Paracetamol if you are feeling feverish. But if your symptoms aren't settling down in the next couple of days, so forty eight hours, I want you to give me a call back.\n[Patient] \n[Doctor] Because um, you know if you are getting dehydrated then we need to do further investigations, OK? But I think let's, let's see how you are in the next one to two days.\n[Patient] OK.\n[Doctor] And uh, we'll catch up soon, OK?\n[Patient] OK. So you're saying that I should, I could, uh I'll try and buy this Dioralyte. What, what should I do in terms of um, food and that kind of thing? Should I just focus on fluids?\n[Doctor] clear fluids. You can use soft diet, things like soup, mash. And then gradually build up, um as much as your body can tolerate. Um, but let's try and keep yourself well-hydrated first, OK?\n[Patient] OK. Is it OK for me to carry on having like, um Paracetamol and things like that?\n[Doctor] Absolutely. If you are having, if you've got a bit of tummy pain, if you're feeling feverish, then I think Paracetamol is very sensible.\n[Patient] OK.\n[Doctor] OK? Try and avoid alcohol if you can.\n[Patient] Uh, OK I'll try. Yeah.\n[Doctor] OK. Alright then.\n[Patient] OK.\n[Doctor] Thank you for your help.\n[Patient] Alright. Thank you very much. Thanks, thanks for helping me out.\n[Doctor] . Thank you. Bye bye now.\n[Patient] K. Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: pouring diarrhoea from my bottom. 3/7 hx of diarrhea - watery stools, opening bowels every hour. No blood in stools. Assoc crampy abdo pain - central, intermittent, severity 6/10. Feels nauseous, has vomited occasionally. Feeling feverish, hot/cold Nil urinary sx - passing less urine . no weight loss. Brother also had similar sx - improving Tolerating oral intake NKDA\n\nSOCIAL HISTORY: lives with sister and mum. Works in office. Smokes socially, EtOH - socially. Family history: father - colon Ca\n\nASSESSMENT:\ngastroenteritis\n\nPLAN:\n1. Push fluids 2. OTC diarolyte 3. Encourage soft diet 4. Regular paracetamol 5. Review in 48 hours, or earlier if worsening sx"
},
{
"source": "primock57",
"dialogue": "[Doctor] There's no . , hello?\n[Patient] . Hi there.\n[Doctor] Hello there. Um, thanks for, thanks for, being here. Um, before I go any further, can I uh, confirm your name and your age please?\n[Patient] Yes, it's um Adriana Katherine . And I'm twenty six year old.\n[Doctor] \n[Doctor] OK, Adriana, and how can I help you this afternoon?\n[Patient] Well, I have this like really crazy headache that's been going on for a few days. And it really annoys me.\n[Doctor] Ohh dear, OK. , when, when did it exactly start, this headache?\n[Patient] Eh, around three days ago, maybe.\n[Doctor] Three days ago, OK. And whereabout in your head, is this pain?\n[Patient] Um, it's basically like, it kind of feels all over my head, but like mainly, um, around my right eye. Um\n[Doctor] , OK. Um, and is the, headache there all the time, or does it come and go?\n[Patient] Um it's, it kind of comes and goes. Um but, I mean it is there all the time, but like sometimes it's stronger.\n[Doctor] OK, so it comes and, fine, OK. And if I was to ask you on a scale of one to ten, um, ten being the worst type of pain you ever had. How would you rate this headache?\n[Patient] Ohh it's probably a eight.\n[Doctor] Eight. And if I was to ask you describe the headache to me, um, in terms of the nature of the pain. Is it sharp? Is it dull? Is it crampy? Is it throbbing?\n[Patient] Um, it's kind of, it's dull but sometimes it gets a bit sharper. So basically it like, it developed gradually, I guess. It's like the first day it just started when I was at work.\n[Doctor] Mm-hmm.\n[Patient] And by the end of the day it was like pretty, pretty, like it was a lot, basically. And then I was thinking OK, maybe I'll just go to sleep. And when I woke up the next morning like, it was even, even worse basically. So\n[Doctor] Mm-hmm.\n[Doctor] So, you think the headache is getting worse over the last three days?\n[Patient] Yeah.\n[Doctor] OK. Have you tried anything which has made the headache better?\n[Patient] Um so I tried uh Ibuprofen. Um so I took, like a few. Um for the last two days, basically.\n[Doctor] Did that help?\n[Patient] But it doesn't really help, no. In in the past it did help me, which is why I decided to try it. But\n[Doctor] OK, all right. And except for the headaches, any other symptoms at all?\n[Patient] Um\n[Doctor] So, example any, problems your eyesight or your vision?\n[Patient] Not really, but just when it started, I I got this like weird shooting lights. And like now like light is quite annoying, my eyes.\n[Doctor] So when you say annoying, does it hurt to look, uh, look at bright lights?\n[Patient] Yeah, yeah. It hurts. So\n[Doctor] , OK. And um, have you had any loss of vision or blurry vision?\n[Patient] Not loss of vision, I wouldn't say. It's just like some lights from, shooting lights .\n[Doctor] Mmm, , OK. Any nausea or any vomiting?\n[Patient] Um, well I'm like basically, I I'm sick with the headache. But I, no vomiting.\n[Doctor] When you say sick, you mean you feel sick? OK. Yeah, no vomiting, OK. Any neck pain or neck stiffness?\n[Patient] Yeah.\n[Patient] No.\n[Doctor] OK. And any difficulty with speaking or, um, speech?\n[Patient] No.\n[Doctor] Any difficulty , with weakness in your arms and legs?\n[Patient] No, it's hard to focus though. So, I I had to take a couple of days off work, actually.\n[Doctor] Ohh really? OK. OK, yeah probably, well I'll, I'll ask you a bit more about your work later on. Um, any recent head injuries at all?\n[Patient] Uh, no.\n[Doctor] OK. And have you had anything like this before in the past?\n[Patient] Yeah I mean, headaches, you mean.\n[Doctor] Or, uh, or similar, similar to, similar to this kind of headache, ?\n[Patient] Yeah. I mean I had. But, usually after I I take uh Ibuprofen it kind of goes away. So, but this time it's just not. .\n[Doctor] not, OK. All right. Um, any temperatures, or fevers?\n[Patient] No.\n[Doctor] Any rashes at all, on your skin?\n[Patient] Mm, no not that I've noticed.\n[Doctor] OK. And just moving forwards. Are you otherwise fit and well, Adriana?\n[Patient] Am I what, sorry?\n[Doctor] You fit and well? , do you have any other medical history?\n[Patient] Yeah, I think so. It's just the headache.\n[Doctor] Any history of migraines at all?\n[Patient] Not myself, I've never had a migraine. But my sister and my mom have them quite frequently.\n[Doctor] OK. Um, fine. I'll ask you a bit more about that in just a second. Before I go any further, can I ask, do you take any regular medication?\n[Patient] Uh, no no.\n[Doctor] Are you on the pill?\n[Doctor] OK. Do you have any allergies to any medications?\n[Patient] Mm not that I know of.\n[Doctor] OK. So you mentioned your mother and sister both have migraines.\n[Patient] Yeah.\n[Doctor] Are they, is that normally well-controlled or are they um, having difficulty, controlling their symptoms?\n[Patient] Um so my sister's, like better. Like it's kind of, it's very rare. But my mom's is like quite bad, um usually when there's like a season changing and stuff like that. It's, yeah.\n[Doctor] Mm-hmm, OK.\n[Patient] Takes her out for a few days, basically.\n[Doctor] Ohh right, OK, fine. Um, socially, tell me a bit more about your life, outside of, um, outside of, work. So , who lives at home with you?\n[Patient] Uh I live with housemates. So, three of them. So we're four .\n[Doctor] OK. Excellent. And are you working at the moment? You mentioned this , impacting on your work.\n[Patient] Yeah so I work, well I work in IT. So I work with computers a lot. So it kind of is difficult to focus. Um I had to like reduce the uh, brightness of my screen.\n[Doctor] Mmm. OK. Do you wear glasses?\n[Patient] Yes, I do.\n[Doctor] Have you had any, uh, have you had any recent eye check, done? Eye test?\n[Patient] No, uh I've been wearing them since I was five , five year old. So, it's quite a long time.\n[Doctor] OK, all right. Something for you to bear in mind if you feel that you are, your eyes are straining. Um I would always recommend having a repeat eye test done. Um, have you been feeling more stressed or anxious at work recently?\n[Patient] \n[Patient] Well, it's been a bit stressful, kicking off a new project. But um, yeah nothing out of the ordinary, really.\n[Doctor] OK, all right. Great. Um, regarding smoking or alcohol. Do you drink or smoke at all?\n[Patient] I socially smoke. And I drink only socially.\n[Doctor] But only socially? OK. Right. Now um, Adriana, do you have any ideas as to what could be causing your symptoms? Have you, have you read anything online, or spoken to people?\n[Patient] Um Not really. Um at first I thought it's stress, or maybe I didn't drink enough water. Because sometimes when I don't drink enough water, I I like get headaches. Um\n[Doctor] Mm-hmm.\n[Patient] But, I don't think that's it. And I'm like worried, it's, I don't want it to be a migraine. Because I know what it's like, from my mom and my sister.\n[Doctor] \n[Doctor] Mmm.\n[Patient] And it's really annoying. So I I really don't want to have that. And I know it's genetic. So I've researched that. Um but I don't know if that is the case. So, yeah.\n[Doctor] OK. Is it anything in particular you were hoping I could do for you today?\n[Patient] Yeah maybe just kinda, if you have any recommendations of that I can take something stronger. Because apparently, Ibuprofen doesn't help me. Uh\n[Doctor] OK.\n[Patient] Usually it gets resolved if I have headache in like, after like one or two days. But currently it, it didn't help me.\n[Doctor] How many tablets did you take of Ibuprofen?\n[Patient] Uh, three a day.\n[Doctor] Three a day, OK. All right. Um, so uh, Adriana, so um, really what I think is going on here. I , uh, unfortunately I do think this could be, a headache very similar to a migraine.\n[Patient] \n[Doctor] Um, the reason I say that is because the history is very suggestive of it, given your mum and your sister also migraines. I think it's something for us to think about. Um, now I'm not saying it's gonna, keep happening, but, it may just be a one-off. But it's certainly worth treating it today stronger analgesia or painkillers. Um, now moving forward, we have some options which we can discuss. Uh, you tried the Ibuprofen. Now, my only worry is, I'm not sure whether you're taking, the correct dose. You can take up to two tablets, three times a day.\n[Patient] Ohh right.\n[Doctor] So, so , there's definitely room for, improvement there. Or, I can prescribe you something stronger, like Naproxen, which is another anti-inflammatory, which can be helpful.\n[Patient] Mm-hmm.\n[Doctor] Um, we can also add in other, painkillers like, Paracetamol, or Codeine. Which might be helpful as well.\n[Patient] Mm, yeah. I think is what my mom takes for when she has um, um migraines.\n[Doctor] OK. And I think it's , certainly worth looking into that, so I can give you a , prescription for that today. Um, with regards to um, the next few days. It may be worth keeping a headache diary so we can try and work out what's, you know, if there's any triggers which could be causing your headaches to become worse.\n[Patient] Mm-hmm.\n[Doctor] And, and, you know I'd like you to come back and see me, in about uh, a week's time, week to two weeks' time. If you are having , more frequent episodes of these type of headaches. We can think about giving you medications as, prophylactic. Which basically means, medications to stop you from having these headaches on a regular basis. But we can have that discussion next time.\n[Patient] Mm, OK.\n[Doctor] OK. In the meantime if your headaches aren't getting any better, or they're getting worse. Um, you know, I want you to give me a call, or come back and see me sooner. OK?\n[Patient] OK. Yeah.\n[Doctor] So, if you're having any problems with your vision, or weakness in your arms and legs, or you're just not feeling very well. Just give me a call, and come back and see me.\n[Patient] OK.\n[Doctor] All right?\n[Patient] Great.\n[Doctor] Great. Well, have a good day.\n[Patient] Thank you. You too. Bye!\n[Doctor] Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I've had a blinding headache for a few days. 3/7 hx developed headache - all over of my head and mainly over right eye. Constant, severity 8/10, dull ache with associated sharp pain, gradual onset. Progressively worsening. Has tried ibuprofen with limited relief. No visual sx Visual aura prior to headaches. Some photophobia. Feels nauseous, no vomiting No neck pain/stiffness No speech disturbances No arm or leg weakness No head injury No fevers No rashes NKDA ICE: ?related to stress/dehydration. Concerned about migraines.\n\nSOCIAL HISTORY: lives with housemates, works in IT, wears glasses, denies stress. Socially smoke/EtOH. Family history: mother and sister - migraines\n\nASSESSMENT:\nmigraines\n\nPLAN:\n1. Paracetamol/NSAIDs regular 2. Headache diary 3. Review in 1/52 - discuss prophylactic Rx if necessary 4. Patient aware of red flag sx - knows to seek urgent medical attention if present"
},
{
"source": "primock57",
"dialogue": "[Patient] Hello?\n[Doctor] Hello? Hello. Um, before I go any further, can I confirm your name and your date of birth?\n[Patient] Uh, yeah. Uh my name is April, and I'm fifty.\n[Doctor] You're fifty, OK. April, how can I help you this afternoon?\n[Patient] Well I've just been having this like, cough, for quite a few days. And my nose is running. Um and it's just been super annoying, and it's not going away.\n[Doctor] , OK. When did it all start?\n[Patient] Uh I think it started like maybe, a bit less than a week ago. Like maybe, maybe five or six days ago.\n[Doctor] OK. And you mentioned a couple of things there. You mentioned a cough. You mentioned a bit of a runny nose. Is that right?\n[Patient] \n[Doctor] OK. Let's focus on your cough first. Can you tell me a bit more about your cough?\n[Patient] Uh, it's just so continuous. It's really, really frustrating. It's quite dry. And it's just all day, it like keeps me up at night as well, which is really annoying.\n[Doctor] OK. So it's a dry cough. So you're not bringing up any , you're not bringing up any mucky, ohh I can hear that, yeah. Um you're not bringing up any uh, mucky phlegm or anything like that. No, OK. So it keeps you up at night. Um you mentioned uh the cold symptoms as well, the runny nose. Do you have a do you have a sore throat at all?\n[Patient] I mean, apart from, I mean the coughing is giving me a sore throat. But it's not like, you know not more than, than that. You know just, just my throat is irritated from coughing. But it's not like, it's not that bad when I swallow or anything.\n[Doctor] \n[Doctor] Right. Do you have any uh, how are your ears? Do you ears feel blocked or?\n[Patient] No.They feel OK, actually. Yeah. . Nothing, nothing on the ears.\n[Doctor] No pain, no discharge coming from your ears. \n[Doctor] OK, alright. Um fine. In terms of your breathing, how is your , how's your chest? Is your breathing more labored?\n[Patient] Um, I don't think so. Like, I guess I get laboured when I'm coughing and I can't breathe. But I, not, yeah, not, I, I don't think so. Not really.\n[Doctor] Day to day when you walk around, uh you don't feel breathless do you?\n[Patient] I don't feel restless. No, I feel you know, generally tired.\n[Doctor] \n[Doctor] OK. OK.\n[Patient] So like, yeah, but not, not anything special with my chest.\n[Doctor] Any pain in your chest? \n[Patient] No not, not that either.\n[Doctor] OK. You mentioned feeling tired. Um have you felt feverish at all? Have you had a temperature?\n[Patient] Um I've been having like, like shivers, even when I'm in, when I'm in bed. You know like, when you, when you go to sleep and, and you feel like I I should be warm. But I'm still, still you know, shivering a little bit.\n[Doctor] \n[Doctor] OK.\n[Patient] But I haven't taken my temperature, so I'm not a hundred percent sure if I had a fever. But it feels like I probably did. 'Cause I was just, I was next to my boyfriend. And he was completely warm and totally fine. And I just like couldn't stop shivering. And kept adding more sweaters on, and I was still cold.\n[Doctor] \n[Doctor] OK. OK. OK. Alright. Um, fine. And in terms of any other symptoms, so have you had any nausea? Have you had any vomiting?\n[Patient] No. No, no nausea. No vomiting. Like, um yeah, nothing like that.\n[Doctor] OK.\n[Doctor] How's your appetite?\n[Patient] Um, I mean it's OK. I, at the beginning, like when I was starting to have the , the , the coughing and stuff. Um, I had a little bit of diarrhea. Um but, but it didn't, it didn't cut my appetite or anything. I just like, my stomach wasn't feeling great.\n[Doctor] \n[Doctor] \n[Doctor] OK. Has that got better now, the diarrhea?\n[Patient] Yeah, yeah. It got better. It was only like the first, like it started at the same time as the cough started. And then it stopped. So I thought everything would be fine. But then the cough just kept going.\n[Doctor] OK fine. Um, any problems with your waterworks at all? \n[Patient] With my what?\n[Doctor] Uh your your waterworks, your urine. \n[Patient] Ohh. Uh, no. No no, it's fine.\n[Doctor] you're passing urine OK. You're drinking plenty of fluids, and passing urine OK.\n[Patient] No. I, I drank loads of water, when I started having the diarrhea. Now that it stopped, I just went back to normal.\n[Doctor] OK, alright. Um in terms of any other thing, do you notice any, any find any skin rashes, or um problems with your muscles or joints?\n[Patient] Uh like my, you know when I had the, when I was telling you I had like the, I had chills, and I was really cold. My muscle was really hurting.\n[Doctor] Yeah. OK. \n[Patient] Sometimes I do pilates. But like, it's hurting me so much at the moment. Um so, to be honest, all I feel like doing is just lying in bed.\n[Doctor] Right.\n[Doctor] Right, OK. OK. I'm sorry. That must be very difficult for you. \n[Patient] Yeah, right. Especially like in my arms, my legs, like just everywhere basically.\n[Doctor] quite lethargic and weak, you mentioned. Um, OK. And um, April are you normally otherwise fit and well?\n[Patient] Yeah, pretty much.\n[Patient] Am I normally what?\n[Doctor] Uh fit and well. So do you have any other medical history?\n[Patient] Uh, well I have type two diabetes. And I have quite high blood pressure.\n[Doctor] OK.\n[Doctor] OK. And what do you take for your blood pressure? Any, or what what medications do you take on a regular basis, if you don't mind saying?\n[Patient] Um I take Metformin for the diabetes. And I take Lisinopril for the high blood pressure.\n[Doctor] Yep.\n[Doctor] Zinopril. OK, fine. Any allergies at all, to medications?\n[Patient] No. No allergies.\n[Doctor] No, OK. Regarding any family history, is there anything I should be aware of?\n[Patient] Uh my dad also has type two diabetes. But I think that's it.\n[Doctor] OK, alright. Who's looking after your diabetes? Is there anyone, is there a doctor in a hospital, who looks after your diabetes?\n[Patient] I just regularly go see a doctor. Um, that just checks up on it. Same with the high blood pressure. Like I, I have it under control. And since I've started taking this medication, I've just been like regularly checking that it, it's under control.\n[Doctor] \n[Doctor] Right, excellent. And in terms of your social situation, who lives at home with you?\n[Patient] Uh just, it's just me and my partner.\n[Doctor] lives OK, um fine. Is your partner well at the moment?\n[Patient] Yeah he has none of this. Like he's just going ahead like, like nothing. Like I was a bit worried that I would pass it to him but, not uh, diarrhea, nothing, fine.\n[Doctor] Right, OK. So he\n[Doctor] Go away, he's got away with it, at the moment. OK. And uh, are you working at the moment, April?\n[Patient] \n[Patient] Uh, yeah I am working. But the, the first day I skipped. because I was feeling just too shit. Um, but then, I just felt like had to go back, 'cause I had so much to do. So I've been going in. But it's not been fun.\n[Doctor] Yeah.\n[Doctor] \n[Doctor] No, I can imagine. What is it that you do for work?\n[Patient] Uh, I am a developer.\n[Doctor] Ohh, so you work in the IT field. OK. IT field. Right, OK. Uh\n[Patient] yeah. Work in IT. not too active a job. Uh, yeah.\n[Doctor] No. Has it been quite stressful recently?\n[Patient] Not more than usual. I don't think it's related to stress. Like I, I don't feel like I've had a particularly hard time at work that way. Um\n[Doctor] OK.\n[Doctor] The reason I ask is sometimes\n[Patient] I've been able to take a day off to try and recover. So yeah, I don't think it's related.\n[Doctor] Sure. reason I ask is because sometimes stress can really affect your immune system. Um but uh it's good to know you're you're you're not feeling stressed. Um, do you smoke at all, April?\n[Patient] I used to, but I've stopped for about six months now.\n[Doctor] OK. Um and what about alcohol?\n[Patient] I mean, yeah I, I don't think I drank that much. Like, I I don't really know how you count the units. So I guess like I don't drink more than like, like, let's say three evenings a week? And I rarely get like properly drunk, or anything.\n[Doctor] And what is it that you drink?\n[Patient] Wine, mostly.\n[Doctor] The wine. How much do you drink on those nights?\n[Patient] Uh, I'd say like maybe two or three glasses.\n[Doctor] OK. So um, yeah so you're probably just about under the limit of um, the recommended limit. Something think about, just in terms of your blood pressure and diabetes, maybe something that you can maybe cut down on if you can.\n[Patient] Yeah? I should cut down on it.\n[Doctor] really ideally, the the the right answer is to cut down completely. But so in practice I know that's not realistic. So maybe for the first few weeks, why don't you cut down to two glasses a week. And then, one week thereafter Um and if you are coping OK, then you can maybe try and cut down altogether.\n[Patient] OK.\n[Doctor] OK? Just something for you to think about. Um, right so uh just as we wrap up really, um April I think based on your story, I think uh essentially I think you're, you're going through a bit of a bit of a viral illness. Um, I don't think there's anything to worry about.\n[Patient] Yeah.\n[Doctor] You know you've had a bit of a cough, bit of a runny nose, feeling quite weak and lethargic. I'm hoping that, you know, you're probably over the worst of it now. It's been five days. I'm hoping you're maybe going to get better in the next couple of days. It normally lasts for about a week to ten days.\n[Patient] What, what should I do if it just keeps going on and on? Like if it's still going on in, in say four days?\n[Doctor] Yeah, absolutely. So, you know things you can do to help yourself in the meantime is to, you know get some nice, good rest. Drink plenty of fluids. Keep yourself well-hydrated. You can take regular Paracetamol. If you feel like you're still not getting any better in two to three days, it's probably worth coming back to see me again. We can check you over. And if you are still feeling feverish, um and your cough isn't getting any better, then we may look to give you some antibiotics for your chest. some of the uh uh common source of infection. Um\n[Patient] Do you think I should keep going to work? Or do you think I should just\n[Doctor] Yeah so I think you know , really I think it depends on you. it's um if you are coughing, then there is a theoretical, you know risk that you're maybe slightly infectious still. So I would say maybe take a day or two off work, if you can. Uh and get some good bed rest. Um and maybe think about work early next week.\n[Patient] OK. OK. Thank you.\n[Doctor] But um, if your cough isn't getting any better, or your breathing is getting worse, I want you to come back and see me sooner. OK?\n[Patient] OK. But otherwise, I don't need to worry.\n[Doctor] No no no , nothing to worry about otherwise.\n[Patient] OK. Alright. Thank you very much.\n[Doctor] OK. Well, have a good day. Appreciate it.\n[Patient] Thank you. Bye!",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have a cough and cold. 5/7 hx of cough and runny nose. Dry cough, keeps pt up at night. Runny nose, no ear pain, no sore throat. No SOB/chest pain Feeling tired, weak and myalgia. Feeling shivery, hot/cold, ?fever No nausea/vomiting Appetite maintained. Initial diarrhea - but now resolved Nil urinary symptoms No rashes NKDA\n\nPAST MEDICAL HISTORY: Type 2 diabetes, HTN\n\nMEDICATIONS: metformin, lisinopril\n\nSOCIAL HISTORY: lives with partner, works IT, denies stress. Ex-smoker - stopped 6/12 ago. Social EtOH <14 units/week. Family history: Father - type 2 diabetes\n\nASSESSMENT:\nviral URTI\n\nPLAN:\n1. Supportive mx - bed rest, fluids, regular paracetamol 2. Review 5/7 if no better, or earlier if worsening sx (fever, SOB, chest pain)"
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hello?\n[Doctor] Hello. Can you hear me?\n[Patient] Yes.\n[Doctor] Great, excellent. Before I go any further, can I confirm you name and your, um, age please?\n[Patient] Uh yes. Um Laura Parkinson. And uh I'm forty five.\n[Doctor] Forty five. Alright Laura, well how can I help you this afternoon?\n[Patient] Uh yeah. So I have uh soreness in my fingers, my finger, like, the skin on my hands is kind of cracked.\n[Doctor] OK. When, when did this all start?\n[Patient] Um, a couple of months ago. I got it three, four months ago.\n[Doctor] OK so it's been that long, has it? OK. And so you mentioned your , is it the skin on your hand, mainly that's dry?\n[Patient] Yeah.\n[Patient] Yeah, I haven't noticed. I mean, I have dryness, like you know, in other parts, like my legs. But it's not, it's not very, it's not severe. It's just you know, I've always, you know, I don't hydrate very much. So\n[Doctor] Right. OK.\n[Patient] Yeah. Like it's very, it's very bad in my hands.\n[Doctor] OK. Can I ask why have you come to see me today? Uh is it because it's got worse recently, your symptoms?\n[Patient] Yeah I mean, it's gotten to a point where, where it hurts a lot. And I can't really do my job. So, I thought I should probably get it checked out.\n[Doctor] Yeah, that sounds like a very sensible plan. Um, which part of your hands are affected, mainly?\n[Patient] Uh the palm. I don't get, yeah.\n[Doctor] Um, OK alright. Um, have you any itchiness in your palms?\n[Patient] Yeah, it's itchy. Not all the time, but yeah, it does get itchy.\n[Doctor] OK. Any bleeding at all?\n[Patient] Um um I don't, I mean, no I don't think so.\n[Doctor] you scratch yourself, you scratching yourself often, and bleeding?\n[Patient] Um, yeah I guess when I scratched it, yes it has bled sometimes but, yeah. Otherwise, it hasn't bled on its own.\n[Doctor] OK. Um, fine. Uh OK. Sorry, I'm writing notes as we go along. Um, and you mentioned that skin is quite cracked as well. Is that right?\n[Patient] Yes, that's right.\n[Doctor] OK, alright. Um , I know it's a long time ago, but do you remember how it all started? what were you doing at the time when it all started? Is it anything you may have done, to bring your symptoms on?\n[Patient] Uh, I mean I am a, I do work as a housekeeper. Um\n[Doctor] \n[Patient] And to be honest, I'm not always very good about wearing gloves. So that could be related. Um, I switched jobs, uh four months ago. Uh\n[Doctor] OK. OK.\n[Doctor] OK.\n[Patient] I've been working for, as a housekeeper for, for a while now, but um, that's the only thing I can think of.\n[Doctor] Yeah, I think that might be quite important actually. I think there's definitely, maybe a correlation between the two. Um, fine. And so you mentioned something about having general dryness. Is that, you mentioned in your legs as well?\n[Patient] Yeah. Yeah but isn't, sorry.\n[Doctor] Is that, is that something you've, you've had for a while now?\n[Patient] Yeah. It's not really, it's not really major. Uh yeah it's just like literally grinding my legs.\n[Doctor] OK.\n[Patient] \n[Doctor] Right, OK. \n[Patient] trouble.\n[Doctor] OK. I'm just going to ask you some very brief yes or no questions, if that's OK. With your symptoms, have you, have you had any other symptoms, such as fever, or temperatures?\n[Patient] No.\n[Doctor] Any nausea, or any vomiting?\n[Patient] No.\n[Doctor] Any problem with your bowels?\n[Patient] No.\n[Doctor] Any problem with your urine, or waterworks? \n[Patient] No.\n[Doctor] Otherwise you feel well, do you? And yourself, your eating, drinking, your appetite is well-maintained?\n[Patient] Yeah. \n[Doctor] \n[Doctor] OK, alright. Fine. Um, in terms of your past medical history, do you have any other conditions at all?\n[Patient] I have diabetes.\n[Doctor] Do you know if that's type one or type two?\n[Patient] Type two.\n[Doctor] Diabetes, OK. Anything else?\n[Patient] Um no.\n[Doctor] Any skin problems?\n[Patient] No.\n[Doctor] Eczema, dermatitis, for exmaple?\n[Patient] Not that I know of. No, I haven't been diagnosed.\n[Doctor] No, OK. Which medications do you take?\n[Patient] \n[Doctor] Metformin, OK. Do you have any allergies, either to any medications or in general?\n[Patient] No.\n[Doctor] OK. Family history-wise, is there anything I should be aware of?\n[Patient] Diabetes and what?\n[Doctor] Diabetes as well. OK. Again, any skin problems?\n[Patient] Yeah.\n[Patient] Uh no, not that I know of.\n[Doctor] Any history of asthma, or bowel problems?\n[Patient] Uh, no.\n[Doctor] No. OK, alright. Um Fine. In terms of social history, you mentioned that you work as a housekeeper. Um are you, you're not always very good at wearing gloves.\n[Patient] Yeah.\n[Doctor] Um, you've recently changed jobs. Which which kind of places do you work in? Is it mainly residential, or is it commercial?\n[Patient] Yeah.\n[Patient] At a hotel. I have to do the whole thing like bedrooms, bathrooms, .\n[Doctor] Hotel, OK.\n[Doctor] OK. OK. Do you think there might be a relationship between the two? Between the, kind of the products you're using, and your symptoms?\n[Patient] Yeah, I usually use those for bathrooms. But, yeah bedrooms and corridors not always.\n[Doctor] OK. Have your symptoms stopped you from doing any work? Have you had to take time off work recently?\n[Patient] Uh, yeah like the past three days, I haven't been able to go to work.\n[Doctor] OK. Can I ask a couple questions? Do you smoke at all?\n[Patient] No.\n[Doctor] Do you drink much in the way of alcohol?\n[Patient] pints a week.\n[Doctor] Once a week?\n[Patient] Uh, a couple of pints a week.\n[Doctor] a week. OK so, very minimal, alcohol there. Um have you tried anything for your symptoms? Have you tried anything over the counter? Any creams?\n[Patient] Yeah. I tried uh E forty five.\n[Doctor] Any luck with that? \n[Patient] Yeah, no it didn't really do anything.\n[Doctor] No, OK. Alright. Um \n[Patient] I also tried an antihistamine, antihistamine. Uh but it didn't\n[Doctor] . OK, alright.\n[Doctor] Um, Mrs. Parkinson, so I think um, based on your story, I I think you might have something called dermatitis or contact dermatitis. Which is very common in, particularly people in your in your in your field, who are using cleaning products, not using gloves. And sometimes you get a bit of reaction between the chemicals and your skin. Um, so moving forward there's a couple of options. So firstly, what we try and do is, you know, avoid the triggers. In your case, I strongly recommend that you wear gloves when cleaning at all times.\n[Patient] Yeah.\n[Doctor] OK. And in terms of helping your dryness and the cracking of your skin, um we can try some steroid creams to help with the inflammation.\n[Patient] Yeah.\n[Doctor] \n[Patient] \n[Doctor] As well as some stronger emollients, um which you really need to kind of coat on, three four times a day, for the next couple of weeks, just to help with the moisturizing of your skin. \n[Patient] \n[Doctor] Um if it still hasn't got better in about a week, two weeks time, I really need you to come back and see me again. And we can maybe think about other things we can give to you. \n[Patient] OK.\n[Doctor] Is that all clear?\n[Patient] Uh yeah, that sounds good.\n[Doctor] Great. Do you have any questions for me?\n[Patient] Um, where do I get the medicine from?\n[Doctor] I'll I'll I'll do a prescription for you now, and send it over to your pharmacy.\n[Patient] OK great. Yeah, uh so you said a couple of weeks, it should get better, right?\n[Doctor] OK.\n[Doctor] I think I think minimum couple of weeks. Uh ten days to fourteen days. Um and if it still hasn't got better, or indeed if it's getting worse, like if it's spreading, or dryness is getting worse, come back and see me sooner.\n[Doctor] OK. Great. Thank you Laura. Thank you.\n[Patient] Alright. Thank you very much.\n[Doctor] . Bye bye now.\n[Patient] Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have sore, cracked skin on my hands. 3-4/12 hx of sore and cracked skin on my hands - mainly palms. Occasionally itchy and bleeding on scratching. No pain Works as a cleaner and does not always wear gloves - possible trigger No fever No bowel/urinary sx Appetite maintained NKDA Nil smoking Minimal etOH Has tried E45 cream and antihistamines with minimal relief\n\nPAST MEDICAL HISTORY: Type 2 diabetes\n\nMEDICATIONS: metformin\n\nSOCIAL HISTORY: works as a housekeeper, recently changed jobs 4/12 ago, works in a hotel.. Family history: Type 2 diabetes,\n\nASSESSMENT:\ncontact dermatitis\n\nPLAN:\n1. Steroid cream BD 2. Emollients - regular use 3. Avoid trigger, wear cleaning gloves 4. Review in 10-14d INB, or earlier if worsening sx"
},
{
"source": "primock57",
"dialogue": "[Patient] Hello?\n[Doctor] Hi there. Good morning!\n[Patient] Hi. . Nice to meet you. Hello.\n[Doctor] Hello. I, I'm Doctor . Nice to see you. Hi. Um, so, before we start your appointment, could I confirm your full name and date of birth, if that's OK?\n[Patient] Uh, yeah. Uh, Mary Richards. Uh, and my, I'm forty years old. So.\n[Doctor] You're OK, fine. So, you're you're forty years old, you said, yeah?\n[Patient] \n[Doctor] Perfect, OK. Um, are you in a private place where you're OK to speak at the moment?\n[Patient] Yep.\n[Doctor] OK, great. Um, so how can I help you today?\n[Patient] Um, so, just been having some, um, problems with my hearing, I can't really hear very well, and my , noticed that my face has been feeling a bit numb recently.\n[Doctor] Right, OK. OK. And how long has this been going on for?\n[Patient] Um, it's been, it's been a few weeks now. Um, been about three weeks or something.\n[Doctor] Right, OK. And, is this just on one side, or both sides?\n[Patient] Just one side, just on my left side, I've noticed that the hearing's kind of gone down a bit.\n[Doctor] Right, OK. And your face feeling numb, where exactly is that? Which part of your face? Can you, can you show me with your finger?\n[Patient] \n[Patient] Yeah, so again it's the left side, it's kind of like around my left ear, and kind of, along here. So like, my jawline's just all feeling a bit numb round here.\n[Doctor] Right, OK. OK. Um, has anything else happened, um, in this time? Any other symptoms you have at all?\n[Patient] Not that I, not that I've noticed, .\n[Doctor] \n[Patient] I think, occasionally noticed a, ringing in my ear. Um.\n[Doctor] Some, some ringing in your ear. OK.\n[Patient] , yeah it's .\n[Doctor] Sure, OK. Um, and um, have you had any weakness or numbness, down the, in the rest of the body at all?\n[Patient] No, no, no, no, nothing like that.\n[Doctor] OK. Have you had any difficulty swallowing?\n[Patient] No.\n[Doctor] And, have you had any difficulty speaking?\n[Patient] No, no.\n[Doctor] Have you noticed any problems with your vision, at all?\n[Patient] No, that's all good.\n[Doctor] OK. Uh, and do you have the numbness present right now?\n[Patient] Uh, yeah. It kind of, kind of, there quite often, so, all the time. So yeah, right now it feels very, doesn't feel like when I touch this side of my face.\n[Doctor] Sure. Sure, OK. Alright, um, just going back to the kind of feeling in, in the ear, um, do you have any discharge coming from that ear at all?\n[Patient] No, nothing, nothing coming out.\n[Doctor] K. Any pain in the ear, or from the ear?\n[Patient] Uh, no, don't think so.\n[Doctor] Right, OK. And um, have you had any fever at all?\n[Patient] No, nothing like that.\n[Doctor] And, do you, um, have any itchiness in the ear?\n[Patient] \n[Doctor] Do you use cotton buds to kind of clean your ears out?\n[Patient] Pardon? Ohh, no, no, no, don't use cottons buds, like that.\n[Doctor] No. Alright. OK. Alright. Um, need to, need to ask a few other general questions. Um, do you have any other illnesses at all?\n[Patient] Um, I've, well I've got kind of, been told I have polyps in my nose in the past and, occasionally get them kind of . Um, that, that's all fine and, you know I take a Rennie's if I need to, and if my nose polyps are playing up I've got a spray. Um.\n[Doctor] \n[Patient] Other than that I think they said, ages ago, I had something called, can't quite remember but, labyrinthitis, something like that, but again, nothing, nothing ongoing.\n[Doctor] Sure. Sure, OK. So, are you on any regular medication? You mentioned the spray for your nose.\n[Patient] Yeah, so, no, uh, I only take the, spray for my nose when I need it for, and um, sometimes take like Rennies, but I just get that from the chemist.\n[Doctor] Sure. and, and the spray for your nose, where do you get that from? Is that from a doctor?\n[Patient] Uh, yeah, they gave me a prescription ages ago.\n[Doctor] Yeah. Do you remember the name of the spray, at all?\n[Patient] Unfortunately I don't, sorry.\n[Doctor] that's alright. That's alright. Uh, and you're not on any other medication at all?\n[Patient] No.\n[Doctor] No, OK. Do you have any , any allergies to any medication?\n[Patient] Uh, no just Latex.\n[Doctor] Latex, OK. Alright, that's good to know. Um, and um, in terms of your family, are there any kind of illnesses within your family at all?\n[Patient] My brother had, Neurofibromatosis, I think it is. Um, other than that everyone else is OK.\n[Doctor] Right, OK.\n[Doctor] OK, good. That's good. Um, and in, in terms of your own kind of background now, are you, are you working at the moment?\n[Patient] Yeah, so I'm a, I'm a jockey, um, but, because of all the kind of, these symptoms I've been getting, especially sometimes when I get a ringing, I can feel a bit dizzy. Ohh, I've just had to do far less training. So, kind of beginning to, yeah, impacting work, um, a little bit now.\n[Doctor] OK. So you have to excuse my ignorance, you mean, jockey like with horses? Is that what you're talking about? Yeah. Alright, OK. Fine. Um, great. Um, uh, and, uh, do you live alone?\n[Patient] Yeah, yeah.\n[Patient] Um, I, uh, live with my partner.\n[Doctor] Uh, OK. Right, um, do you have any pets at all at home?\n[Patient] No, no pets.\n[Doctor] OK, fine. OK so, alright. Um, Is there anything else that you wanted to tell me about what's been going on, recently?\n[Patient] Uh, no, just like, like I said, like the ringing um, occasionally and, when I get that I can sometimes feel a bit dizzy but, the main thing is really the, lack of hearing, and the numbness that's got me like, yeah, no idea what's going on there.\n[Doctor] \n[Doctor] OK, fine. Alright. Um, So, , what I think , go on.\n[Patient] I mean, there was just like, there was one thing I think just, 'cause I can panic and you can look online, get a bit, frantic.\n[Doctor] \n[Patient] , I guess what I'm trying to think is, you know, is there something particularly serious that, you know, will need to be sorted and. Obviously, really, anything can just make you really frantic . Hopefully nothing , so serious I will die from it, I don't know I just, I think got myself in a pickle.\n[Doctor] \n[Doctor] OK. so um, uh, obviously we're limited in terms of assessment via the video, uh, portal.\n[Patient] Mmm.\n[Doctor] um, from what you've told me, this doesn't seem to be you know, anything um, that you're gonna die from. However, I would like you to be assessed in a clinic today.\n[Patient] OK.\n[Doctor] OK? I ,would like you to come to one of my clinics. I would like a GP to assess you. what you're, what you're describing might be something called Bell's Palsy. OK? Um,\n[Patient] OK.\n[Patient] Yeah.\n[Doctor] We can go into that, explaining what that is, if um, if that's confirmed on, on physical examination. But um, that's not usually a life-threatening problem.\n[Patient] OK.\n[Doctor] But, um, part of the reason why I'd like you to come in, it's just that we can do a, a what we call a, a neurological examination just to make sure there's nothing else going on, and confirm that might be the diagnosis. Have a look, have a look inside the ear, see if there's any, , anything to see within the ear.\n[Patient] OK.\n[Patient] \n[Doctor] So, um, um, so, in answer to your question. No, I don't think that you need to worry about that, I , think you know , preliminarily I can, I can reassure you.\n[Patient] OK.\n[Doctor] However, , in order to definitively reassure you, I, I think you need a physical examination today, OK. , so what I wanna do, is I'm gonna send a message to our admin team, I'll ask them, to book you in for a face-to-face appointment in one of our clinics.\n[Patient] Mm-hmm.\n[Patient] Yeah, that's fine.\n[Patient] OK.\n[Doctor] Um, within Central London. OK, and then you can ring the , the support team number, I'll leave that number in your notes. And you can ring them after five minutes, and then they'll slot you in to a place that's convenient for you, OK.\n[Patient] OK. Yeah.\n[Patient] , that's fine.\n[Doctor] All right. So, someone will see you, and hopefully you will be able to reassure further but, please make sure the appointment gets done today.\n[Patient] OK, yep, I will do, that's fine. Thank you very much.\n[Doctor] All right then. OK. Nice to see you. Take care.\n[Patient] Bye bye.\n[Doctor] Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I can't hear very well and my face is a bit numb. Hx: 1 week history of left side difficulty hearing and facial numbness No dysphagia, dysarthria, no unilateral weakness/numbness in the rest of the body, no visual disturbances No ear pain, ear discharge, fever, itchiness or cotton bud use. Slight tinnitus at times in this period- not continuous Numbness and difficulty hearing present now Pmhx: labyrinthitis, heart burn, nasal polyps No FH of note Ex: no facial asymmetry, looks well, normal facial expressions and movements\n\nMEDICATIONS: Rennies PRN OTC, nasal spray PRN (pt not sure of name)\n\nALLERGIES: latex allergy\n\nASSESSMENT:\n? Bell's Palsy- need to rule out any other focal neurology\n\nPLAN:\n1. for face to face review today for neurological examination and ear examination Pt to ring support line for GP F2f slot Pt understands and is happy with plan."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hi there. Good morning.\n[Patient] Hello.\n[Doctor] Um, I'm Doctor Deen Mirza from GP at Hand. Nice to see you.\n[Patient] Lovely to meet you.\n[Doctor] OK. So, before we start your appointment. Can I please confirm your full name and date of birth?\n[Patient] Uh my name is, Tracy Chapman, and, um, my date of birth is. God . , I'm forty five.\n[Doctor] Just tell me how old you are. , OK. Uh, and could you just confirm the first line of your address, and your postcode?\n[Patient] Uh, fifteen Babylon Street. Um, W six five .\n[Doctor] That's great, OK, thank you. Um, are you in a private place where you're OK to speak at the moment?\n[Patient] Yes.\n[Doctor] OK, fantastic. All right, so tell me what's been going on. You said you're, a bit short of breath. Is that right?\n[Patient] Yeah, yeah, feeling very sort of breathless recently. Um, like, I don't know, whenever I like breathe deeply, I, it sort of catches in, in the, right-hand side of my back.\n[Doctor] Right, OK, OK. And how long has this been going on for now?\n[Patient] Just, just today really.\n[Doctor] Right, OK. Any other symptoms at the same time, uh, that you've had this pain?\n[Patient] Um, well I've had a , I've got a bit of slight fever, um, and, and, uh, well like, I coughed up a bit of blood on, on two occasions.\n[Doctor] \n[Doctor] Right, OK.\n[Patient] what that means.\n[Doctor] OK, all right. , well it might, it might all be connected then. Um, and um, yesterday, before this, all of this, were you completely fine?\n[Patient] Um, yeah, yeah, kind of, I , I, I can sort of feel my heart beating, but , other than that, no, sort of fine.\n[Doctor] \n[Doctor] OK. So you can feel your heart kind of, um, beating a little bit, bit faster, do you think than normal? Is that?\n[Patient] \n[Patient] , I don't know I can just sort of feel it, more , you know. Um, but I've, I've also, I've been feeling a bit, like a bit tired at work.\n[Doctor] OK. Sure.\n[Patient] Haven't really been, like exercising has been a bit difficult, because I've been feeling tired. Um, and, , yeah performing, , performing daily activities has, has been a bit harder than usual.\n[Doctor] \n[Doctor] . OK, all right. , and um, how long has that been for? The tiredness and, you know, , not wanting to exercise and.\n[Patient] Um, , only after, only for a couple of weeks or so.\n[Doctor] Couple of weeks, OK. And then, and the last day or so that's when you get the cough and the pain in the side? And you've cough blood, OK, all right. Um, you said you felt a bit warm. , have you measured your temperature at all?\n[Patient] Yep.\n[Patient] Um, with the back of my, my hand, yes.\n[Doctor] just with that, OK, fair enough, all right. Um, OK. And now, can I just ask? Um, do you smoke at all?\n[Patient] Uh, no.\n[Doctor] OK. What do you work as?\n[Patient] Um, I work in an office, just a, desk job.\n[Doctor] OK, all right. And, um, do you live alone?\n[Patient] Uh, yes.\n[Doctor] Yeah. In a flat or a house?\n[Patient] Flat.\n[Doctor] OK. Do you have any pets?\n[Patient] Cat.\n[Doctor] A cat, OK. Um, uh, uh, are you on, any medication at all? Regular medication?\n[Patient] \n[Patient] Uh, yeah, um, , Methotrexate, Methotrexate, that's.\n[Doctor] Methotrexate. OK. , what are you on that for?\n[Patient] Um, I've, I've got SLE.\n[Doctor] SLE, OK. Do you have any other , diagnoses? Any other illnesses at all?\n[Patient] No.\n[Doctor] Right, OK. Um, and do you have any allergies to any medication?\n[Patient] No.\n[Doctor] Any other allergies at all?\n[Patient] No.\n[Doctor] OK. So, um, you're on, you're taking Methotrexate at the moment. When was the last time you had Methotrexate?\n[Patient] Uh, this morning.\n[Doctor] Ohh, you had it this morning. OK, ohh right, all right.\n[Patient] \n[Doctor] OK. Um , um, couple of things I'd like to do in order to try and um, get an idea of how, unwell you are. OK. Um, the first thing I'd like to do, is to try and measure your pulse. So, what, the way we're gonna do this, is that, if you're, if I can get you to try and locate the pulse in your wrist. . Not everyone can do this, so don't worry if you can't. But if you, if you can tell me whether you can feel the regular pulse. It's just under the thumb. If you put two fingers up and down like that, you might be able to feel the pulse.\n[Patient] I've got it.\n[Doctor] You got it, OK. Are you sure?\n[Patient] Yep.\n[Doctor] All right. So what I'm going to do, is I'm going to tell you when to start counting, and when to stop counting OK. So I'll just get my stopwatch up.\n[Doctor] OK. So if you can, um, you've still got the pulse?\n[Patient] Yep.\n[Doctor] OK. So if you can start counting, now please.\n[Patient] One, two, three. Five, six, , eight, , ten, . \n[Doctor] If you can stop now, . That, I think that was about eleven or twelve. Um, so that would make your heart rate about, sixty six to seventy four, that's, that's OK, good. Fantastic. And the next thing I'd like you to try and do, OK. Um, it depends on the lighting, so it may not be possible. But the next thing I'd like you to try and do is just, to get you to squeeze the tip of your finger. And then let me see how quickly the redness come back. OK, so if you can see what I'm doing now. My finger's come, right behind the screen, I'm squeezing it, OK. , just watch me first, it's all right, just watch me first. Yeah, I'm, I'm squeezing it. And then you can see, that, it goes, pale and then it goes back to the normal red colour, OK. So if I can get you just to put your finger up to the, your camera. And then with the other hand, just try and squeeze it, and see.\n[Patient] You look like you've got very good circulation. \n[Doctor] OK, perfect, that's great. Thank you so much. The last thing I'd like to do, is I'd like , to , try and have a look down your throat. OK. Are, are you doing this consultation via, um, a phone or a , laptop?\n[Patient] Phone.\n[Doctor] A phone?\n[Patient] rested it on my laptop, so I think we're good to go.\n[Doctor] , sorry, say that again.\n[Patient] Got it rested the laptop but I can.\n[Doctor] OK, , OK. So if you, if you, um, position your device up above your head, put your head back, mouth open wide, and let me see if I can have a . That's, fantastic. And say ah.\n[Patient] Ah.\n[Doctor] Perfect. Thank you for that. Excellent.\n[Patient] Lovely.\n[Doctor] OK. Last thing, is if I can get you to feel inside your neck. Just on the sides here, OK, um, by your Adam's apple. Tell me whether you can feel any enlarged glands or not.\n[Patient] No, they feel pretty normal to me.\n[Doctor] . OK.\n[Patient] I think.\n[Doctor] All right. Um. Now, um, uh, . Sorry, I've forgotten your name.\n[Patient] Um, Doris.\n[Doctor] Doris, OK Doris. Um, so, so Doris, um, what, what I think we need to do, is um. This sounds like you might have a chest infection. OK. If you're coughing up blood, and you're feeling your heart racing. Um. Uh, I think, you need to be examined today, someone needs to listen to your chest. And, um, maybe check your blood pressure as well, check that, you're stable. I have to say examining you now, from what limited, examination I could do online.\n[Patient] \n[Doctor] You're, everything does seem to be OK, in terms of, you, you don't seem acutely unstable. However, if you've got, this kind of pain, um, when taking a deep breath in and you're coughing up blood. We do, do, we do need to assess you to figure out whether you have a Pneumonia or chest infection. And um, that would involve someone listening to your chest with a stethoscope, and you may need um, an antibiotic. Uh, there's one thing I need to ask you. Have you been, on any long-haul flight recently?\n[Patient] \n[Patient] No, no.\n[Doctor] No, OK. Have you ever had any clots in your legs, or clots in your lung? Blood clots?\n[Patient] Not that I know of, no.\n[Doctor] No, OK. Anyone in the family have that?\n[Patient] No.\n[Doctor] No, OK. All right. Um, what I think we'll do is um, we'll arrange for you to get reviewed in a clinic today. OK. Um, I would like someone to listen to your chest, and check your blood pressure. And to, to recheck your pulse as well. Just make sure, and check your temperature, make sure all those parameters are OK. You may well need an antibiotic, OK. Um, do you have any allergies to any antibiotics?\n[Patient] No.\n[Doctor] No, OK. Um, I, I'm not, I'm gonna, not, I'm not going to prescribe anything for you now, because I think you need to have that, basic assessment first. Um, before we proceed to the next step. But the, that's what I would predict the next step might be. Um, I'm going to leave the number in the notes for this appointment, for you to ring our support team. And then, they will, book you in for a face-to-face appointment with one of our GPs today. And then, they'll do that assessment, and then we'll take it from there, OK.\n[Patient] OK.\n[Patient] But we don't think I'm dying of lung cancer.\n[Doctor] Um, uh, given the, the way in which you uh, have presented now. Just one day, with a fever and, this slight pain, , concurrent with the, the blood in the, the, the flem. That's not usually how lung cancer is presented. It's more insidious, over a longer period of time, with other symptoms. Um, however, we might need to get some investigations to exclude that. It depends on the examination finding, when we see you.\n[Patient] OK.\n[Doctor] All right. , are you worried about lung cancer?\n[Patient] Well you know, you start coughing up blood and you think you're, gonna, die of lung cancer, so.\n[Doctor] . Sure, of course yeah. So, just remind me how old you are again. I'm sorry.\n[Patient] Forty five.\n[Doctor] Forty five, OK. It's something we do need to be cognisant of, OK. Um, and, we may end up having to do a follow-up chest X-ray, if things don't settle down. But at the moment, it, it seems more like a chest infection, rather than a lung cancer.\n[Patient] That's good to know.\n[Doctor] Yeah, that, that is good to know, yeah, so that's, 'cause that's easier to treat. But we still need to make sure that things are OK because, chest infections can become nasty as well. It can lead to infection inside the body, , we want to avoid that as well. So, let's get you checked out today, and hopefully we can put your mind to rest, and get you on the right course of treatment.\n[Patient] Yep.\n[Patient] Perfect. Thank you very much.\n[Doctor] All right, you're welcome. All right, take care then. All the best.\n[Patient] \n[Doctor] Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I feel breathless. 1 day hx of SOB, slight pleuritic pain (right side), feeling warm (not measured temperature), 2 episodes haemoptysis and palpitations. No recent long haul flights No FH or PMHx of DVT/Pes Has been feeling TATT/ fatigue for the last few weeks preceding these symptoms Pmhx: SLE No allergies SH lives alone, has cat, works in an office Ex: pulse around 66, normal CRT, throat inspection normal, pt cant feel any LNs in neck, not SOB, looks well\n\nMEDICATIONS: on methotrexate\n\nASSESSMENT:\nprobable LRTI, possibly secondary to immunosuppression\n\nPLAN:\n1. needs F2f gp assessment today to listen to chest and check BP/pulse/ temp May also need blood tests to check immune status in view of methotrexate."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hi, good morning!\n[Patient] Hello there!\n[Doctor] Hi there, this is uh this is Doctor Dean from .\n[Patient] Hello there? Um, I'm wondering if you can help me today.\n[Doctor] \n[Doctor] OK, sure, I'll try. Before we start, could I please confirm your full name and date of birth?\n[Patient] Yes, it's Sarah Smith, and it's the second of November, um, nineteen ninety two.\n[Doctor] That's great! Thank you, sir. So are you in a private place where you are OK to speak at the moment?\n[Patient] I am indeed, yes.\n[Doctor] OK, so tell me what's been going on.\n[Patient] OK. I, I've really not been feeling so well at all recently. I, I've been struggling with fever for the past week. Yeah, I would say it's about seven days ago. I'm just, I'm really hot and sweaty all the time, and just generally not feeling good.\n[Doctor] OK, alright, sorry to hear that. Now, um, uh, along with this fever and this any other symptoms at all?\n[Patient] Um, I'd say that I'm aching all over really, my muscles are really aching. I'm feeling quite nauseous, uh, so I've not been able to eat very much, and I have been drinking but it's been quite a small amount. Um, and, yeah, just generally quite tired and unwell. I'm sweating during the the the night, I'm quite cold.\n[Doctor] \n[Doctor] OK, all right. Um, and um, so you're having periods of when you're feeling hot, and also periods when you're feeling cold as well.\n[Patient] Yes, yes, quite interchangeable, not really a pattern to it.\n[Doctor] OK, uh, and have you been taking your medication?\n[Patient] Uh, I've been trying to, like, take ibuprofen and paracetamol just to from over the counter, but it's not really helping, just been taking the recommended dose every day of those.\n[Doctor] Sure, and when you say it's not helping, is it bringing the temperature down at all?\n[Patient] Perhaps slightly, yes, but I'm still experiencing these symptoms, so, it does take the edge off a bit.\n[Doctor] OK, alright. And can I just double check have you gotten any cough or cold or sore throat or anything like that?\n[Patient] Mmm, not those sort of symptoms, really. Um\n[Doctor] But which are you getting, other than the ones you've already mentioned to me?\n[Patient] Um, so, I have a habit that it's mainly just the sweating, really, and the and the nausea, uh, that's overtaking all all day and, uh, the aching muscles all over.\n[Doctor] Sure. Have you have you had any ear pain ?\n[Patient] Mmm, no, my ears are fine, actually. I haven't had any problems with my ears.\n[Doctor] OK, um, just, I just need to check for any other causes of infection in the body. So I'm gonna go through some, um, kind of systemic questions. Have you had any diarrhoea?\n[Patient] And not, not really no, not that I can find.\n[Doctor] OK. Have you got any neck stiffness at all?\n[Patient] Um, no. My neck's, my neck's been fine.\n[Doctor] OK.\n[Doctor] Alright. Um, do you have any headache?\n[Patient] Not more than usual, no. Just like the, general headaches but not, just from staring at the screen. No migraines, or anything.\n[Doctor] OK.\n[Doctor] OK, so, you know your normal headache, where is that, in the back of your head or the front of the head?\n[Patient] Uum, it's quite centralized over, over the head.\n[Doctor] OK. and how long have you been having that for?\n[Patient] \n[Patient] It's something that I've struggled with through, years really, just related to a screen use, or, uum, like changes in weather patterns. Yeah, high pressure days, sometimes I struggle with migraines, and headaches.\n[Doctor] \n[Doctor] OK. Um, have you got any rash on your body anywhere at all?\n[Patient] Uh, I haven't noticed any rashes, no.\n[Doctor] Uh, any joints swollen or tender or sore?\n[Patient] Mmm, not really. I mean, I, I often have problems with back pain but not really any other joints.\n[Doctor] OK, alright.\n[Patient] Any problems?\n[Doctor] Alright, and, um, have you got any kind of symptoms down below when you're passing urine?\n[Patient] Uh, no, there's been no problems there.\n[Doctor] OK. Any painful urination at all?\n[Patient] Uh, not at all, no.\n[Doctor] Are you passing urine more often than normal?\n[Patient] Uh, I don't think so, no it's been fairly regular.\n[Doctor] OK. Have you been abroad anywhere recently?\n[Patient] Yes, I have actually.\n[Doctor] Where have you been?\n[Patient] I went to Vietnam. Uh, I came back four weeks ago now.\n[Doctor] OK. Uh, and, um, uh, did you take malaria preventative medication when you went out there?\n[Patient] I did, yes.\n[Doctor] Which one did you take?\n[Patient] Ooo, I can't remember now, off the top of my head.\n[Doctor] Was it a weekly tablet or a daily tablet?\n[Patient] I think it was daily.\n[Doctor] OK, um, and was it one tablet or was it another one that you would take on top of the first one?\n[Patient] I think it was, uh another one that I took on top of the first one.\n[Doctor] OK. And, and what were you doing out in Vietnam? Was it just seeing the cities or going through villages or hiking? What what kind of activities were you doing?\n[Patient] It was quite really, 'cause we were there for a few weeks, and we toured to, uh, several different parts of the country, and uh, the countryside and some cities as well.\n[Doctor] OK. Uh, and um, did you do any kind of, were you in rivers or things like that? Were you, you know, how adventurous were you?\n[Patient] I'm sorry, could you repeat that? I missed that.\n[Doctor] Where you going out into the rivers? Were you going on beaches? I mean how adventurous was your trip?\n[Patient] Yes, it was quite adventurous. We were sort of trekking and, um, cycling, uh, through the farmland and, um, seeing how people lived in a day-to-day life in, in, in farmland.\n[Doctor] Right, OK. Um, thank you for sharing that with me. Now, do you have, um, any other illnesses at all, in the past?\n[Patient] Mmm, as I said I've, I've been struggling with back pain for quite a while, but I haven't really had any, uh, major illnesses in the past, I can think of.\n[Doctor] And that back pain have you, um, have you seen anyone about that?\n[Patient] Yes, yeah, I'm under a physiotherapist at the moment for that.\n[Doctor] Have they, have they give you any kind of diagnosis at all?\n[Patient] Um, they've said that it's, u,h related to long periods of time sitting at a desk, and just, uh, bad posture. So mainly the exercises are focused on improving posture and, and to strengthen the muscles in the back.\n[Doctor] Alright um, are there any illnesses in your family at all?\n[Patient] Hmm, the main one would be, um, heart attack. My, my father passed away of that.\n[Doctor] I'm sorry to hear that. Um, how old was he when that happened?\n[Patient] in his sixties.\n[Patient] Um, sixty eight, I think. Yeah.\n[Doctor] OK. Um, are you on any medication at all?\n[Patient] Uh, just Seroxat.\n[Doctor] OK. Uh, do you have any allergies at all? medication?\n[Patient] No, I've just really pollen allergy. That's all I have.\n[Doctor] OK, so hay fever.\n[Patient] Yes, yeah, just hay fever.\n[Doctor] Alright. Um, are you, um, you're working at the moment?\n[Patient] Uh, I am, yes.\n[Doctor] What do you work at?\n[Patient] I work as a nurse.\n[Doctor] OK, all right. Um, and, um, you're up to date with all the vaccinations, Hepatitis B, and that kind of thing?\n[Patient] Yes, indeed. Yeah.\n[Doctor] OK.\n[Patient] But I'm, I'm really struggling quite a lot at work at the moment. It's been quite difficult, feeling so, uh, tired all the time.\n[Doctor] So, I can .\n[Doctor] Sure, OK. Um, and, are you a, uh, are you a smoker at all?\n[Patient] No, I'm not.\n[Doctor] OK, and ohh do you drink much alcohol?\n[Patient] Mmm, moderate alcohol intake. Yeah, I don't drink too much.\n[Doctor] OK, and how much kind of physical exercise do you do normally?\n[Patient] I try and do, uh, some moderate physical exercise a few times a week.\n[Doctor] OK, that's good, alright, um, so, um What, uh, I think we're gonna need to do is we're gonna need to bring you into one of our clinics. Examine , and we're gonna need to arrange some blood tests as well.\n[Patient] OK.\n[Doctor] OK, um, so, what what I want to do is, the first question I have in my mind is that we need to find a reason for why you've got this fever and these symptoms, because there's no apparent reason from what you've told me.\n[Patient] OK.\n[Doctor] There's no, uh, when someone has got fever and sweats, we want to find out have they got chest infection, have they got a throat infection? Um, and if we can't find a focus of infection, then that's something, that, that's an outstanding question that needs to be answered, OK? Um, the second thing, second factor, is that you've recently come from, uh, Vietnam.\n[Patient] OK.\n[Doctor] And you've had exposure to rural areas. And we need to think about things like malaria or other exotic infections as well. So, um, you're probably gonna need some blood tests. After you've been seen by somebody. Um, now, the urgency of those blood tests depends partly on what we find when we examine you, which is why we're going to go, go for the examination first. You come into one of our clinics in central London, that's one option, and then the the GP there who examines you can then decide on how urgent the blood tests and things are going to be.\n[Patient] OK.\n[Doctor] Or, if it's inconvenient for you to come into central London because you you're living further out, you could actually just attend a local A and E. I'm going to type up what my thought process is and what kind of test I think you need in the notes for this appointment, so you could show that to them at reception. Um, I'll be asking for something called thick and thin blood films, to check for malaria. And inflammatory markers and things like those, technical terms, but they'll understand what that, what I'm talking about. But, um, I, I don't think you can go into work, uh, until we've sorted this out. And we, we, we need to sort this out sooner rather than later.\n[Patient] OK. That sounds great. Thank you so much for your help. I, I think, yeah, I can come straight into central London today to get that sorted.\n[Doctor] OK.\n[Doctor] OK, fine, so what I'm going to do is I will send a message to one of our admin team members asking them to book you in. And if you can ring the number that I leave in your consultation notes, after a few minutes, and then they'll slot you in, and then we can sort things out from there. OK?\n[Patient] That's brilliant. Thank you very much.\n[Doctor] Alright then, OK. Take care then. All the best.\n[Patient] Goodbye.\n[Doctor] Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I've been feeling very hot and sweaty for the past week. Hx of fever for a week with associated sweatiness, body/muscle aches, nausea, fatigue, night sweats, hot/cold episodes Drinking less cf normal Taking ibuprofen and paracetamol otc- not helping, helps with temp slightly No cough, sore throat, runny nose, ear pain. No diarrhea, no neck stiffness, no headache (no more than usual- normal headache on top of head through looking at screen). No rash, no joint swelling (ongoing back pain), no dysuria or frequency. Recent foreign travel- returned from Vietnam, took malaria prevention daily- cant remember medication, present there for a few weeks, rural and urban tourism, trekking and cycling. Pmhx: nil of note, back pain- under physiotherapy, working diagnosis ? muscular/ posture Nil allergies, hayfever\n\nMEDICATIONS: on cerazette\n\nSOCIAL HISTORY: works as a nurse, UTD with hep B etc, non smoker, moderate alcohol intake, moderate physical exercise. Family history: father has MI at age 68\n\nASSESSMENT:\nPUO, need to exclude malaria\n\nPLAN:\n1. for f2f appointment with GP today Thereafter, for blood tests including crp, esr, thick and thin blood films (possibly routine, possibly via a/e- depending on second GP's assessment)."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello. Good afternoon.\n[Patient] Hiya.\n[Doctor] Hi there. This is Doctor , from GP at Hand.\n[Patient] Hi there. My name's Atan.\n[Doctor] Hi Anthony. So, could I have your um, before we start, could I have your full name and date of birth? If that's possible?\n[Patient] Sure. So, it's Ayrton Warren. Um, and my date of birth, is the sixteenth of May, nineteen, eighty two.\n[Doctor] That's , thank you for that. Are you in a private place where you're OK to speak?\n[Patient] I am, yes.\n[Doctor] OK, great. So how can I help you today?\n[Patient] Um, so I kind of woke up this morning, um, and I've just got this, really horrible pain on the left side of my head. Um, a real kind of headachy feeling.\n[Doctor] Sure, OK. And, um, uh, , did the, did the pain wake you up?\n[Patient] Yeah, it woke me up, um, quite early this morning.\n[Doctor] What, what time did it wake you up?\n[Patient] Um, probably around, five thirty ish.\n[Doctor] And, what time do you normally get up?\n[Patient] Um, I normally get up at about, seven o'clock.\n[Doctor] Is the headache still present now?\n[Patient] Yes, it is.\n[Doctor] OK. Have you had this kind of pain before?\n[Patient] Um, I mean uh, I've, had a bit of a history with headaches, but nothing as severe as this before.\n[Doctor] So they were less severe. Were they similar in nature in terms of being one-sided and the type of pain?\n[Patient] Um, not so much on the one side, it tends to be, a bit of a cluster at the front of my head in a way. Um, but this time it's just kind of more prominent on the left side which, I've never really had it, normally they kind of spread across the front of my head.\n[Doctor] OK, all right. And, um, can I just double-check, do you have any neck stiffness at all?\n[Patient] Uh, no.\n[Doctor] OK. And do you have any fever?\n[Patient] No.\n[Doctor] All right. Um, how are you with bright lights at the moment? Do you feel sensitive to bright lights or can you, can you tolerate them all right, OK?\n[Patient] Um, it, I'm a little bit sensitive it just, it kind of, makes my eyes a little bit sore, but nothing that I can't really handle.\n[Doctor] OK. And, can I just double-check, um, are you feeling nauseous at all?\n[Patient] Um, not really, like . When I first got up this morning, my head felt a bit dizzy, but that's kind of subsided now, and I, seems to, be fine.\n[Doctor] OK. Um, and um, can I just double-check, does anyone in your family have any migraines or anything like that? They've been diagnosed with migraines?\n[Patient] Uh, no. They haven't.\n[Doctor] OK. Um, and um, are you under any particular stress at the moment?\n[Patient] Um, work's kind of, um, a bit stressful at the moment. I've got a lot going on. Um, yeah, I just seem to have like, a lot of, kind of, a backlog of work that I need to go through at the moment. So, I've kind of, been, doing a lot of late nights as well.\n[Doctor] Right, OK. Um, and, um, how long has that been the case for?\n[Patient] Uh, for probably about a couple of months now.\n[Doctor] , how would you say your mood is?\n[Patient] Um, I'm not, like moody, I'm not angry or, um, like I get a bit frustrated during the day. Um, but , it kind of, um, ebbs and flows every now and then, but, yeah.\n[Doctor] OK. Do you have, have you ever been diagnosed with anxiety, or depression or stress in the past?\n[Patient] Um, I've had, um, so I had, like anxiety for about, two years now, and I've been on, uh, Sertraline for, a while.\n[Doctor] OK. Are you taking Sertraline at the moment?\n[Patient] Yes.\n[Doctor] OK. Um, and how do you feel in terms of , anxiety at the moment? Do you feel anxious at the moment?\n[Patient] , no, not necessarily at work, sometimes I do feel a bit anxious. Um, but I, I kind of just, uh, the panic of not being able to get my work done on time.\n[Doctor] \n[Patient] Um, but other than that, I, I don't, feel, um, massively anxious.\n[Doctor] OK, all right. Um, now, sorry to ask this, just need to ask this for , anyone suffering from anxiety. Do you have any , have you had any thoughts about harming yourself or hurting yourself?\n[Patient] No.\n[Doctor] Good, I'm glad to hear that. Um, now, with regards to this headache. Is it worse when you lie down, or um, is, is, is it better when you lie down?\n[Patient] Um, when I lay down, like, uh, it kind of feels a little bit sore at first, um and it takes me a while to get comfortable. Um, so yeah, at the beginning it does, but then again that's just kind of, um, soothes a little bit.\n[Doctor] OK. Um, so, would you say ultimately, it's better when you lie down? Or have you not ?\n[Patient] Uh, yeah, I would say so.\n[Doctor] OK. Um, and um, in terms of um, this, headache since this morning, have you taken anything for it yet?\n[Patient] Um, I've taken some Paracetamol.\n[Doctor] Has that helped?\n[Patient] Um, not really, no.\n[Doctor] OK. Taking anything else at all?\n[Patient] No that's it, just Paracetamol.\n[Doctor] OK. Um, do you have any other illnesses at all?\n[Patient] Uh, none.\n[Doctor] Have you ever been diagnosed with high blood pressure?\n[Patient] No.\n[Doctor] Have you ever had your blood pressure checked?\n[Patient] No.\n[Doctor] OK. Um, and are there any illnesses in your family?\n[Patient] Um, no, there's nothing. My parents, uh, my mum's had a history of anxiety as well but, no kind of like physical illnesses or anything like that.\n[Doctor] OK, all right. And um, are you on any medication?\n[Patient] Um, no, other, other than Sertraline and having taken, um, Paracetamol this morning, uh, nothing else.\n[Doctor] Do you have any allergies to any medication?\n[Patient] Not that I'm aware of, no.\n[Doctor] All right. And, are you living by yourself at the moment, or living with someone else?\n[Patient] Um, I live with my partner.\n[Doctor] OK. Are you a smoker?\n[Patient] No.\n[Doctor] OK. And, uh, do you have any pets at home?\n[Patient] Uh, I have a cat.\n[Doctor] OK. And, can I just double-check, how much exercise would you do normally a week?\n[Patient] Um, so normally I, try to go running at least three times a week.\n[Doctor] OK. And what's your diet like?\n[Patient] Um, it's OK, um, it's nothing, it's nothing um, really healthy, um, but it's fine.\n[Doctor] OK.\n[Patient] I wouldn't say unhealthy.\n[Doctor] All right. Um, now um, in terms of this headache, uh, obviously I haven't been able to examine you, or see you directly. But, um, it sounds like it might be one of two things. It could be an element of what we call tension headache.\n[Patient] Sure.\n[Doctor] OK. That's one possibility. Um, and what makes that, more likely is the fact that, you've been under some pressure, and you have a history of anxiety in the past, OK. Um.\n[Patient] OK.\n[Doctor] The other possibility is, um, migraine as well. OK. Um, and, the fact, what makes that more likely is the fact that it's on one side, and that you've got some sensitivity to light.\n[Patient] OK.\n[Doctor] OK, So, what, what I think we can do, is um, I think we can give you some, um, generic, pain relief.\n[Patient] OK.\n[Doctor] That would be the appropriate first step, for, migraine type headaches. OK. So I'll tell you what it is in a second.\n[Patient] OK.\n[Doctor] And the other thing that I was gonna suggest is, we maybe look, explore things to try and decrease the stress from work. So, um, the medication-wise, the things that we'd start off first line, if someone had migraine was to, would be to start Ibuprofen.\n[Patient] OK.\n[Doctor] And um, uh, that, the doses of Ibuprofen can be a bit, more than the normal doses Ibuprofen so that's one thing we can start. You can keep on taking Paracetamol as well if you like, but the, the Ibuprofen's um, actually more effective , for migraine.\n[Patient] OK.\n[Doctor] And, um, yeah, so the, the guidelines have changed, recently we used, we, before that we used to give Paracetamol as first line but now it's, um, Ibuprofen or Aspirin.\n[Patient] Ohh right, O.\n[Doctor] That's, thing. Um, the other thing I'd like you to do, is maybe consider taking some time off work. OK, because if the headache is due to stress from work.\n[Patient] OK.\n[Patient] OK.\n[Doctor] Um, maybe having a week off if you self-certify, that might help with things. And I'd also like you to explore, counselling options as well so there's, a counselling service in your area, that I can give you the link for, for you to self-refer.\n[Patient] \n[Doctor] I'd like you to, , OK I'd like you to try that. Um, what, we're gonna do is, we'll have a follow-up in a week's time.\n[Patient] Yeah, that'd be.\n[Doctor] As well as those two things, other things I'd like you to do, is to try and ensure that you're having a minimum of seven, eight hours sleep at night, every night. And you're drinking a minimum of, um, one point five to two litres uh, of water or fluids a day, and that's not including coffee or tea.\n[Patient] OK.\n[Patient] OK.\n[Doctor] All right, because sometimes dehydration and you know uh, fatigue can be causes of headaches as well. Um.\n[Patient] Ohh OK, I didn't realise that.\n[Doctor] Yeah, so it, that, that, that is um, you know, we need to rule those things out. Um, let's, let's try that. OK. Um, and let's have a follow-up appointment, if we're finding that things are not getting better, we might need to arrange some blood tests or um, look at uh, other possibilities, but, we'll try that in the first instance. Um, if anything changes in the meantime, or you get worried or things get worse. Feel free, have a lower threshold for ringing us back and we can book you an appointment, and we can reassess the situation.\n[Patient] OK. Yeah, the, that, that sounds brilliant. Thank you so much for your help.\n[Doctor] OK, no problem. So there'll be a summary of all of this in the notes. Um, and I'll also leave a link, to some of the danger signs of symptoms of headaches, in the notes. If you can read through that in your own time, that will just help you to have a bit more, control over what's going on and understanding of what, what, what kind of things, should trigger you contacting another doctor.\n[Patient] OK. That's perfect. Thank you so much for your help.\n[Doctor] No problem, OK. So we'll, we'll touch base in a week's time, with me or, myself or one of the other doctors, and we , we'll take it from there, OK.\n[Patient] OK. Thank you. Yeah, I'll book an appointment, in, um, yeah, in that time.\n[Doctor] Brilliant, OK then, all right. Take care then, all the best.\n[Patient] Bye. Thank you, and you.\n[Doctor] Bye bye.\n[Patient] Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I've got a really bad headache. Hx: Has had headache upon waking from this morning on left side head- pain woke pt up at 530am Headache still present now Has had hx of headaches less severe and in front of the head in past No neck stiffness, no fever Some sensitivity to bright lights now, no nausea now Felt dizzy this morning, but not now No FH of migraines Work is stressful, late nights at work- ongoing for a few months. Mood is stable- pmhx of anxiety for 2 years, on sertraline. Doesn't feel anxious right now- gets this at work at times No thoughts about self harm Headache is better when lying down. Pt has taken paracetamol- not helped Pmhx: nil, has not had BP checked Nkda Non smoker Hss cat Good exercise, reasonable diet\n\nMEDICATIONS: sertraline\n\nSOCIAL HISTORY: live with partner. Family history: mother has anxiety\n\nASSESSMENT:\ntension type headache +/- migraine\n\nPLAN:\n1. for ibuprofen first line as per SIGN 2018 migraine guidelines 1. 2. 5-2 litres water hydration daily To sleep 7-8 hours minimum daily Consider time off- to self certify for a few days to see if this helps Self referral to IAPTs Review in a week If any red flag symptoms as per www. 3. patient. 4. co. 5. uk/ headache, to ring back sooner Patient understands and is happy with plan."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hello?\n[Patient] Hi there!\n[Doctor] Hi, hi, I'm doctor Jacob and welcome to Babylon. Hello.\n[Patient] I, uh\n[Doctor] Hi. So just before we start, is it alright if you could confirm your full name for me please?\n[Patient] Uh, , that's, uh, John Jones.\n[Doctor] \n[Doctor] And your date of birth.\n[Patient] Uh, that's, uh, the, twenty ninth of September, nineteen eighty.\n[Doctor] K. And your email address for me please?\n[Patient] Uh, that's, uh, John Jones, at, John Jones dot net.\n[Doctor] OK. And just to confirm that you're in a secure location, and we can have a confidential conversation.\n[Patient] Yep. That's absolutely fine.\n[Doctor] OK. So, you've mentioned on our notes that you're having a bit of a cough and a cold. Is that correct?\n[Patient] Yeah, yeah, it's just it's been going on for, like a few days now. Um, sort of like, coughing, and like, general runny nose, and stuff, and, like \n[Doctor] is it two to three days, or longer?\n[Patient] Little bit, uh about like five days around that, uh, yeah it started like, what day is it today? Uh, yeah the week, it started with the start of the weekend, so.\n[Doctor] Fine.\n[Doctor] OK. So, so it started off with a cold, did it?\n[Patient] Yeah just like coughing, and like running nose, and like kind of muscles aching and stuff, like occasional feeling like headache, cold, chills, and things like that.\n[Doctor] \n[Doctor] OK. Important cold, yeah? And, so about your cough, are you bringing up any phlegm at all?\n[Patient] Yeah.\n[Patient] No, no, it's like a, it's like a dry cough Sort of like like, almost hacking, hacking kind of like .\n[Doctor] OK. You're not bringing up any blood, are you?\n[Patient] \n[Doctor] OK. Are you feeling short of breath at all?\n[Patient] No, no, no shortness , like yeah, I'm breathing fine.\n[Doctor] Yeah. So you're not wheezy or rattly noises in your chest.\n[Patient] No.\n[Doctor] OK. Um, right. So what have you taken so far?\n[Patient] Uh, so, uh, just like pain killers and such. I mean that I, I, um, in addition to like my normal medication and such. Um, but like\n[Doctor] Well you mentioned, uh, you've come to your normal medications but you've mentioned you've taken some painkillers like, would you tell me the names please?\n[Patient] I'll just like pass it along.\n[Doctor] Paracetamol, OK. Any Ibuprofen at all?\n[Patient] No\n[Doctor] No, OK. And also um you mentioned some regular medication. Unfortunately I don't have your medical, complete medical history. So if you could tell me what your medications are, and what you use them for?\n[Patient] Yeah, so I take, um, uh, what's it called, it's like metformin. I'm a diabetic, so. And, um, I also, like have, uh, lisinopril .\n[Doctor] Lisonopril, OK.\n[Patient] Yeah, but the like slight blood pressure.\n[Doctor] Yeah, OK. And, how long have you been a diabetic for?\n[Patient] Um, like a, a few years, maybe five or six years.\n[Doctor] Five six years, OK. OK. Do you monitor your blood sugars at home?\n[Patient] Yes.\n[Doctor] OK. And how have they been doing at the moment?\n[Patient] Uh, no issues nothing like out of the ordinary there.\n[Doctor] OK. So there's no problems with your blood pressure control at the moment, even though you're not, OK so that's fine. That's absolutely fine. And when was the last time you took your blood pressure?\n[Patient] Uh, I've been this morning.\n[Doctor] This morning. And what was it? What was the readings like?\n[Patient] I can't remember off the top of my head, but it was within the normal range.\n[Doctor] Cool, 'cause there's nothing alarming yeah? No more. OK. That's fine. OK. So that seems all right. OK. So, um, can I, hypothetically, look into your mouth here?\n[Patient] Sure.\n[Doctor] Yeah? Yeah, so, uh, looking into your mouth\n[Patient] \n[Doctor] Um, you know, there's just a bit mild redness at the back of your throat. Um, there's no enlarged tonsils. Can you feel any glands around your neck, at all? No. No.\n[Patient] No, I haven't had anything like that.\n[Doctor] OK. So, it looks like, it's just a viral infection. Um, because it's just a cold and a cough. There's nothing there. And generally if you have things like a chest infection, you would have a bit like a wheeze or shortness of breath. So, um, things that we would recommend is you can use the, you know, Night Nurse, Day Nurse. It's still OK with your medications, yeah. So I'm, I'm sure that you are a bit wary to use them. But it's still OK with your current medication. You can still use that. Might be able to make you feel a bit more better quickly.\n[Patient] OK.\n[Doctor] If there's any change, like you're feeling short of breath or be your symptoms are lasting more than three weeks or something Or you're becoming poorly, uh, things like that, then you need to get in touch with us, then probably we might need to examine you and especially your chest. But I don't think so, that's necessary at this point in time\n[Patient] OK, that sounds good.\n[Doctor] OK. Any questions at all ?\n[Patient] Uh, no, I I think that's been very helpful thank you.\n[Doctor] OK. So just to round up, just use the night, Night Nurse, Day Nurse, if any change in your symptoms, like shortness of breath, wheezy, or symptoms are lasting more than three weeks, then get in touch with us.\n[Patient] OK, so I don't need any prescription, or anything like that.\n[Doctor] No, no you don't need anything at the moment. OK. Take care, then. Bye. Bye bye.\n[Patient] OK. Thank you very much, bye!",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have a cough and a cold. History : Cough and cold for 5 days Cough is dry, no sputum , no blood No wheeze No breathlessness Used paracetamol Diabetic and high blood pressure since 5-6 years Sugar levels and BP normal today\n\nMEDICATIONS: Medication: metformin, lisinopril\n\nASSESSMENT:\nUpper respiratory tract infection\n\nPLAN:\n1. advised to use night and day nurse. 2. If there is breathlessness, wheezying or cough more than 3 weeks to call back."
},
{
"source": "primock57",
"dialogue": "[Patient] Hello.\n[Doctor] Hello, hi, I'm Doctor Jacob and welcome to Babylon. Hello.\n[Patient] Nice to meet you.\n[Doctor] Nice to meet you too. So just before we start, is it all right if you could confirm your name for me please?\n[Patient] Michael John .\n[Doctor] And your date of birth?\n[Patient] Oh nine two nine eighty-three.\n[Doctor] OK, and your address for me please.\n[Patient] Two three one, Leonard, London street uh, sorry, London.\n[Doctor] OK and that's correct, and just to confirm that you're in a secure location and we can have a confidential conversation.\n[Patient] Yes.\n[Doctor] OK, uh, you've mentioned on our notes that you're suffering from bad diarrhea. I'm sorry to hear about it. So if you tell me a bit more about it, please.\n[Patient] Uh, it's been happening for about, three days now? Um, yeah it, started off uh, was, I don't know it's just something that I thought would go away pretty quickly.\n[Doctor] OK.\n[Doctor] \n[Patient] I've had that from time to time after eating certain types of food or going on certain travels, but, uh nothing funky in my diet and no travels recently, um and it just kinda kept up. I'm a bit confused as to what to do .\n[Doctor] Mmm.\n[Doctor] Mm-hmm.\n[Doctor] So you haven't had anything from outside? Nothing dodgy anything ? No.\n[Patient] No, no no no, just a little bit, yeah I I don't know I mean it's pretty standard diarrhoea, where it's was like a little bit of abdominal pain. I threw up once, that was a little worrying, uh.\n[Doctor] \n[Doctor] Mm-hmm.\n[Doctor] Repeat that please, that wasn't clear. What did you say?\n[Patient] I threw up once, yeah.\n[Doctor] After that we'd said something.\n[Patient] Uh, nothing else was worrisome.\n[Doctor] OK, right, and with the diarrhea, how many times a day are you going to the toilet?\n[Patient] Uh, four to five.\n[Doctor] Four to five times, yeah. And is there any? And it's like water? Is it like water or is it just loose?\n[Patient] Uh, what do you mean?\n[Doctor] Are you going like water? Or is it just, you know bit, bit of solid stools, bit loose kind of thing?\n[Patient] It probably depends on the time of day to be honest, .\n[Doctor] Sure OK. Bit of both and is there any blood or mucus?\n[Patient] No blood. What do you mean mucus?\n[Doctor] It's like the snotty stuff.\n[Patient] In the stool?\n[Doctor] Yeah, it looks like snot .\n[Patient] No.\n[Doctor] No, so no mucus, OK. Any fever at all?\n[Patient] Uh, maybe a little bit, but.\n[Doctor] Mm-hmm.\n[Patient] It hasn't been, that in particular hasn't been too worrying.\n[Doctor] Are you still able to eat, and drink?\n[Patient] Uh, a little bit of. Appetite loss I guess worse than normal, but also not something I've, like I, if that was alone I wouldn't have, reached out.\n[Doctor] OK.\n[Doctor] Sure. So but you're you're still able to drink quite a bit yeah? You're drinking plenty.\n[Patient] Yeah yeah yeah.\n[Doctor] OK. Excellent.\n[Patient] Mostly it's been dry and red.\n[Doctor] OK, and, um, what have you take, have you taken anything so far for the diarrhea?\n[Patient] Nothing yet.\n[Doctor] Nothing yet, OK. Anything for the abdominal pain?\n[Patient] Uh, nothing yet.\n[Doctor] OK. Right, and any unfortunately we don't have any of your past medical history, is there anything you'd like to say?\n[Patient] Uh, I.\n[Patient] Probably I I had asthma.\n[Doctor] Mm-hmm.\n[Patient] Um or, or I don't know I guess I still have it.\n[Doctor] OK and uh, are you, any, uh, anything else other than asthma?\n[Patient] Uh, my dad had hypertension.\n[Doctor] OK.\n[Patient] Has hypertension. Had hypertension. Yeah he died of bowel cancer ten years ago.\n[Doctor] Yeah .\n[Doctor] Ohh dear, OK. Bowel cancer. Ten years ago. And how old was he when he died?\n[Patient] Uh, sixty-two.\n[Doctor] K, and um, you mentioned you had asthma, are you using any inhalers at all?\n[Patient] Yes.\n[Doctor] Which ones?\n[Patient] Lexapro.\n[Doctor] Sorry?\n[Patient] Lexapro.\n[Doctor] Laxepro.\n[Patient] Yes.\n[Doctor] OK, not heard of it may. Is it like Salbutamol? Is it like a blue colour?\n[Patient] Yellow.\n[Doctor] Yellow, OK. I'll have to check that one, not sure. Laxepro.\n[Doctor] OK. Um, that's fine. Any other medication that you're using? Over the counter, anything at all? OK. Right. Any allergies?\n[Patient] No.\n[Patient] Nothing, yeah, nothing.\n[Doctor] No allergies at all, righty . Fine so, obviously, you know you just have diarrhea it's about four to five times a day. Um, you're still drinking plenty and you look like you're not dehydrated which is a good sign, OK? Um, when we start worrying about diarrhea is if you're going more than eight times a day. That means probably you are, you know, whatever you're eating is going straight through, OK? You still need to drink plenty of water because you're losing a lot of fluids.\n[Patient] Mmm.\n[Doctor] OK, when you go to the toilet. Um, things that one would advise is a soft diet. So avoid dairy, fish, meat, eggs, while you're having the diarrhea. Go, sorry?\n[Patient] Soft . What is a soft diet? What does that ? Like, outside of, not those things, what do you mean by soft?\n[Doctor] OK, so that will be like crackers, toast, jam, those kind of things that's easily digested. Like what we are good give babies yeah. When they start eating you give, simple food for babies. You don't give eggs or meat the first time they start feeding. So that's the kind of soft diet we're talking about, yeah? Once you are able to, you know keep most of it in, you can start off with some just boiled vegetables and mash. Once you're OK with that for about forty-eight hours then you can start having meat. So just don't have meat once you feel like you're slightly better, because you might go back to square one again, all right?\n[Patient] \n[Patient] What do you mean OK with that diet, like once?\n[Doctor] Forty-eight hours you're not having any diarrhea, you're fine then you can go and start having meat, egg, fish and all. So that .\n[Patient] OK, if if the diarrhoea is getting better but isn't getting, or do you want it to go away completely at that point, or if it's like trending upwards?\n[Doctor] No, no, no preferably just don't because, what why do we say this? It's because it takes much more time for meat to get digested. So because your gut flora, you know, the, the, the bacteria in your gut is not you know as it should be, it takes a bit more effort for one to digest these food. While it doesn't take that much of an effort to, you know digest mash and vegetables. Does that make sense?\n[Patient] Yes.\n[Doctor] Yeah? So, um, at the same time you could have some, although you can't milk is not a good idea, yoghurts are a good idea because they are probiotics, it help to build up the normal, um gut, gut bacteria back. OK.\n[Patient] OK.\n[Doctor] So those kinda, now, things to look out for, if your diarrhoea doesn't go away in a week's time, or if you're passing blood, we need a stool sample, because that means you you may have , um, some particular bugs that might need treatment with antibiotics.\n[Patient] OK.\n[Doctor] OK. If you're again, as I've mentioned previously if you're going about six to eight times a day, that means there's a high chance that, uh, you are, having dehydration and you might need to go into hospital at that point in time. If that happens you get in touch with us again, all right?\n[Patient] OK.\n[Doctor] Any questions? You look a bit confused.\n[Patient] No, that's it.\n[Doctor] Yeah? OK and also you could get something called Dioralyte over the counter. So, it helps to uh, replenish your, the salts that you've been, that's lost through going to the toilet.\n[Patient] OK.\n[Doctor] OK? If you're a bit confused you know you can actually, uh, all this is all recorded in your app. So you can go back. I'll put that all in detail so if, you know I know sometimes it's a bit difficult to process everything, you can go back and read, read the notes.\n[Patient] Perfect, that's great.\n[Doctor] Is that OK? All right then, you take care.\n[Patient] Bye.\n[Doctor] Bye now, bye bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I have really bad diarrhea. Diarrhoea for 3 days Also associated abdominal pain No mucous, no blood Vomiting once Still eating and drinking Diarrhea like water 4-5 times a day No fever Loss od appetite Did not eat out No foreign travel No dehydration on examination Medication ? Lapriso No allergies\n\nPAST MEDICAL HISTORY: asthma\n\nSOCIAL HISTORY: Family history: Dad died of bowel cancer 10 years, HTN\n\nASSESSMENT:\nGastroenteritis\n\nPLAN:\n1. advised soft diet , drink plenty. 2. Start with crackers, soups and mash. 3. Then can build on with mash and vegetable. 4. Can use yoghurts as probiotics and will help build the gut. 5. If the diarhoea goes on for more than a week or there is blood , we would need a stool sample. 6. If there is diarrhea more than 8 episodes, you may get dehydrated please book an appointment."
},
{
"source": "primock57",
"dialogue": "[Doctor] Good morning. I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address please?\n[Patient] Hi. My name is Susan. Um, thirty, Redbridge Street, SW two two HZ.\n[Doctor] Hello.\n[Doctor] And your date of birth?\n[Patient] forty, oh two, nineteen seventy four.\n[Doctor] OK. Are you in a private place so you can have a consultation today?\n[Patient] Yes I am.\n[Doctor] OK. What can I do for you?\n[Patient] It hurts when I pee.\n[Doctor] OK, and how long has that been going on for?\n[Patient] It stays now.\n[Doctor] Pardon?\n[Patient] Uh, six days.\n[Doctor] Six days, OK. And just tell me a bit more about that. How did it start?\n[Patient] Um, I've got this thing when I pee, and it hurts when I go to the loo, and I've got this very unpleasant smell that comes out.\n[Doctor] \n[Doctor] OK. And, have you had any other symptoms along with that? Have you had any abdominal pain, or back, lower back pain at all?\n[Patient] I've got, pain in my tummy.\n[Doctor] Uh, whereabouts?\n[Patient] In my lower tummy.\n[Doctor] OK. Is it one-sided, or in the middle?\n[Patient] In the middle.\n[Doctor] And how bad would you say that is on a scale of one to ten? With ten being the worst pain.\n[Patient] Seven. Seven.\n[Doctor] And is it, constant, or does it come and go?\n[Patient] Comes and goes.\n[Doctor] OK. And have you actually been able to pass water OK?\n[Patient] Yes, but I've had spotted, uh, blood in my urine. Spots.\n[Doctor] OK. And is that just over the last, six days?\n[Patient] Yes.\n[Doctor] Right. And have you been able to eat and drink OK?\n[Patient] Yes.\n[Doctor] Um, and, have you had a temperature? Do you feel like you've been feverish, or had a temperature with this?\n[Patient] No, not at all.\n[Doctor] Um, and any, did you , you said you didn't have any lower back pain?\n[Patient] No, I've got. Um, and no loin pain as well.\n[Doctor] OK. And, have you had these symptoms before?\n[Patient] No.\n[Doctor] Never.\n[Patient] No.\n[Doctor] And was there anything you were doing recently, which you think may have contributed to it? Have you , have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse or anything?\n[Patient] No.\n[Doctor] No, OK. And, any, any other symptoms, any vaginal discharge or, anything like that?\n[Patient] No, just the blood spot, in my.\n[Doctor] No. Do you have regular periods?\n[Patient] Yes I do.\n[Doctor] OK.\n[Doctor] Um, and , in the past, have you had any medical problems at all?\n[Patient] No medical, no.\n[Doctor] Have you had any problems with your kidneys, or any urine infections?\n[Patient] I had IBS before.\n[Doctor] OK. And how's that been recently? Any change in your bowel habit? Any blood when you pass stool?\n[Patient] Yeah, I've had spotting in my urine.\n[Doctor] In your, OK. Um, any change in your bowel habit? Any weight loss or anything?\n[Patient] No.\n[Patient] No.\n[Doctor] Any other medical problems, or surgery in the past?\n[Patient] No.\n[Doctor] Do you take regular medications?\n[Patient] I've had Mebeverine, Mebeverine. I've had Mebeverine.\n[Doctor] Pardon? No birth . Do you take that regularly?\n[Patient] Yes.\n[Doctor] OK. And it, do you take it three times a day?\n[Patient] Yes I do.\n[Doctor] Two hundred milligrams?\n[Patient] Yes.\n[Doctor] Any allergies?\n[Doctor] Any allergies?\n[Patient] Clindamycin.\n[Doctor] You're allergic to Clindamycin, OK. And anyone in your family had any medical problems?\n[Patient] No.\n[Doctor] That's fine. And whereabouts, do you live? Do you live with friends, family?\n[Patient] I live with friends.\n[Doctor] OK. And where do you work? What's your job?\n[Patient] I'm a support worker.\n[Doctor] OK. Do you drink alcohol at all?\n[Patient] Occasionally.\n[Doctor] So how much in a average week?\n[Patient] One glass of wine a week.\n[Doctor] OK. And do you smoke?\n[Patient] No.\n[Doctor] OK. Um, it sounds very much like you, might have an infection in your urine. Did you say, you haven't felt feverish?\n[Patient] No fever at all.\n[Doctor] Have you got a thermometer at home?\n[Patient] No.\n[Doctor] OK. It would be helpful if you could get a thermometer from the pharmacy and, do check your temperature, just to make sure that it isn't, going up and down.\n[Patient] OK.\n[Doctor] Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n[Patient] OK.\n[Doctor] Um, how do you feel about that? Are you happy to take a course of antibiotics?\n[Patient] Yes I would be.\n[Doctor] It would just be for three days.\n[Patient] OK.\n[Doctor] Um.\n[Patient] , get my prescription.\n[Doctor] Yes, so I can send a prescription through to your requested pharmacy for that. If you take them, as soon as you can, get them, pick them up as soon as you can, and start taking them. The other thing which is important to do is to drink, lots of water. So, two and a half to three litres a day.\n[Patient] \n[Doctor] Um, you can get some cranberry juice and take, drink that as well, that sometimes helps. And also some, sachets um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n[Patient] Yeah.\n[Patient] OK then.\n[Doctor] Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine. Then it's very important that we speak to you again.\n[Patient] OK.\n[Doctor] Um, the other thing is that if it becomes a, common, thing or a recurrent problem. Then we need to talk to you again about it.\n[Patient] So, do I have to call after I finish my course of antibiotics.\n[Doctor] No, not if you're better. If you're, if you feel like your symptoms get worse at any point, or they're not resolving with the treatment. Or you keep getting a similar, um, you keep getting a similar, problem, reccurently. Then it's important for us to talk, talk to you in more detail about that.\n[Patient] OK.\n[Patient] Yeah.\n[Patient] OK then.\n[Doctor] Um, have you got any other questions?\n[Patient] Uh, no. Uh, where will be the pharmacy I'll be picking up, my medication from?\n[Doctor] Um, so have you already requested a pharmacy through Babylon?\n[Patient] Yes I did.\n[Doctor] Can I just check that with you?\n[Patient] Knightsbridge, Practice.\n[Doctor] OK, that's fine. So the antibiotics, that I'm gonna prescribe, um, will go through to that, pharmacy.\n[Patient] How soon?\n[Doctor] And then , you'll be able to pick them up from there.\n[Patient] How soon is that gonna be, at the practice? In five minutes?\n[Doctor] Um, I would give it longer than that. Give it a, an hour or so.\n[Patient] All right then. Thank you, I'll pick that at lunchtime.\n[Doctor] OK. All right then. Take care. Bye.\n[Patient] Thank you. . Bye.\n[Doctor] Sorry, I .",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: It hurts when I pee. PC: Dysuria HPC: 6/7 hx dysuria, burning stinging sensation when PUs. No problem with actually passing urine. Strong odour. E&D normally. No new PV discharge. No back/loin pain. Not feverish but not checked temp.No obvious trigger, no hx dehydration/frequent SI. No PHx urine infections/similar sx. No recent change in BH/blood in stool.\n\nPAST MEDICAL HISTORY: IBS\n\nMEDICATIONS: Mebeverine 200mg TDS. NKDA.\n\nSOCIAL HISTORY: Lives with friends. Works as support worker. Non smoker. Drinks 1 unit/week.\n\nASSESSMENT:\nLikely UTI.\n\nPLAN:\n1. Nitrofurantoin 3/7 course. 2. Advised patient to contact us if fever/back pain/persistent symptoms or if recurrent episodes of similar symptoms occurs."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hi there. I'm Doctor Smith from Babylon.\n[Patient] Hi.\n[Doctor] Hi there. Can you just confirm your name, date of birth, and the first line of your address, first of all please?\n[Patient] Yeah. Uh, my name is Valerie Cole. My date of birth is the nineteenth of September, nineteen ninety three.\n[Doctor] My name's .\n[Patient] My address is, uh, sixty four, Cliveden Place, in, South Wimbledon.\n[Doctor] OK. Are you in a private place where you can have a confidential consultation today?\n[Patient] Yes I am, yeah.\n[Doctor] What can I do for you?\n[Patient] Um, I've been feeling really anxious over the past few months. Um, I just get really nervous every morning about leaving the house, and it's started to really worry me, and just add up, and build up on that anxiety. And I just didn't know, who to talk to or, so I wanted to check with my GP.\n[Doctor] OK. Do you mind just telling me a bit more about, when it started? Do you think there's something which changed in your life at that time?\n[Patient] Um, I guess so, I think um, I would say maybe about two months or so, I've been feeling like this, and that probably coincides with, me starting a new job, um. Which I , I would say it's quite , I mean every job is stressful, and when you first start, but it's been really stressful I think over the past two months, definitely.\n[Doctor] What's your job?\n[Patient] Um, so I work for a, a, a fashion retailer, in um, the head office team, and it's just a brand new sector. I've never worked in retail before, my boss is not very nice to me and I don't. But I also think that, it's just been, I just really dread, going there. I just hate, speaking to her, I hate like seeing everyone and, really worried about whether I'm doing well or not. And it's really impacting on like, on the rest of my life, like my sleep and stuff like that.\n[Doctor] OK. So, um, just day-to-day, tell me, from the start of your day, how it affects you. You said that you, you dread going to work. How, how does it affect you, in terms of like your sleep at night, and things like that?\n[Patient] Right.\n[Patient] Yeah, this is really so, I, I, I've, as I say like, I don't want to go to work in the morning, so I just find no way of, I can't get out of bed. But it's also because, when I leave I just, when I've left work, I just feel so stressed and so worried about everything I've done, I can't get to sleep for hours and hours and hours. So I.\n[Doctor] OK. So what time, what time do you go to bed at night-time?\n[Patient] About ten, eleven, probably.\n[Doctor] And what time do you get to sleep?\n[Patient] Not for ages, I'm, I'm lying awake all night\n[Doctor] OK. And, when you eventually get to sleep, do you wake up with your alarm in the morning, or does something else wake you up, before then?\n[Patient] Mmm.\n[Patient] So I find my, my heart kind of racing, and then I'm just like panicking that I'm gonna be late, and that that's gonna make work even more stressful. So I do have an alarm, but I find myself waking up before that, 'cause I'm just my heart is racing. And actually the other day, I was just like, I was lying in bed and I really thought my heart was racing so much, I thought I was gonna have a heart attack in the morning.\n[Doctor] OK. And, so how many hours sleep do you think you get a night?\n[Patient] , I just, I can't even tell because I feel like I'm, even when I'm in sleep it's such a shallow sleep, but maybe, three, four hours, I'm getting now.\n[Doctor] OK. And, what about your eating patterns, any change in how you're eating, or whether you, your appetite's changed?\n[Patient] Probably, not, significant changes maybe. No I wouldn't say that, I wouldn't say that I'm eating like, much differently. Ohh that, I probably have more chocolate than normal, just because I feel, so down.\n[Doctor] OK. You're eating regularly otherwise?\n[Patient] Yeah, .\n[Doctor] OK. And, you told me about the palpitations, just tell me a bit more about that.\n[Patient] Yeah, So um, it's, it's usually kind of like, when I realise in the morning that, either um, I feel like I'm gonna be late, because I've like overslept 'cause I'm so tired. Um, or I wake up in a panic thinking I am gonna be late so, it's just kind of like, just a constant like, rapid heart beating. It's just really, really stressful. I don't know if it's, stress or if, , or I did think it was like, a heart problem really actually.\n[Doctor] \n[Doctor] Does it feel like a regular fast beat, or an irregular, beat?\n[Patient] Irregular, I think.\n[Doctor] And how long do you think it lasts for when you get it?\n[Patient] Ohh it can be anything, I think couple of minutes, or the other day I was actually just, sort of lying there for like, holding my hand on my chest for like ten minutes.\n[Doctor] OK. Is that something that you've had before this, or is that a new thing?\n[Patient] Yeah, but I would say this is only in the past. Sort of like, couple of months as I say that I've been, experiencing this.\n[Doctor] OK. Any chest pain with that?\n[Patient] No, um, well yeah it's painful to , when the heart, when my heart is beating fast but, but, yeah.\n[Doctor] OK.\n[Doctor] And, in the daytime, how, how, you said you, you're not getting much sleep so, how's your energy level in the daytime?\n[Patient] It's just, really, really low, I mean I, I'm finding now that I'm just, I find no enjoyment at all. It's kind of day-to-day, and anything that I'm doing. It's not just my job it's, you know when I leave I'm just so tired that, anything that, previously was, really fun is just not, it's not enjoyable. And I'm like, yeah, on edge the whole time.\n[Doctor] OK. So what do you do in the evenings?\n[Patient] Well right now I'm, I'm working so late, and everything is really, really stressful. So I don't really get much time to myself but, when I do wanna go out, or, you know, see friends or just relax. It, it seems quite difficult to do that.\n[Doctor] OK, and , are you avoiding contact with friends, or do you still see them?\n[Patient] I avoid them insomuch that I, feel like I'm. Yeah, so I mean sometimes it just, I know that I'm not gonna have fun, because I don't want to, go out and, do things that I would normally have done.\n[Doctor] OK. What about, hobbies, or exercise, or anything else outside work? Do you do anything else outside work?\n[Patient] Yeah, as I say like everything that I had previously been doing has been, just difficult to continue with like, I did used to like to like go running, and. And to play tennis and stuff, but now it's just not, I'm just not enjoying it, I'm not, I'm not like, I'm not going out to do that quite so much.\n[Doctor] And have you, has it ever got so bad that you've actually had to miss work?\n[Patient] No, 'cause I think that would just add to the tension, but I do like pretty much every morning I think, ohh I should call in sick or like, just not go.\n[Doctor] OK.\n[Doctor] And, what's the worst that it's got? Have you ever, been, um, so overwhelmed that you couldn't, get in to the office, you couldn't, go into a situation? Have you ever had a panic attack?\n[Patient] , um.\n[Patient] No I wouldn't say so, I think, I've always managed to make it to work. But I, I wonder if it's building up. So this is why I wanted to call, I'm just worried it's building up to that, and I don't know what to do 'cause I have, feel it, felt it, get worse and worse over the past couple of months.\n[Doctor] OK. And apart from work, are there any other situations which evoke quite extreme anxiety, like being, in public places, social situations, public transport, anything like that?\n[Patient] Yeah I mean, I find public transport really stressful anyway, especially being on the tube it's, 'cause it's quite, getting warmer so it's just really airless. Um, but I think the majority of it, 'cause my life is just so focused around work right now, the majority of it is focused around work as well.\n[Doctor] OK. Before this did you have any similar times in your life when you felt like this?\n[Patient] Not really I, I'm, no, I would say. I mean everybody always has a bit of tension, a bit of anxiety but, I've never felt, anything this bad before.\n[Doctor] OK. And what about your mood day-to-day? I mean, I can see that you're quite distressed by like that. Do you ever get really down about this?\n[Patient] Yeah.\n[Patient] Um, I mean, yeah, yeah, 'cause I do, yeah. I'm pretty much, down like, I don't enjoy, being and not just my day at all 'cause. I'm just so worried about everything, um, and I find that even when I'm not, like even at the weekends and stuff it's just the, kind of like constant, feeling of just being a bit, down, a bit unhappy.\n[Doctor] When do you think you last felt yourself?\n[Patient] Um.\n[Patient] I don't know, that's a good question, I can't really, I can't really put a on that at all.\n[Doctor] . And has your mood ever been so low that you've felt like you just couldn't carry on with your job, or with your life, or with your normal, uh, things as they we're going on?\n[Patient] I wouldn't, no I wouldn't say that I've had, I haven't had any suicidal thoughts or any, thoughts that have been that extreme like, I haven't. You know I have, I have a good support system, like I do have good family and stuff. So I, I have, I don't have, uh worries about, actually wanting to, um, not go on. It's just that, I don't wanna go on like this.\n[Doctor] Yeah. OK. And where do you, who do you live with at home?\n[Patient] Sorry?\n[Doctor] Who do you live with at home?\n[Patient] Yeah, I live with my parents, just my parents.\n[Doctor] Um, and, how much alcohol do you have in an average week do you think?\n[Patient] Um, ooh I don't know, probably quite a lot on the Friday or Saturday, just because, that, that's kind of normal, um. Uh, maybe I, maybe I do have like a bit during the week. Like, my parents obviously are retired, so they just drink whenever they want, so, whenever they're having a glass of wine, they'll offer it to me and it's like. I guess I don't really keep track of it that much.\n[Doctor] OK. So, how much would you, would you guess?\n[Patient] Probably like, probably quite a lot on a Friday or Saturday, because it's usually going out, so maybe like. I probably go over my limit just on those days, anyway, and then like, maybe a glass of wine during the week .\n[Doctor] OK. Do you smoke or take any other drugs, or anything?\n[Patient] Um, I try not to smoke, but I do, occasionally, but I don't take drugs.\n[Doctor] OK. And have you done , anything yourself to help? Have you , have you talked to anyone, talked to any counsellors? Done any, online, looked online at all? Any ways to ?\n[Patient] I, well I talk to my mum, because she also suffers from, well she's , suffered from like depression in the past. I didn't think that it was, that I was suffering from, actual depression because it just seems to be, manifesting as, as total , as just stress the whole time.\n[Doctor] OK.\n[Patient] But um, I did talk to my mum about it but I haven't sought any, she recommended that I come to the GP, um, but I haven't sought any other.\n[Doctor] OK.\n[Doctor] And would you be happy to, have, some one-to-one therapy?\n[Patient] \n[Patient] Yeah I think, yeah I think so. I've never done that before, but yeah.\n[Doctor] OK. I mean what we would suggest in the first instance is to, to. So you can self-refer via the NHS, for what we call like, talking therapy which is a type of inter-behavioural, where they can really look at your situation. How you're reacting to, the, , why, what's provoking anxiety, and what you can do, to try and overcome that.\n[Patient] OK.\n[Patient] Yeah.\n[Doctor] Um, so I can send you the link for that. Um, in the meantimes it can be a bit of a wait. There are some online resources that are really helpful. Um, can put the details, on there and you can, get on with them straight away and try and work through them as well.\n[Patient] Uh-huh.\n[Doctor] Um, and if you're feeling like it's not helping at all, or your anxiety is getting worse, to the point where you can't cope with work, or you can't, just do your normal things day-to-day. Then, it's important for us to, for you to give us a call, back and just discuss that, further.\n[Patient] OK. .\n[Doctor] I mean some people, with anxiety they, do need to take medication to control that but that's, not something that we'd suggest in the first instance.\n[Patient] OK.\n[Doctor] And I'll put some more information on your notes about, helping with your, sleep patterns and things like that.\n[Patient] That's great, I look forward to reading it.\n[Doctor] Um, in terms of palpitations, it is most likely to be a, , associated with anxiety, but it's probably worth having couple of basic blood tests just to make sure that, there's not something triggering that off. And then arranging a GP follow-up a week after you've had the tests, so we can just go through the results with you.\n[Patient] \n[Patient] OK, OK. Yeah, .\n[Doctor] So if you call the support line you can arrange the, to have the blood test done.\n[Patient] OK, I'll call them up.\n[Doctor] OK?\n[Patient] Thank you so much.\n[Doctor] All right. Take care.\n[Patient] Have a good day. Bye.\n[Doctor] Sorry. .",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: I'm feeling very anxious. PC: Anxiety symptoms HPC: 2/12 hx feeling anxious all the time. Seems to have started when started new job. Different industry, pressures from boss. Dreads work every morning. Initial insomnia ++ 3hrs + EMW. Often has only 3-4 hrs sleep. Tired in the day. Low energy. Eating pattern normal but more chocolate. Anhedonia in work and outside. Previously enjoyed running, tennis, socialising. Now still sees friends but often avoids. Associated palpitations, only started with anxiety sx. Can feel irregular and chest discomfort. Rapid beat, lasts approx 2-10 mins. No panic attacks, not missed work. Other anxiety provoking things include public transport. Low mood most of the time but denies any suicidal ideation. FHx: Mum has had depression.\n\nPAST MEDICAL HISTORY: Nil Past Psych hx/significant anxiety.\n\nSOCIAL HISTORY: Lives with parents. Supportive. Drinks Fri/sat, not sure of amount but sometimes overdoes it. Smokes occ, no illicit drugs.\n\nASSESSMENT:\nWork related anxiety. Insomnia.\n\nPLAN:\n1. Advised self referral to NHS talking therapies. 2. In meantime advised to access online CBT: attached info. 3. If anxiety/mood symptoms worse or unable to cope with work to contact us for further discussion. 4. Advised blood test as initial investigation for palpitations. 5. Patient advised to book via support team."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hi there, I'm Doctor Smith from Babylon.\n[Patient] \n[Doctor] Hi. Can you just confirm your name, date of birth and your address, please?\n[Patient] Yes. Italy. And,\n[Doctor] I see, sounds a bit . Um. Are you in a private place so you can have a consultation today?\n[Patient] Sorry?\n[Doctor] Are you in a private place so you can have a consultation today?\n[Patient] Uh, yes.\n[Doctor] What can I do for you?\n[Patient] So, I have had a pain in my lower tummy the last two days. I feel kind of hot and sweaty.\n[Doctor] \n[Doctor] OK. And any pain like this in the past?\n[Patient] Uh, not yet, no.\n[Doctor] OK, can you just describe to me whereabouts it is?\n[Patient] Um, so, I don't, what, sorry?\n[Doctor] Can you describe to me whereabouts the pain is? Is it, is it.\n[Patient] So it's my lower tummy.\n[Doctor] Yeah. Is it in the middle or to one side?\n[Patient] Uh, not, um, with a needle.\n[Doctor] In the middle, OK. And any other symptoms along that, with that? Have you had any nausea or any vomiting?\n[Patient] Uh, no. I'm just a bit nausea but no vomiting.\n[Doctor] OK. Any change in your bowel habit recently, or any diarrhoea? Constipation?\n[Patient] Uh, I had been constipated in, like, in the last, um, last week, but now it's fine. And, yeah, like \n[Doctor] to the toilet?\n[Patient] Sorry?\n[Doctor] When did you last go to the toilet?\n[Patient] Uh, like two hours ago.\n[Doctor] And was it normal?\n[Patient] Yeah.\n[Doctor] Any blood in the stool?\n[Patient] Um, so there was some, like, slight, uh, blood in the urine, but, like, it was a little bit pink but.\n[Doctor] OK. And has this ever happened in the past before?\n[Patient] Um, no.\n[Doctor] Right. Any pain when you pass water?\n[Patient] Uh, no, that's fine.\n[Doctor] Are you having to go more often than normal?\n[Patient] Uh, yeah, a little bit, but I wasn't drinking a lot in these days.\n[Doctor] Are you more thirsty than normal?\n[Patient] Uh, yeah.\n[Doctor] And you said you felt hot and cold. Have you measured your temperature?\n[Patient] Uh, yes, I measured it but it's fine, like, around thirty seven.\n[Doctor] What was it? Thirty seven. Have you measured it at any other time when it's been raised?\n[Patient] Yeah.\n[Patient] Sorry?\n[Doctor] Have you measured it at any other time when it's been raised?\n[Patient] Um, no, no, I just measured, like, one hour ago.\n[Doctor] OK, that's fine. And, are you getting any pain higher up in your stomach? Any acid coming up into your throat or anything like that?\n[Patient] No, no, but like just a bit of nausea but not vomiting.\n[Doctor] OK. And any other discharge below?\n[Patient] Uh, no.\n[Doctor] OK. Um, and have you been abroad recently?\n[Patient] Um, no, no.\n[Doctor] No. And no similar problems to this before?\n[Patient] No.\n[Doctor] Have you had any other medical problems in the past?\n[Patient] Um, no, no, nothing sore. I mean, depends what, like, normal stuff like cold, flu.\n[Doctor] OK, nothing significant. Any allergies to medications?\n[Patient] \n[Patient] Uh, yes, amoxycillin.\n[Doctor] OK. Do you take any regular medications?\n[Patient] Uh, no.\n[Doctor] Any over the counter medications?\n[Patient] No. I have had the just, the, uh, internal uh, contraceptive implant, but like, for one year, now, no more.\n[Doctor] OK. Um, and do you have regular periods?\n[Patient] Uh, yeah.\n[Doctor] Any bleeding in between periods or after intercourse?\n[Patient] Um, no, no, no.\n[Doctor] OK.\n[Patient] Just like \n[Doctor] Right. Um, and you haven't felt shivery or sweaty? You said you had felt a bit sweaty.\n[Patient] Yeah. , yeah.\n[Doctor] OK. And any, any back pain or strong smell to the urine?\n[Patient] Uh, no back pain. No, I typically don't suffer from back pain, so, no.\n[Doctor] Right, OK. Anyone in your family had any medical problems before?\n[Patient] Uh, so, actually my mom had the breast cancer. Uh, but, again, not so important. I mean, just, like, the beginning it was , uh, cured in time.\n[Doctor] OK.\n[Doctor] OK. And who do you live with at home?\n[Patient] Um, sorry?\n[Doctor] Who do you live with at home?\n[Patient] Uh, with my parents.\n[Doctor] And, do you smoke or drink alcohol regularly?\n[Patient] Uh, yes.\n[Doctor] How much in a normal week?\n[Patient] Uh, so, I don't smoke. I drink, I . Four times per week.\n[Doctor] And how much?\n[Patient] Uh, yeah, a beer like, per time, let's say. .\n[Doctor] \n[Doctor] What per time?\n[Patient] Uh, let's say a beer.\n[Doctor] OK.\n[Patient] Four times a week on average, yeah.\n[Doctor] Right, OK. Um, so, it, it may be possible that you might be having an infection in the urine.\n[Patient] Uh-huh.\n[Doctor] If you feel like you're, you're going, you're having a little bit of difficulty when you're passing urine.\n[Patient] Yeah.\n[Doctor] Um, it might be worth taking a three day course of antibiotics. To clear that. Um, but, if the pain is getting worse, or you have a high temperature or back pain or develop any new symptoms, we feel like it's not getting better, then, um, we should speak to you again, because we might need to see you face-to-face for an examination.\n[Patient] Uh-huh.\n[Patient] Uh-huh, OK.\n[Doctor] Um, have you allocated a pharmacy with Babylon?\n[Patient] Uh, yes.\n[Doctor] OK. So, are you happy to take a course of antibiotics, if I send it through to the pharmacy?\n[Patient] Uh, yeah, that's fine. If it helps, yeah. OK.\n[Doctor] OK, so I can do that for you. Start taking them as soon as you get them, it's just twice a day for three days. Um, if your pain's getting worse,\n[Patient] OK.\n[Doctor] um, or you've got new symptoms, just contact us straightaway, or if you're getting a recurrence of the same problem again.\n[Patient] Uh-huh, OK. Sure. OK.\n[Doctor] OK? Alright then, have you got any other questions?\n[Patient] Uh, no, that's fine. Yeah. Thank you. Thank you. Bye.\n[Doctor] OK, thanks a lot. Bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: My tummy hurts. PC: Abdo pain HPC: 2/7 hx lower abdominal pain, central location. Has noticed some blood in the urine. Has check temp - 37. No back pain. Feels sweaty. More thirsty than normal, drinking well. No dysuria/freq. Constipated last week, now BO normally. No blood in stool. Last BO 2 hrs ago. No N&V, no dyspepsia. FMH: Mum had breast cancer, now in remission.\n\nMEDICATIONS: Nil. Allergic to amoxicillin.\n\nSOCIAL HISTORY: Lives with parents. Non smoker. No drugs. Drinks 1 beer x 4/week.\n\nASSESSMENT:\n? UTI.\n\nPLAN:\n1. Advised 3/7 course Abx. 2. Will pick up from pharmacy. 3. To start asap. 4. If develops temperature/persistent/worsening pain to call back or if recurrent similar sx."
},
{
"source": "primock57",
"dialogue": "[Patient] Hello?\n[Doctor] Hi there, it's Doctor Smith from Babylon.\n[Patient] Uh, hi, Doctor Smith.\n[Doctor] Hi there. Could you give me your full name, date of birth, and your, the first line of your address, please?\n[Patient] Um, I.\n[Doctor] \n[Patient] \n[Doctor] \n[Doctor] Your full name, date of birth, and your address, please? Yeah, OK.\n[Patient] Yeah, my name is Barbara . Um, and my date of birth, fourth October, nineteen eighty four.\n[Doctor] OK.\n[Patient] And address fifty Avenue.\n[Doctor] OK. Are you in a private place so you can have a confidential consultation today?\n[Patient] Yes, I am.\n[Doctor] What can I do for you?\n[Patient] Um, I've just been for the past couple of days. I've been having this serious diarrhoea and this really, Giving me trouble.\n[Doctor] OK. So when did it start?\n[Patient] It was three days ago. Now.\n[Doctor] OK. And when you say diarrhoea, what do you mean by that? Is it watery or just loose?\n[Patient] It's, it's, it's very loose but it started as being very watery.\n[Doctor] OK. And how many times are you going to the toilet?\n[Patient] I lost count, um. Today alone, I've been at least four time.\n[Doctor] OK. And any, any high temperatures? Are you feeling feverish?\n[Patient] Yes, I've been running a serious temperature. I'm literally boiling.\n[Doctor] Have you checked your temperature with a thermometer?\n[Patient] No, 'cause I've not got one but like, to the touch, I'm, like, literally roasting.\n[Doctor] OK. Um, and any nausea or vomiting?\n[Patient] Yes, I've been throwing up. I can't keep to, uh, I can't seem to be able to keep anything in me. Not even water, not even my tea, not even any liquid stuff. I've just been throwing up everything.\n[Doctor] OK. And when, when were you last sick?\n[Patient] Um, I was sick just after trying, uh, trying to have breakfast this morning, so maybe about two hours ago.\n[Doctor] OK. And have you been passing water OK?\n[Patient] Yeah, I've been, I've been, yeah, urinating OK. Is that what you mean, like?\n[Doctor] Yeah, yeah, urinating, yeah. Any, and what sort of color is the urine?\n[Patient] To be honest, I have a look so I really couldn't say.\n[Doctor] OK. OK. And when did you last pass urine, do you think?\n[Patient] Um.\n[Patient] an hour ago.\n[Doctor] OK. And any blood in the stool or in the urine that you've noticed?\n[Patient] No blood.\n[Doctor] OK. Any episodes like this before? How's your bowels normally?\n[Patient] Sorry, I didn't catch that.\n[Doctor] How is your bowels normally?\n[Patient] Ah, ah, my, my bowels is normally fine. I would normally go to the toilet every day. You know, in the morning, just once, yeah, and that's fine.\n[Doctor] OK. Any episodes of diarrhoea or constipation normally?\n[Patient] No.\n[Doctor] And is there anything you think might have triggered this off? Have you been abroad anywhere?\n[Patient] No, but then, um, my, um my brother, um, has actually been having similar symptoms, um, for the past, um, few days as well, and he does say like everyone in school's got this so, I, I don't know, that might, that might be something.\n[Doctor] So you've been in contact with him, have you?\n[Patient] Yes.\n[Doctor] OK. Um, and any other medical problems?\n[Patient] \n[Doctor] Have you had any other symptoms at the moment, like rash?\n[Patient] No, no rash, no, nothing that, um.\n[Doctor] No. OK. Um, any surgery before, or abdominal problems, or any other medical issues?\n[Patient] Well, apart from the fact that this one is giving me abdominal pains, no previous abdominal pains before. Obviously I get the odd, um, you know, menstrual cramps and all that but, you know, that's, you know, that comes and goes.\n[Doctor] Yeah.\n[Doctor] OK. And whereabouts is the pain that you're getting?\n[Patient] Um, it's kind of like towards my navel area, like I can't touch my navel area. It's just so sore. And it gets, yeah, it's almost like the center of my navel.\n[Doctor] \n[Doctor] Um, and does the pain come and go?\n[Patient] Yes, it does come. When it comes, I feel this strong urge to go to the, to the loo, and then and sort of like comes again, it comes and.\n[Doctor] OK. Um, and do you take any medication regularly?\n[Patient] Well, I, I take my, my vitamins, vitamin D, every day. That's about, that's about all that I regularly take.\n[Doctor] OK.\n[Doctor] And have you got a normal diet?\n[Patient] Yeah, I eat well, normally.\n[Doctor] Right. Do you smoke or drink alcohol?\n[Patient] Well, I don't smoke, but, you know, I have a pint from time to time.\n[Doctor] And do you take any other drugs?\n[Patient] No. Like I said, I only take, um, vitamins. And for my menstrual cramps, when they come, maybe I might take a, a, an ibuprofen just to ease the pain, but.\n[Doctor] And when was, when was your last period?\n[Patient] Um, two weeks ago.\n[Doctor] OK. Are you on any contraception?\n[Patient] No.\n[Doctor] Are you having regular sexual intercourse?\n[Patient] No.\n[Doctor] OK. Um, and what's your job?\n[Patient] Um, um, uh.\n[Patient] Um, uh. A graphics designer.\n[Doctor] Have you had to miss work because of this problem?\n[Patient] Well, yes, I've had to actually work from home today. I'm working from home today because I can't, I can't be out for work. \n[Doctor] OK. And who do you live with at home?\n[Patient] I live with my brother and my mum.\n[Doctor] OK. OK. And, um, have you tried anything yourself for this problem?\n[Patient] Well, I've tried a home remedy. Um, I've tried the, the, uh, ORS, you know, thing I bought from my, my local, my local, uh. Um.\n[Doctor] What? Could you just repeat that?\n[Patient] The ORS, the, the salt sugar ORS, um, um, mix, the salt sugar mix.\n[Doctor] OK. And how often have you been taking that?\n[Patient] Yeah.\n[Patient] I've taken that, I've taken that, like, um, three times a day for the past two days.\n[Doctor] OK. Um, and do you feel like your symptoms are easing off, or getting worse, or ?\n[Patient] I, I, I they're not getting any better, 'cause like I said, I've been, I've been vomiting literally everything I take, so, so I doubt that even that had, had the chance to work.\n[Doctor] Yeah.\n[Doctor] OK. Um. I mean, it sounds like, because your brother's had a similar thing, it sounds like it might be some, an infectious gastroenteritis that you've got, which is usually caused by a virus. But, it can be from something you've eaten, as well. Um. If the symptoms, they do normally start to settle by themselves with the oral rehydration salts. Um, if the symptoms are continuing to get worse, the key thing is that we want to make sure that you're hydrated enough. Um, sometimes you do require certain medication to help this, if it's, sometimes if it's caused by a bacteria. Um, what I would say, probably worth as it's been going on for a few days and you feel like it's not starting to ease off. I think it's probably important to get a sample of the stool, so we can make sure that you haven't got a nasty bacterial infection which needs specific treatment.\n[Patient] OK.\n[Doctor] Um, and we should also check that you're not getting dehydrated, because if you're, if you're not keeping fluid down, then you can get dehydrated. Um, so.\n[Patient] So, how, how do I, how do I get myself hydrated when I'm not able to even, like, drink water? I'm throwing up everything.\n[Doctor] Yeah. So you need to carry on with your rehydration salts, and just have very small amounts. It's a positive sign that you passed urine an hour ago. So, you're obviously still, um, hydrated enough to pass urine.\n[Patient] OK.\n[Doctor] But we, um, we should see you so that we can check your hydration and, um, get that sample sent off as soon as possible. 'cause if, if, if you come into the clinic, you can send that sample off straightaway. Otherwise, we would have to post it out to you which would take time.\n[Patient] OK.\n[Patient] Ohh, OK. So, when can I come to the clinic to have this done?\n[Doctor] Um, so we can, we can make you an urgent appointment, um, and then you can, you can get the sample sent off and we can check your hydration. Um, but if, in the meantime, you're feeling more unwell, then we would get you seen urgently in A and E.\n[Patient] OK.\n[Doctor] So you can call us back in the meantime.\n[Patient] OK. So, what I'll do is, yeah. If you could, please book me the appointment and, um, yeah, I'll see how I feel, um, for the end of the day. Hopefully I don't need to go to the A and E, and, um .\n[Doctor] Yeah. If you keep drinking, keep going with the rehydration salts. Just tiny sips constantly, to so that your stomach doesn't get overfilled and, and you vomit, so just tiny, tiny sips but just keep going with it. Um, and just have very simple food, if you're gonna have anything, like toast or biscuit or something really light like that. Avoid, um, fruit, vegetables, uh, milk, anything like that, which might just make it worse.\n[Patient] Mm-hmm.\n[Patient] OK.\n[Doctor] OK. So you'll have to book an appointment through the support line.\n[Patient] OK.\n[Patient] Yes, please.\n[Doctor] Right, OK. We'll do that for you.\n[Patient] \n[Doctor] OK, take care.\n[Patient] Thank you.\n[Doctor] Thanks, bye.\n[Patient] ",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: Diarrhoea. PC: Diarrhoea HPC: 3/7 hx diarrhoea. Watery stools. Urgency. No blood in stool. Periumbilical cramps, comes in waves. Worse when needs to open bowels. Very regular BO, today already 4 x by midday. Vomiting, last vomited 1 hr ago. Doesn't feel like she is holding down fluid. Still PUing ok. Last 1 hr ago. Not sure of colour. BH normally regular. 1 x day. No foreign travel. . Has been taking ORT regularly, difficulty keeping down. No rash. Feels hot but hasn't checked temperature. LMP 2/52 ago. No regular SI. Not using contraception. Has been at work til today. Now working from home. Works as graphic designer.\n\nPAST MEDICAL HISTORY: Nil. DH: Vitamins.\n\nSOCIAL HISTORY: Lives with brother and mother. Non smoker. Drinks 1 pint a week.\n\nASSESSMENT:\nGastroenteritis ?Viral/?food poisoning.\n\nPLAN:\n1. As ongoing, fever needs stool culture sent to exclude bacterial origin. 2. Advised to continue taking small sips ORT constantly. 3. Booked for urgent appointment to assess hydration status. 4. If feels worse in meantime, abdo pain, unwell to contact us to arrange urgent A&E assessment."
},
{
"source": "primock57",
"dialogue": "[Doctor] Hi there, it's Doctor Smith from Babylon.\n[Patient] Hello.\n[Patient] Hi there.\n[Doctor] Hi, can you confirm your name, date of birth and your home address, please?\n[Patient] Yeah, it's Matt Carter, and it's fourteenth of August, nineteen eighty nine, and what was the last bit?\n[Doctor] \n[Doctor] Your address.\n[Patient] And it's one Babylon Avenue.\n[Doctor] And are you in a private place where you can have a consultation today? What can I do for you?\n[Patient] Yes. Um, coming, I, I don't really know what's been going on, but it's just aching all over, but, definitely the last six weeks, it might have been slightly longer than that, but it's just sort of that, feeling really tired, run down.\n[Doctor] OK, um, so when do you think you were last well?\n[Patient] Uh, where are we now, we've just started April. I, definitely Christmas, New Year, I felt relatively well, I think. Um, so, since then. Actually, yeah, I, I was on holiday in, um, in the States. And yeah, it probably coincided with some time around then. End of January, start of Feb.\n[Doctor] So do you think it started when you were on holiday or after you got back?\n[Patient] Uh, probably a couple of weeks after I got back.\n[Doctor] Were you well when you were on holiday?\n[Patient] Yeah, had a had a great time, very active, uh.\n[Doctor] Did you get any infections, chest infections, diarrhoea, vomiting, anything like that?\n[Patient] Um, no, not that I recall. Um, yeah, not. No, the symptoms sort of all started afterwards.\n[Doctor] OK. So, just tell me what symptoms you've been having, in terms of just your general health. Any persistent cold symptoms or earaches, sore throat, chest cough, shortness of breath, phlegm, anything like that?\n[Patient] Uh, no.\n[Doctor] Any change in your weight at all?\n[Patient] Uh, I don't think so. Like, I'm probably less hungry, but no, no weight change, just a bit.\n[Doctor] OK, and are you eating different amounts?\n[Patient] Uh, yeah, probably slightly smaller portions, or it, yeah, more of an effort to, to actually eat everything that's in front of me.\n[Doctor] Any difficulty swallowing or acid in your throat, or abdominal pain?\n[Patient] No.\n[Doctor] Any change in your bowel habit, diarrhoea, vomiting or blood in the stool?\n[Patient] Uh, no.\n[Doctor] Any difficulty passing urine or blood in the urine?\n[Patient] No, that's all fine.\n[Doctor] OK, and any other general symptoms like rashes? Or.\n[Patient] Um, I don't have any rashes now, but there was, uh, in fact I've got a photo, um, on my phone if if that's helpful. I can try and show you, hang on. Um, because this, yeah, this was weird, this sort of came up, and then, uh.\n[Doctor] OK.\n[Doctor] OK.\n[Patient] Disappeared after a couple of weeks, where's the light, that, you see that?\n[Doctor] OK, right, yeah, whereabouts was it?\n[Patient] Uh, I think sort of calf, back of my calf, because I didn't notice it, my wife noticed it actually.\n[Doctor] When did you first notice it?\n[Patient] Um, probably, uh, around the end of February, the middle to end of Feb. And then it, like, it didn't actually cause too much itching, or anything, at the time. And, I, it faded over a couple of weeks, I guess.\n[Doctor] Did you have any fevers at that time?\n[Patient] Um, I, to be honest that actually turns out it was a bit of a sore throat I had, um, so possibly a little bit feverish, but I, I sort of put it down to that.\n[Doctor] Do you know where you got that, when it started? Had you been walking, did you get any bites that you noticed?\n[Patient] Uh, I like, I do quite a lot of walking, and we did, um, quite a lot while we were out in the, on holiday as well, but definitely, um. Yeah, I mean, I don't, I don't recall any bugs, I don't remember seeing anything bitten but you often, like, yeah, as you're walking through, I was in shorts and, and boots but /\n[Doctor] OK.\n[Doctor] Whereabouts were you in the States?\n[Patient] Um, just sort of, um, he examined me, so.\n[Doctor] OK, and any headaches, blurred vision, tingling, numbness?\n[Patient] Um, no. But it's the sort of headache maybe in just generally feeling a bit crappy. \n[Doctor] And have you been able to go to work as usual?\n[Patient] Um, I've been going to work. I don't know how effective it's been. But, yeah, been, been.\n[Doctor] And what's your job?\n[Patient] Um, I work for a health technology company actually.\n[Doctor] OK, and has your concentration been affected, or your tiredness levels in the daytime at work?\n[Patient] Yeah, definitely sort of tired and, um, yeah, less energy, sort of probably than I, I would normally be.\n[Doctor] \n[Doctor] Have you been able to exercise OK?\n[Patient] Um.\n[Patient] Not as much. I, I don't know if it's, I haven't been able to or I've just been a bit lazy with it. I I'm not exercising as I would normally.\n[Doctor] OK, fine, and, um, how's your mental health, your stress levels, all that?\n[Patient] Hey. Pretty good at the moment, actually. Like, it previously that has been an issue, but, um. Other than, sort of, physically feeling a bit. Uh, crappy, I've. Yeah, in a pretty good place.\n[Doctor] OK. Apart from that rash, any other rashes on your skin, or swelling of your joints, or pain in your joints?\n[Patient] Uh, yeah, sort of aching shoulders, back, the hips, knees, but sort of, yeah. Not ,\n[Doctor] Any swelling that you've noticed?\n[Patient] No, .\n[Doctor] Your hands, wrists, ankles, toes.\n[Patient] Uh, no.\n[Doctor] OK, um, and any other significant medical problems in the past?\n[Patient] Uh, I mean. \n[Doctor] Pardon?\n[Patient] Asthma and hay fever if they can help.\n[Doctor] OK. Any flare-ups of your asthma recently?\n[Patient] Uh, no, pretty well , I think.\n[Doctor] Do you take your regular inhalers or other medication?\n[Patient] Uh, yeah. I've got one of those, um, preventative, I think. Yeah , but I've not used one.\n[Doctor] You haven't been using it, you said?\n[Patient] I, I have it. I've been using the everyday for the morning and night but not the, uh, .\n[Doctor] OK. And any, erm, do you take any other medications?\n[Patient] Um, I take, um, one of the antihistamines it might be can I get that from, just from the pharmacy.\n[Doctor] Yeah, that's fine. Um, and do you smoke?\n[Patient] uh, .\n[Doctor] Drink any alcohol?\n[Doctor] No.\n[Patient] Sorry, occasionally, that was.\n[Doctor] OK, and who do you live with at home?\n[Patient] Uh, just my wife.\n[Doctor] Um.\n[Doctor] Sorry, um, so with this rash, we would need to investigate whether this has been a contributing factor to your symptoms. And just because of your symptoms, which have been ongoing for six weeks, that's obviously quite a long time to notice a change in your energy levels. Um, I think it's important to get some blood tests, checking all the normal things, like liver, kidneys, blood count, etc. But also, some more specific things like, um, a bacterial infection you can sometimes get, uh, including one which you can get which can produce a rash like that. So, that would involve blood tests. Are you happy to do that?\n[Patient] \n[Patient] Uh, yeah, I but, uh, what, what's the infection?\n[Doctor] Well, you can get, uh, you can get a bacterial infection caused which is called, um, it's called lyme disease that you can get a rash like that from a tick bite. So that's something we would do a test for, as well. Um, and if that comes back positive, then there are specific antibiotics that we would give you to treat it.\n[Patient] OK.\n[Patient] OK.\n[Doctor] So it's definitely worth checking for, but we would also check just for which can cause reduced energy, tiredness and aching for, persistent over six weeks.\n[Patient] OK.\n[Doctor] So if you're happy to do that, if you book that through the support line, and then when you've had the test arrange a follow up about a week after, after you've had the test done.\n[Patient] OK, so, do the test first and then, and that follow up we can just do over the phone again? Or, yeah.\n[Doctor] Um, yeah, we can do that over the phone to start with.\n[Patient] All right. Excellent.\n[Doctor] OK?\n[Patient] That, that's really helpful, thank you very much.\n[Doctor] \n[Patient] Oops, sorry, you broke up a bit there.\n[Doctor] Any other questions?\n[Patient] Ohh, no, not , no.\n[Doctor] OK, that's great. Take care.\n[Patient] OK, take care, thank you, bye.\n[Doctor] Sorry ",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: Tired all the time. PC: Tired all the time. HPC: Tired and feeling run down for last 6 weeks. Last felt well at xmas. Seemed to start after return from holiday in the States. Did lots of walking in shorts in Yosemite, didn't notice bite. Well when on hol. Felt unwell on return. Initially had red circular rash on back of calf mid-end Feb. Lasted few weeks and faded. Had fever, sore throat at that time. Reduced appetite, no wt loss, SE: GI - Dec app, no change in BH, no blood in stool, no dyspepsia. Neuro: General headache/no visual disturbance/altered sens/weakness.Yosemite Park. RS: No cough/sputum/CP/SOB. No coryzal sx/sore throat. Not exercising due to lack of energy LS: Aching shoulder/legs/back. No joint swelling. No other rashes noted. No sx depression. Occ.Lives with wife. Non smoker. Occ alcohol. FMHx: Mum has migraine.\n\nMEDICATIONS: Mercilon. BP last checked 1 yr ago was normal.\n\nSOCIAL HISTORY: Non smoker. No illicit drugs, 3 beers/week. Works from home.\n\nASSESSMENT:\nLikely migraine but as ongoing and persistent needs neurological examination to exclude other pathology. Advised regular paracetamol and naproxen with food (will prescribe). If gets worse in meantime contact us straightaway or go to A&E is severe/unrelenting.\n\nPLAN:\n1. Needs screening bloods for TATT including Lyme serology. 2. FU 1 week later with GP. 3. 10. 4. 13:30-13:50 \u201cI have a blinding headache\u201d Note: PC : Headache HPC: 3/7 hx headache. 5. Starts on waking up. 6. Over right eye. 7. Seeing lights in front of eyes. 8. Can be worse when stands up not when bends over/cough/sneeze. 9. Vision not disturbed. 10. No nausea/vomiting. 11. No altered taste/smell. 12. Worse in the light. 13. No rash. 14. No fever. 15. No coryzal symptoms. 16. Not woken up in the night. 17. No tingling/numbness/weakness. 18. Well before this episode. 19. Has been lacking in energy but no wt loss. 20. Severity 5-8/10. 21. Taking ibuprofen, eases slightly but not resolving. 22. Has had some generalised headaches before but not bad and associated symptoms/altered vision."
},
{
"source": "primock57",
"dialogue": "[Patient] Hi.\n[Doctor] Hi there. It's Doctor Smith from Babylon.\n[Patient] Hey. How are you?\n[Doctor] How are you doing? . Good thank you. Can you confirm your name, date of birth, and your, home address please?\n[Patient] Um, yes I can. Uh, it's, Mary Smith.\n[Doctor] \n[Patient] Um, I'm twenty eight, and I live at apartment four oh five, nine C, Clerkenwell Road.\n[Doctor] OK that's fine. Are you in a private place so you can have a consultation today?\n[Patient] Yes I am.\n[Doctor] What can I do for you?\n[Patient] Um, I keep having a headache.\n[Doctor] OK, and when did it start?\n[Patient] It started yesterday, um. Uh, it's unusual for me, to have a headache.\n[Doctor] OK. Can you just tell me whereabouts in your head it is?\n[Patient] It's on the left side at the back, sort of here.\n[Doctor] . OK. Just on the left side.\n[Patient] Yes.\n[Doctor] And, when did it start? What time of day did it start yesterday?\n[Patient] About mid-morning.\n[Doctor] And how did it feel when it first started?\n[Patient] Um, just quite, intense, and kinda quite throbbing. It kind of built up gradually after, over. A short period of time.\n[Doctor] OK. And did you get uh, have you got any other symptoms along with that? Any nausea, vomiting, tingling, numbness, weakness, anywhere?\n[Patient] No, nothing.\n[Doctor] OK, and, uh. Sorry . Um, any blurred vision, or any pain over your eyes?\n[Patient] Um. No.\n[Doctor] Any , any funny lights or, anything like that in your vision area? Any problems when you look into the light?\n[Patient] No, .\n[Patient] No.\n[Doctor] Um, and have you been eating and drinking OK?\n[Patient] Yes, yes, like normal.\n[Doctor] . Are you feeling sick, or vomiting, or anything?\n[Patient] No, nothing like that, .\n[Doctor] Any high fevers? Are you feeling shivery? Sweaty?\n[Patient] No, no fever, no .\n[Doctor] Any , any rashes at all?\n[Patient] No.\n[Doctor] And, in the past, have you had any headache before?\n[Patient] Not really.\n[Doctor] OK. How bad would you say the headache is from, zero to ten, if ten is the worst pain that you could have, and zero is nothing?\n[Patient] I'd say about eight.\n[Doctor] OK. And have you taken any pain killers?\n[Patient] Um, I took some, um, um, Nurofen, yesterday.\n[Doctor] OK, and did that make any difference?\n[Patient] Not really.\n[Doctor] And last night, did you manage to sleep through the night OK?\n[Patient] Uh, yes I did.\n[Doctor] Has it been worse at any particular time of the day?\n[Patient] No, it hasn't made any difference, the time of the day.\n[Doctor] Any difference if you lie down, stand up, bend over, cough or sneeze, or anything like that?\n[Patient] Um, no.\n[Doctor] And, have you got any other medical problems?\n[Patient] Um, no I haven't.\n[Doctor] Anything you take medication for?\n[Patient] No I don't.\n[Doctor] Um, any over-the-counter medications or allergies?\n[Patient] No, only the, Nurofen I took yesterday, Ibuprofen.\n[Doctor] That's fine. And any stomach problems, or asthma at all?\n[Patient] No.\n[Doctor] Anyone in your family got any medical problems?\n[Patient] Uh, my mother's had hypertension, and she does get migraines.\n[Doctor] . And, have you had your blood pressure checked ?\n[Patient] Um, no, not recently.\n[Doctor] And who do you live with at home?\n[Patient] Sorry?\n[Doctor] Who do you live with at home?\n[Patient] My partner.\n[Doctor] And what's your job, day-to-day?\n[Patient] I'm a designer.\n[Doctor] Have you had to miss any work at all?\n[Patient] Uh, no, but I don't feel that, I'm finding it really hard to , to do any of, my work, or, normal things.\n[Doctor] OK. Um, and do you smoke at all normally?\n[Patient] No I don't.\n[Doctor] Do you drink any alcohol regularly?\n[Patient] No.\n[Doctor] Um, and any other drugs?\n[Patient] No.\n[Doctor] No, OK. Um, I mean the fact that you haven't had headaches before, um, is, is unusual the fact that they've developed. Is there anything you think's changed? Any increased stress, , change in your diet or lifestyle?\n[Patient] Not that I can, not that I can think of.\n[Doctor] OK. So, what we would suggest is, trying a slightly stronger, pain relief. Uh, so, similar to Ibuprofen, but taking instead of Ibuprofen not at the same time, and taking that regularly with food.\n[Patient] OK.\n[Doctor] Um, hopefully that will settle it down. You can take Paracetamol along with that.\n[Patient] Yes.\n[Doctor] Try and um, take rest, have lots of good hydration.Um, but if the pain's getting worse, or you get new symptoms, fever, rash, vomiting, neck stiffness. Um, or you keep getting episodes of the same type of thing, then we need to speak to you, and, and make a plan for, for what we can do next.\n[Patient] OK. Thank you.\n[Doctor] Have you got any other questions?\n[Patient] How long do you think it will last for?\n[Doctor] Well I should think it should down, if it's getting worse or not settling in the next day or two. Then certainly give us a call back, if, when you've tried the medication that I've prescribed from the pharmacy.\n[Patient] \n[Patient] OK.\n[Doctor] OK?\n[Patient] Thank you.\n[Doctor] All right then. Thanks a lot. Bye.\n[Patient] , bye.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPresenting complaint: Headache. PC: Headache HPC L sided posterior headache. Started mid morning. 8/10 severity. No visual disturbance/visual floaters/tingling/numbness/weakness/nausea/vomiting/fever/neck stiffness. No worse cough/sneeze/bending. Did not wake her up in the night, slept ok . E&D fine. Finding it hard to concentrate on work. No headaches in the past. No change in diet/liestyle/increased stress. FMH: Mother hypertension\n\nSOCIAL HISTORY: Lives with partner. Designer.\n\nASSESSMENT:\nNew onset headache.\n\nPLAN:\n1. Advised prescribed naproxen to take instead of ibuprofen. 2. Can take alongside paracetmol. 3. If pain not settling/worse or new symptoms to contact dr asap. 4. If recurring episodes of same to have further assessment with GP."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hey, bud. What brings you in today? \nPatient: A rash on my upper arms and torso. \nDoctor: When did it start? \nPatient: Bout a day or two ago. \nDoctor: Any itchiness to the area? \nPatient: Yes, a lot actually. \nDoctor: Have you had episodes of shortness of breath or wheezing? \nPatient: No. \nDoctor: How about swelling to your lips, tongue, or throat? \nPatient: No. \nDoctor: And no nausea or headaches? \nPatient: No. \nDoctor: Have you applied anything to the rash? \nPatient: No, I thought it'd go away on its own.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nsudden onset headache, blurry vision, scotoma, swelling in face. 25-year-old right-handed Caucasian female, headache occurring at approximately 11 a.m. on the morning of the July 31, 2008. Rash on upper arms and torso, itchiness Rash started about a day or two ago, accompanied by significant itchiness, denies shortness of breath, wheezing, swelling of lips, tongue, or throat, headache, or nausea\n\nASSESSMENT:\nmigraine.\n\nPLAN:\nadministered migraine cocktail, administered morphine."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How old are you, sir? \nPatient: I am sixty two year old African American. \nDoctor: Do you have any relevant past medical history? \nPatient: I do have diabetes, high blood pressure and I had a stroke in the year two thousand and two. I do have weakness on my right side after that. I also had two heart attacks. Ah. \nDoctor: Any history of surgery? \nPatient: I have a pacemaker. \nDoctor: It shows here that you came to us in two thousand and one for weakness and numbness in your legs. How is that now? \nPatient: Oh, it was never gone. Instead, it has also moved to my hands and areas above my knees. \nDoctor: What are your symptoms now? \nPatient: It's mostly like something is burning and numbness is still there. \nDoctor: Is that your main concern? \nPatient: Yeah, it is. That is my main problem. I do have pain, but it is not that much of a concern. \nPatient: For the last six months, I cannot feel anything hot in my hands. Things slip out of my hand. I don't have any weakness as such, but it's just like that feeling of clumsiness and it's just lots of sensation. \nPatient: Sometimes I feel, like, these jerks in my body, mainly my shoulders and both hands. \nDoctor: Has it been for some time? \nPatient: It has been like forever but now I am noticing it more than before. \nDoctor: Do you get any kind of tremors? \nPatient: No. \nDoctor: Any neck pain? \nPatient: No, but as you might have noticed I am using this walker because I do not feel safe walking. \nDoctor: Have you used anything for your pain? \nPatient: Yeah, they tried different medicines but only oxycodone helped a little. It does give me sometimes around three hours of relief. Gabapentin did not work at all. \nDoctor: How is your sleep?\nPatient: I cannot sleep properly because of the pain. It has been for many years. I haven't had a proper sleep. \nDoctor: When did you get your pacemaker? \nPatient: It was around six months ago after the heart attack and pacemaker I was transferred to a nursing home. There they stopped my insulin and since then, I'm taking tablets for that. \nDoctor: Do you have any back pain?\nPatient: Nope. \nDoctor: Any change in bathroom routine? \nPatient: No. \nDoctor: Did you ever have any accidents or any injury before all this started? \nPatient: No, nothing like that.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nLeft hemibody numbness, stiffness and clumsiness in right hand, listing to the right when walking. Symptoms started on 7/29/93 with left hemibody numbness, followed by stiffness and clumsiness in right hand on 7/7/93, and listing to the right when walking. Denied recent colds/flu-like illness, history of multiple sclerosis, Symptoms of Lhermitte's or Uhthoff's phenomena. Progressive numbness and weakness in lower extremities since 2001, now involving legs above knees and hands, burning sensation and numbness, difficulty feeling hot objects in hands, objects slipping out of hands, muscle jerks in hands and shoulders, unsteadiness with gait, pain (primary concern), difficulty sleeping due to pain Symptoms initially presented in 2001, progressively worsening, recent exacerbation of symptoms including difficulty feeling hot objects, objects slipping out of hands, muscle jerks, and pain\n\nASSESSMENT:\nDiabetes, hypertension, previous stroke in 2002 with residual right-sided weakness, two myocardial infarctions, status post pacemaker insertion\n\nPLAN:\nTried gabapentin with no effect, oxycodone provides partial relief, insulin stopped after pacemaker insertion, currently only on oral medication for diabetes"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello, ma'am. How are you doing today? \nPatient: My right hand hurts. \nDoctor: Is that your dominant hand? \nPatient: It is. \nDoctor: I see. What seems to be the problem? \nPatient: I feel like my right thumb just locks up, and I can't move it anymore. \nDoctor: Does it stay locked? \nPatient: No, it doesn't. It just moves out of nowhere. Like right now! \nDoctor: I can see that. Have you seen someone about your thumb before? \nPatient: I have. These are the notes from that visit. Here you go. \nDoctor: Thank you. It looks liked you were diagnoses with stenosing tendinosis, which is trigger finger. \nPatient: Is that common for a fifty one year old woman like me? \nDoctor: Yeah, it is. We can proceed by releasing the A one pulley? \nPatient: Could you describe what that means? Could you also go over the risks and benefits of the surgery?\nDoctor: Of course. I'll explain it and give it to you in writing. \nPatient: Thank you. I'll most likely agree to it. I need to fix this thumb.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPain and locking sensation in the right thumb Patient has a longstanding history of pain and locking sensation in the right thumb, diagnosed with stenosing tendinosis\n\nASSESSMENT:\n1. Hypoglycemia, hypertension, renal insufficiency. Poor renal sufficiency possibly due to dehydration or diabetic nephropathy, high blood pressure, hypoglycemia due to irregular meal consumption.\n2. Stenosing tendinosis (trigger finger)\n\nPLAN:\nProceed with release of A1 pulley, risks and benefits of the surgery discussed and agreed upon by the patient"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Are you keeping up with your food journal? \nPatient: Yes, and I have it with me today. \nDoctor: Good, and you're using calorie points, correct? \nPatient: Yes, I range from twenty six to thirty. \nDoctor: Good, are you exercising regularly?\nPatient: Yes, I am. I'm also going to Overeaters Anonymous. \nDoctor: How is that going? \nPatient: Good, my sponsor is helping me, and told me to think about snacks that can help with my high blood sugar. That was what we talked about last. \nDoctor: Good, all of that is good to hear. \nPatient: I'm feeling a lot better, and I've lost weight, but do you have any information on diabetic exchanges, doctor?",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPatient is keeping a food journal, counting calorie points (26 to 30 per day), exercising regularly, attending Overeaters Anonymous, receiving support from sponsor to plan snacks for high blood sugar, feeling better and has lost weight\n\nASSESSMENT:\nBlood-borne pathogen exposure secondary to contaminated needlestick.\n\nPLAN:\nPatient requests information on diabetic exchanges"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning. So, you are here for your follow up today. \nPatient: Yes, sir. \nDoctor: Update me what happened, why were you in the hospital? \nPatient: I had a lot of back pain and less of urine output. I always had burning sensation whenever I used to go to the bathroom. So, I went to the doctor, and they said it is kidney stones. I knew something was wrong, but then I started having fever. So, I went to the hospital and they said that it was infection. It all began with my kidney stones. \nDoctor: I see. So how are you feeling now? \nPatient: I'm feeling better. The burning sensation is gone. Pain has subsided. \nDoctor: It says that they put a stent in your ureter. Are you feeling any discomfort with it? Who was your doctor there? \nPatient: No discomfort, I'm just here for my follow up. Doctor X Y Z did operate on me to remove all those stones, the kidney stones. She is a good doctor. She did take care of me. I feel all new now. \nDoctor: That's nice to hear. I'm glad you are feeling okay. You remember I wrote down all the medications with their doses on your progress note, a sheet that we gave to you. Your nephew called me and he said that the prescription was lost and instructions were lost. What happened there? \nPatient: I don't know. I remember you gave me a paper saying it has all the medicines. It's everything related to them and all the things that I have to do. But I don't know what happened between the hospital and the home. I completely lost it. And I don't know where did it go. \nDoctor: It had instructions to follow up here and also to follow up with Doctor F. Do you have an appointment with Doctor F? You never did call me after the day you were dismissed from the hospital saying that you might have lost the paper that we gave to you. \nPatient: No, unfortunately I don't have any appointment with Doctor F. I was not even aware about that, that I have to take an appointment because maybe it was only there in the paper. It completely got out of my mind. Somehow, I did find the prescription paper where all the medicines were and I was able to get them filled and I was taking all my antibiotics and everything else which was there. \nDoctor: I think it was Levaquin. Do you have any more to take? \nPatient: I do have one more to take. \nDoctor: So, when are you seeing Doctor X Y Z? \nPatient: Do I have to see her? I haven't set up anything. \nDoctor: You do. Any other issues? \nPatient: Yeah, I'm not still feeling very well. I still feel that I'm sick or something like that. It's just that I didn't get my whole self back. You said I got a stent. I have no idea. I don't feel like having one. \nDoctor: Are you the husband? \nGuest_family: Yes, I am. I just wanted to be here with her today. \nDoctor: That's good. Okay, let me explain it to both of you once again. See, she got a ureteral stent. It means that the doctors there, they have made a pathway for the urine to flow around the kidney stone without blocking anything. So, it is to help her overall. She needs to take her medicines and make her appointment with Doctor F. Also, she does need to see if Doctor X Y Z needs a follow up. You can call them and ask. Other than that, everything seems fine. \nPatient: Yep. I will make those appointments. Thank you for your guidance. \nDoctor: Take care.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nFeeling better, burning sensation gone, pain subsided, still feeling somewhat sick Recent hospitalization for sepsis from nephrolithiasis, ureteral stent placement and lithotripsy performed by Dr. XYZ, lost instructions and prescriptions post-discharge, nephew called regarding lost prescriptions, patient found prescriptions and filled them, currently taking Levaquin with one more dose remaining, no follow-up appointment with Dr. F scheduled, patient unaware of ureteral stent\n\nASSESSMENT:\nNephrolithiasis, sepsis, ureteral stent placement, lithotripsy\n\nPLAN:\nContinue antibiotic treatment, make follow-up appointments with Dr. F and Dr. XYZ, educate patient on the purpose of ureteral stent and follow-up care"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: It looks like your white blood cell count is normal according to your most recent labs. But, I do want to keep an eye on it given your history of high white blood cells. \nPatient: That's good to hear. I'm glad that it's back to normal. \nPatient: However, I must say that I've been having a lot of pain over the past several days. \nDoctor: Where's the pain located? \nPatient: It's mainly my left shoulder and lower back. \nDoctor: Oh, I see. Have you been taking anything for the pain? I remember you were having problems with your lower back the last time you were here. Did you get a chance to see the orthopedist? I believe the left shoulder pain could be due to impingement syndrome. \nPatient: No, I haven't taken anything for it yet and I forgot to make an appointment with the doc you recommended. I've been smoking cigs to help with the pain. \nDoctor: I'd advise that you try to wean off smoking for now and consider looking into nicotine patches. Let me see what I can do for the pain and if we can schedule you to see an orthopedist. \nPatient: Thanks, doc. I've had a lot of trouble weaning off cigs for a while now. I've also been eating pretty bad, too. I got to do better.\nDoctor: It'll take time, but with the right diet and regimen, you'll be on better track towards attaining a healthy weight and lifestyle. \nPatient: Oh, and before I forget-\nDoctor: Yes? \nPatient: I seem to be peeing a lot more these days. \nDoctor: Are you experiencing any other urinary symptoms? \nPatient: No, nothing else. \nDoctor: I'll order a urine sample for today's visit to see if you have an infection.\nPatient: Thank you, doc. And before you write the order, do you know why my one leg is more swollen than the other? \nDoctor: Let me take a look.",
"note": "ASSESSMENT:\n1. Impingement syndrome (left shoulder pain), chronic low back pain, obesity, tobacco abuse\n2. Left shoulder and lower back pain, increased urination frequency, left leg swelling History of leukocytosis, chronic low back pain, obesity, tobacco abuse\n\nPLAN:\nConsideration for orthopedist referral for impingement syndrome, encourage weaning off smoking and consideration of nicotine patches, evaluation of urine for possible infection, assessment of leg swelling"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: When are you planning to quit? \nPatient: I always plan to do it.\nDoctor: Okay let me refer you to a substance abuse clinic because you need it.\nPatient: Okay, I will look at it.\nDoctor: Sure. But please try to stop your substance abuse. It is a bad habit.\nPatient: Yes.",
"note": "ASSESSMENT:\nSubstance abuse\n\nPLAN:\n1. Continue monitoring patient's progress.\n2. Patient reports feeling fair, with slow improvement. Patient received treatment and is experiencing gradual improvement.\n3. Referral to substance abuse clinic, encouragement to stop substance abuse"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Do you have a history of tobacco, alcohol or recreational drug use? \nPatient: No.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nDecreased level of consciousness, facial injuries, possible elderly abuse, history of falling from wheelchair. Patient experienced decreased mental status for a whole day following an accidental overdose of Xanax and lack of Sinemet and other home medications for the past 2 days.\n\nSOCIAL HISTORY: Denies history of tobacco, alcohol, or recreational drug use\n\nASSESSMENT:\nN/A (awaiting further evaluation).\n\nPLAN:\nEvaluate for possible overdose, assess facial injuries, investigate possible elder abuse, administer appropriate medications including Sinemet, monitor for improvement in mental status."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How are you Miss G? \nPatient: I am good doctor, thank you for asking. \nDoctor: So, tell me what is going on?\nPatient: I have this ear pain and headache for some time. It's better than before but I still want to get it checked. \nDoctor: Okay, when exactly did it start?\nPatient: Um, almost three weeks ago. I am having difficulty hearing. I also feel this pressure on the left side of my sinus causing tooth pain. I went to my dentist yesterday, but my teeth are fine. \nDoctor: Okay, do you have headache now?\nPatient: No, just ear pain and this jaw pain on the left side. \nDoctor: Any fever, cough, sore throat, or any cold like symptoms? \nPatient: No, but I have a sinus problem and I suffer from chronic left sided headache.\nDoctor: How old are you?\nPatient: Oh, I am forty nine.\nDoctor: Hm, so are you taking any medications for your pain?\nPatient: No, currently I am just using Cutivate for my eczema. It has helped me a lot, I do need a refill for it. \nDoctor: Okay I will send a prescription for it to your pharmacy.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nEar pain, headache, difficulty hearing, left-sided sinus pressure, tooth pain on left side, left-sided jaw pain Symptoms started approximately three weeks ago, difficulty hearing has improved, chronic left-sided headache, history of atopic dermatitis, sinusitis\n\nSOCIAL HISTORY: Stable mood, positive response to Wellbutrin. Patient reports feeling good with Wellbutrin treatment for depression.\n\nASSESSMENT:\nDepression.\n\nPLAN:\n1. Continue Wellbutrin regimen, advise against alcohol or recreational drug consumption.\n2. Refill prescription for Cutivate cream, further evaluation and treatment for ear pain and headache"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: So, I have the evaluation report from your psychiatrist.\nPatient: Ah, okay and what does it says?\nDoctor: Well, he thinks you are doing really good. \nPatient: Nice!",
"note": "SOCIAL HISTORY: No specific Symptoms reported. Patient reports family medical history related to heart disease, cancer (breast cancer in cousins), and diabetes (type II diabetes in father and grandfather, type I diabetes in son).\n\nASSESSMENT:\nFamily medical history assessment.\n\nPLAN:\n1. Document family medical history for reference and potential future screenings or interventions.\n2. Refer to psychiatric evaluation report"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How are you today? \nPatient: I am doing okay. \nDoctor: Just to confirm, you are fifty seven years old? \nPatient: Yes. \nDoctor: What brings you to see me today? \nPatient: I have been having these headaches every day for the last six months. \nDoctor: That is a long time. I am sorry that you have been experiencing that. \nPatient: Well, I am hoping you can make them stop. \nDoctor: I will do my very best to help.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nDaily headaches for the last six months\n\nSOCIAL HISTORY: None reported. Patient is a civil engineer working from home, currently working half-time due to disability, frequent physical therapy appointments, and childcare responsibilities. Patient denies smoking or alcohol use.\n\nASSESSMENT:\nOccupational status and lifestyle assessment.\n\nPLAN:\n1. Acknowledge patient's current work situation and schedule, consider adjustments or accommodations as needed, and provide support for managing disability and childcare responsibilities.\n2. Further evaluation and treatment for daily headaches"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Welcome to the office, Miss A. I am Doctor Luna. \nPatient: Thank you. It is nice to meet you. \nDoctor: What is your family medical history? \nPatient: My mother died about three or maybe it is four years ago? \nDoctor: I am so sorry to hear that. How did she pass? \nPatient: She had lung cancer. My mom didn't talk much about her own health problems. \nDoctor: What about your father? Does he have any health conditions? \nPatient: My dad has gout. I think he also had blood clots. That is all that I can remember my dad talking about. \nDoctor: Do you have siblings? \nPatient: Yes. My brother has asthma and uses an inhaler. My sister had some sort of tumors removed from her stomach or something. Oh, I think I remember my mom talking about some of her family having issues with high blood pressure, high cholesterol and someone had a stroke. I am not sure though. \nDoctor: Okay.",
"note": "SOCIAL HISTORY: None reported. Patient denies any family history of hypertension or diabetes. Difficulty providing familial medical history, mother deceased from lung cancer, father has gout and blood clots, siblings treated for asthma and GI tumors, uncertain about other familial medical conditions\n\nASSESSMENT:\nFamily medical history assessment.\n\nPLAN:\nNo immediate action required regarding family medical history."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Are you taking any medications? \nPatient: No.\nDoctor: Any over the counter drugs or anything?\nPatient: None.\nDoctor: Okay.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nNone reported. Patient denies recent anxiety attacks, depression, mood swing problems, or phobias.\n\nASSESSMENT:\nPsychiatric assessment.\n\nPLAN:\nNo immediate action required regarding psychiatric Symptoms."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi sir, let me start by getting your age.\nGuest_family: He is fifty three!\nDoctor: So, tell me what's going on?\nGuest_family: He is complaining of so many things but-\nPatient: But I have a lot of pain from my hernia. That's the number one complaint, but I am also having pain in my lower legs.\nGuest_family: He has so many issues going on with him, that is why I got him to emergency.\nPatient: My wife freaks out easily. \nDoctor: Don't worry, let me take a look. So, any nausea and or vomiting? \nPatient: Yes both. And I am not sure, but I think I noticed some blood in my stool.\nDoctor: Oh, but you are not sure?\nPatient: It is questionable!\nDoctor: I see. And on the scale of one to ten, ten being severe, how will you rate your lower extremity pain?\nPatient: Actually, my leg pain has improved considerably. I did have more significant tingling and numbness in the past but now it has improved a great deal.\nDoctor: Hm.\nGuest_family: He has so many medical issues. Here, I have gotten his reports. You can look at them Doctor. \nDoctor: Oh, that's great, thank you for getting these, let me go through them quickly. So, I see you have a history of multiple-\nGuest_family: Strokes?\nDoctor: Yeah, also called as C V A. Peripheral vascular disease. Oh, and heart failure too. \nGuest_family: Yes.\nPatient: Yeah.\nDoctor: And you also have a history of multiple bowel ischemia. \nPatient: Well, yeah.\nDoctor: There is a reason why your wife is worried. So, are you taking any medicines currently?\nGuest_family: He is taking Coumadin for his atrial fibrillation. Also, they mentioned it's not optimal for his condition but-\nDoctor: Oh, I see its subtherapeutic. \nPatient: Yeah, but I am still taking it.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nSignificant morning pain, improving functionality. Increased muscle girth noted. Positive response to home exercise and pool therapy. Morning pain persists; overall improvement in activity levels. Pain from hernia, lower leg pain, nausea, vomiting, questionable blood in stool 53-year-old man presenting with multiple complaints including pain from hernia, some question of blood in stool, nausea, vomiting, left lower extremity pain. Left lower extremity pain has improved considerably, with past significant paresthesias now improved. History of multiple medical problems including atrial fibrillation, on subtherapeutic Coumadin, multiple CVAs in the past, peripheral vascular disease, congestive heart failure, multiple previous ischemia of large bowel.\n\nASSESSMENT:\nPain management needed; improving muscle strength and function.\n\nPLAN:\nContinue home exercise and pool therapy. Review pain management options for morning pain."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How many days has it been since your headaches started? \nPatient: About two days now. \nDoctor: How long do they normally last? \nPatient: A couple hours. \nDoctor: Any nausea or vomiting with the headaches? Any vision changes?\nPatient: Yeah, it's been pretty consistent. No vision changes.\nDoctor: Have you tried to take anything for it? \nPatient: No, nothing. Oh and I have some dizziness with the headaches, too. \nDoctor: How would you describe the dizziness? Room spinning? \nPatient: Um kind of. \nDoctor: Is this new for you? \nPatient: Yeah. I've never had headaches like this before. \nDoctor: Do you have any chest pains or an irregular heart beat?\nPatient: No.\nDoctor: Any numbness or tingling on any part of your body?\nPatient: No. \nDoctor: Okay. How is your urine and feces? Any blood? Any diarrhea?\nPatient: None, thankfully.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nElevated potassium levels reported from blood test. Headaches for about two days, lasting a couple of hours, consistent nausea and vomiting, dizziness, no vision changes, no chest pain, irregular heartbeat, numbness, or tingling, no diarrhea, melena, hematemesis, no urinary or fecal blood\n\nASSESSMENT:\nHEENT: See has had headaches, and some dizziness. She denies any vision changes. CARDIAC: She denies any chest pain or palpitations. RESPIRATORY: She denies any shortness of breath. GI: She has had persistent nausea and vomiting. She denies diarrhea, melena or hematemesis. NEUROLOGICAL: She denies any neurological deficits. All other systems were reviewed and were negative unless otherwise mentioned in HPI.\n\nPLAN:\nAwait blood report from patient's physician's office to confirm potassium elevation and determine further steps."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Do you have any medical conditions that I should know about? \nPatient: Actually yes, I have high blood pressure and, um, depression. \nDoctor: That's good to know, thank you. What about your bones? \nPatient: Um, yes, I have osteoporosis too.",
"note": "ASSESSMENT:\n1. Multiple trauma due to car accident. Patient involved in car accident, resulting in multiple trauma.\n2. Hypertension, depression, osteoporosis\n\nPLAN:\nAftercare required for patient's injuries sustained in the accident."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How long have you been having this pain in your ear?\nPatient: It's been three or four days. \nDoctor: Okay, let me check your ears, which side is in pain?\nPatient: The left one.\nDoctor: Okay let me check both ears. Well, you have lot of fluid accumulated in your left ear, which has caused infection in your middle part of the ear. It is called as Serous Otitis. \nPatient: Nothing to worry about?\nDoctor: I will prescribe you some antibiotics, it should take care of it. \nPatient: Thank you!\nDoctor: Anything else?\nPatient: Ah yes, my eczema is also acting up. \nDoctor: Hm, you have a history of atopic dermatitis in other words eczema.\nPatient: Yeah, I have had it since childhood.",
"note": "PAST MEDICAL HISTORY: Allergies and asthma.\n\nASSESSMENT:\n1. Serous otitis, atopic dermatitis\n2. Pain in left ear, eczema flare-up Pain in left ear for three or four days, history of atopic dermatitis since childhood\n\nPLAN:\nPrescribe antibiotics for serous otitis"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Well, I have your E K G report, shows you have sinus tachycardia. In other words, your heart is beating faster than normal due to rapid firing of sinus node.\nPatient: Okay.\nDoctor: Well, there are no S T changes.\nPatient: Hm.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPain in tooth.\n\nASSESSMENT:\nSinus tachycardia\n\nPLAN:\nNo acute ST changes"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there! I have the results from your ultrasound. You have kidney stones in the ureter close to the bladder.\nPatient: Oh no. \nDoctor: This explains the pain you have been having on your left side. Are you still experiencing nausea and vomiting? \nPatient: Yes, I have been. \nDoctor: I would like to set you up with a consult with a consult with a surgeon.\nPatient: Okay.",
"note": "ASSESSMENT:\n1. Kidney stones in the ureter close to the bladder.\n2. Pain on the left side, nausea, vomiting. Experiencing pain on the left side, nausea, and vomiting.\n\nPLAN:\nConsultation with a surgeon recommended."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi, how are you doing today? \nPatient: I've been better. Thank you. \nDoctor: So, you are here for your follow up right? Remind me how often are you coming here? \nPatient: That's right. I'm coming around between a month or two. \nDoctor: Yeah, it's every four to eight weeks. \nPatient: I'm not taking any medicine now. I just wanted to let you know. \nDoctor: Yeah, I can see it in your record. It says that you are off of all the immunosuppression. So, just let me check. It says here that you do have mild chronic G V H D. It is not that bad that I should be worried about any therapy or anything else. How long ago did you get that transplant? \nPatient: I think it was around four and a half years ago. I'm feeling much better after that. I do have complaints of blood in my stool. But after you sent me to that doctor, that gastro doctor, I feel good. I know they said that they removed something, but I'm not sure, but after that it has been improved a lot. \nDoctor: Okay, let me see in my chart. You had some rectal bleeding issues because of which I referred you to the gastroenterologist. A complete endoscopy was performed, which was both on the upper and the lower side. There was no evidence of ulcers or any other abnormality. That's good news, right? \nPatient: Yeah, I agree. That was a relief. \nDoctor: They did find some polyps and they removed it. They turned out to be benign, so nothing to worry about there. \nPatient: Yeah, I remember this said they removed something, but I forgot the name. \nDoctor: Is there any other issue that I can help you with? \nPatient: I don't know. I feel a lot of fatigue and like I'm not able to do things like I used to do before. I get tired very easily. I don't know if it is related to something or not, but things have been weird. I'm not able to do even the minor things like I lift two boxes and I'm done for the day. Is it something that I should be worried about? \nDoctor: It looks like you have a mild iron deficiency. I will work on that with you, don't worry.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nFatigue, easy tiredness, blood in stool. Received transplant approximately four and a half years ago, experienced rectal bleeding issues, underwent complete endoscopy revealing benign polyps which were removed.\n\nASSESSMENT:\nMild chronic graft-versus-host disease (GvHD), mild iron deficiency.\n\nPLAN:\nAddressing iron deficiency with patient."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Can you confirm your age for me, ma'am?\nPatient: Absolutely, I'm sixty six now. \nDoctor: Good, so it's been about five months since you last evaluation for type two diabetes and high blood pressure. \nPatient: Yes, and I have a few other problems today, too. \nDoctor: Sure, we can treat all of them. What seems to be the problem today? \nPatient: I'm having some right shoulder pain. \nDoctor: Can you remember an injury to this shoulder? \nPatient: No, not that I can remember. \nDoctor: What aggravates your symptoms? \nPatient: It hurts when I move the shoulder. \nDoctor: Do you have any weakness, numbness, or tingling? \nPatient: No, I don't have any of that. \nDoctor: Okay, back to diabetes, how has that been progressing? \nPatient: Well, I can only check it in the morning, and it's usually less than one hundred. \nDoctor: Have you been checking your blood sugar two hours after meals? \nPatient: No, doctor, I haven't been. When I check them, it's normal though. \nDoctor: Do you have any records to prove that? \nPatient: No, I don't have that with me today. \nDoctor: That's important, do you have any other issues or concerns today? \nPatient: No, I can't think of anything. \nDoctor: Okay. I'm looking at your charts, and I see you had a benign breast biopsy done on June eleventh two thousand four. Did you have a repeat done after six months like they asked? \nPatient: No, I never had that done, I need to.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nRight shoulder pain, Main Complaint: Right shoulder pain, Aggravating Factors: Movement of the shoulder, Associated No weakness, numbness, or tingling reported 66-year-old female presenting for a five-month recheck on type II diabetes mellitus and hypertension. Denies injury to shoulder but experiences pain with certain movements, no weakness, numbness, or tingling. Only checks blood sugar in the morning, which has been below 100, hasn't checked two hours after meals, no records available. No other issues or concerns mentioned. Benign breast biopsy done on 06/11/04, advised to have a repeat mammogram after six months, which hasn't been done.\n\nASSESSMENT:\nType 2 diabetes (controlled in the morning), High blood pressure, History of benign breast biopsy (follow-up needed)\n\nPLAN:\nAssessment and management of right shoulder pain, Review of blood sugar monitoring technique and scheduling a follow-up for comprehensive blood sugar monitoring, Evaluation and management of high blood pressure, Arrange follow-up for overdue breast biopsy repeat."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How are you doing today?\nPatient: I have a long history of lung disease. COPD to be exact. Recently, I was experiencing a lot of coughing and shortness of breath even on walking from one room to another. All the time I felt sleepy, tired, or confused. \nDoctor: How is it now?\nPatient: It is getting better. \nDoctor: What else?\nPatient: I was also diagnosed with pneumonia; I was on trip and there they found it. It is also getting a lot better now, but doctor said to continue taking oxygen for some more time. \nDoctor: Oh wow!\nPatient: With everything going on, I felt weak and tired and it looks like I have lost all my strength and muscle. \nPatient: I also felt very instable and had a fall. I did not call for any assistance but now I think I should have called someone. Everyone including my family and nurses all tell me all the time to call for assistance. I was just being stubborn and hurt myself.\nDoctor: Did you use a wheelchair?\nPatient: No. \nDoctor: You know I would agree with everyone else; you should call for assistance if you need help like getting out of bed or need to use the restroom.",
"note": "ASSESSMENT:\n1. COPD exacerbation, community-acquired pneumonia (both resolving), generalized weakness, deconditioning, fall secondary to instability.\n2. Coughing, shortness of breath, sleepiness, tiredness, confusion, weakness, muscle loss, instability. Long history of lung disease (COPD), recent exacerbation with Symptoms including coughing, shortness of breath, sleepiness, tiredness, confusion; diagnosed with pneumonia while on a trip, currently improving but still requiring oxygen therapy; experienced a fall due to instability and failure to use assistance despite being advised by family and nurses to do so.\n\nPLAN:\nContinue home oxygen therapy for a short period, address generalized weakness and deconditioning, emphasize the importance of calling for assistance when needed."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: It is nice to see you again, miss. We are following up on a few things today. How is your arm feeling? \nPatient: My arm is all better. It is not in pain at all anymore. \nDoctor: How has your mood been? Are you feeling any relief from your symptoms since you have been on the Lexapro? \nPatient: It's helping a little bit. \nDoctor: How much Lexapro are you taking now? \nPatient: I am taking ten M G. \nDoctor: How long have you been taking the full dosage? \nPatient: About a week ago. I don't take it every day. I don't feel like I need it some days. \nDoctor: I want you to take the full dosage every day. This might be why you have not had much relief with your symptoms yet. \nPatient: Okay. \nDoctor: Your hands are a little shaky. Is this a normal occurrence for you? \nPatient: I didn't even notice. \nDoctor: It is very subtle. We will keep an eye on it for now. Your blood pressure is a little better today. Have you experienced any worsening joint or bone pain? I want to check on your osteoporosis and osteoarthritis.\nPatient: No.",
"note": "ASSESSMENT:\n1. Hypertension, depression (improved with Lexapro), osteoporosis, osteoarthritis.\n2. Improved right arm Symptoms, subtle tremor. Right arm Symptoms resolved, depression possibly improved with Lexapro (full dosage started about a week ago), occasional non-daily intake of Lexapro, subtle tremor observed.\n\nPLAN:\nMonitor blood pressure, continue Lexapro at full dosage daily, monitor for worsening joint or bone pain related to osteoporosis and osteoarthritis."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: What happened to you? How did you get involved in this accident?\nPatient: I was just trying to adjust cable that my brother's dog was tied to. All of a sudden, he attacked me out of nowhere. The injury to my leg is V shaped and the V is pointing towards my foot. \nDoctor: What kind of dog?\nPatient: German shepherd. But he is up to date on his shots, and he is completely healthy. \nPatient: He bit me on my foot, and it looks like his teeth went into my skin. I went to my P C P.\nDoctor: What did you do there?\nPatient: They cleaned the wound and did some bandage along with it he gave me a tetanus shot.\nDoctor: And he sent you to us?\nPatient: Yes.\nDoctor: Okay let me examine your wound.\nPatient: Sure!\nDoctor: It looks like there is a flap injury developed after puncture wound. It seems like a centimeter long and viable. How old are you sir? And what ethnicity do you identify with?\nPatient: White male. I am fifty years old. Is my right leg going to be okay?\nDoctor: The skin looks viable. We can save the tissue.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPuncture wound with a flap injury on the right lower leg, V-shaped wound pointing towards the foot. Patient bitten by a German shepherd while adjusting a cable, treated by PCP with wound cleaning, bandaging, and tetanus shot before referral.\n\nASSESSMENT:\nPuncture wound with flap injury.\n\nPLAN:\nFurther assessment and treatment to save tissue viability."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: I'd like to get her in to see you sometime next week for her enlarged thyroid. \nGuest_clinician: Is she symptomatic? \nDoctor: Yes, she's experiencing increased difficulty swallowing. She's also reporting throat tightness on an off. \nGuest_clinician: What's her medical record number?",
"note": "ASSESSMENT:\n1. Enlarged thyroid.\n2. Difficulty swallowing, throat tightness.\n\nPLAN:\nSchedule appointment for next week to address enlarged thyroid, Symptoms of difficulty swallowing and throat tightness."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Welcome back to the clinic, Miss A B C. \nPatient: Thank you. \nDoctor: It looks like we last saw you June twenty first, this year. Doctor X and Y referred you for the evaluation of your pinched nerve in the C six regain on the left side. I also see that we are following up on the significant rotator cuff tear on the left side. Did you get scheduled for the surgery with Doctor Yen yet? \nPatient: Yes. I believe the surgery is scheduled for July twentieth. \nDoctor: How is your shoulder feeling? \nPatient: My shoulder is the same. I am still in a significant amount of pain. \nDoctor: I am sorry to hear that. Your surgery is coming up soon and that should help. \nPatient: I hope so. \nDoctor: We are also following up the pinched nerve in your upper left extremity C six. How are you feeling? \nPatient: I have had some pain starting in that same spot, and it goes down the left arm into my wrist.\nDoctor: Have you had any weakness associated with your upper extremities on the left side? \nPatient: It is mild and it is about the same as the last time. \nDoctor: Is it about the same as the last time you were here? We have it noted in the last note that it was mild as well. \nPatient: Yes. It has been the same. \nDoctor: Any weakness or symptoms on the right side? \nPatient: No, not really. \nDoctor: Any difficulty with mobility or moving around on either side? \nPatient: No. \nDoctor: Have you been experiencing any bowel or, bladder dysfunction. \nPatient: No. \nDoctor: I see in the chart for our last visit, I only had a report of a prior cervical spine M R I. I don't have any recent images. I going to refer you for a cervical spine M R I. Are you able to get the imaging done today and I will have you return to the clinic at the end of today?\nPatient: Yes. I can do that. I took the whole day off of work today. \nDoctor: Great! I will put the order in right now.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nLeft-sided shoulder pain, pain radiating down the left arm into the wrist, mild weakness in the left upper extremity. Continuing Symptoms of left shoulder pain and left upper extremity radiculopathy, scheduled for surgery for rotator cuff repair, no recent changes in Symptoms, no significant right upper extremity Symptoms, no bowel or bladder dysfunction, no difficulty with ambulation.\n\nASSESSMENT:\nLeft-sided rotator cuff tear, left-sided C6 radiculopathy.\n\nPLAN:\nRefer for cervical spine MRI to further evaluate radiculopathy, scheduled for surgery with Dr. Y for rotator cuff repair."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: You have an infection that has become septic. We are going to have to start you on intravenous antibiotics. \nPatient: Okay. \nDoctor: We also need to address the blood clotting. I am going to give you an anticoagulant to prevent any further clotting issues. Do you have any questions? \nPatient: No.",
"note": "ASSESSMENT:\nDisseminated intravascular coagulation, Streptococcal pneumonia with sepsis.\n\nPLAN:\nStart intravenous antibiotics, administer anticoagulant to address blood clotting."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there! Welcome to the clinic. \nPatient: Thank you. \nDoctor: Doctor Murphy sent your records over. I reviewed the ultrasound, and we did find a kidney stone that has become stuck in the ureter on the left side. The stone is large enough to block the flow of urine from the kidney to the bladder. How much pain are you having and where is the pain located? \nPatient: I am in a great deal of pain. It is coming from my left side right here. \nDoctor: Okay. Let use discuss your treatment options. \nPatient: Okay.",
"note": "HISTORY OF PRESENTING COMPLAINT:\npain in the left side\n\nASSESSMENT:\nkidney stone stuck in the left ureter\n\nPLAN:\ndiscuss treatment options"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: You have type two Diabetes? \nPatient: Yes.\nDoctor: And High Cholesterol?\nPatient: Yes.\nDoctor: Your diabetes is poorly controlled.\nPatient: I will keep an eye on it.",
"note": "ASSESSMENT:\ntype two Diabetes, High Cholesterol\n\nPLAN:\nDiabetes poorly controlled, patient will keep an eye on it"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Can you tell me more about your daughter's injury? \nGuest_family: Well, we came in in November, and she was diagnosed with an acute on chronic right slipped capital femoral epiphysis. \nDoctor: Did she have surgery on this? \nGuest_family: Yes, let me look at my notes, I have it written down here, um, a situ pinning. \nDoctor: Remind me, how old are you, dear? \nPatient: I'm thirteen now. \nDoctor: Okay, thank you. So, um, if you look her at the x rays, it appears that the screw is now going into the hip joint. \nGuest_family: They didn't see that before. What can we do about this? \nDoctor: We'll need to do another operation in order to remove this screw and put a shorter one in. We need to do the surgery because this can cause further joint damage.\nGuest_family: Are there any risks of infection from this surgery? \nDoctor: Overall, the risk of infection is very low, honestly its less than one percent. \nGuest_family: That's good to hear, will she go to sleep during surgery? \nDoctor: Yes, we'll use anesthesia the entire time. She won't feel a thing. \nGuest_family: What does recovery look like for this surgery? \nDoctor: I expect her to heal up very well, but there's always a risk of some changes in sensation and motion, and she may be stiff for some time following everything. Other risks include bleeding, but I would not worry about these things. \nGuest_family: Okay, how does that sound, honey? Would you like to do this?\nPatient: Yeah, I want to get back to playing sports with my friends.\nGuest_family: I agree, Doctor, we'll do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\npresented in November\n\nASSESSMENT:\nacute on chronic right slipped capital femoral epiphysis\n\nPLAN:\nunderwent in situ pinning, screw exchange discussed"
},
{
"source": "mts_dialog",
"dialogue": "Guest_clinician: I was not able to get her complete history and review of systems. But she is scheduled for a bladder distension surgery.\nDoctor: Okay.\nGuest_clinician: Also, I am not sure if she is off Coumadin because of the surgery. \nDoctor: Oh yeah, she has chronic AFib and she is on Coumadin. Not sure if she has stopped the medicine due to upcoming surgery.\nGuest_clinician: The only thing she could tell was that she was having tremors for the past three to four years and was diagnosed with early Parkinson's disease.\nDoctor: Alright.",
"note": "HISTORY OF PRESENTING COMPLAINT:\ntremors for the past three to four years\n\nASSESSMENT:\nearly Parkinson's disease\n\nPLAN:\nscheduled for bladder distension surgery, uncertainty regarding continuation of Coumadin due to surgery"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Your culture results came back positive for Streptococcus pneumoniae. This is a bacterial infection. I would like to take a course of antibiotics. This should start to improve your symptoms with in three to four days. \nPatient: Okay. \nDoctor: Please let me know if your symptoms have not improved or becomes worse. \nPatient: I will. Thank you.",
"note": "ASSESSMENT:\nStreptococcus pneumoniae bacterial infection (upper respiratory infection)\n\nPLAN:\ncourse of antibiotics"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, young lady. Is this your mother? \nPatient: Yes, this is my mommy. \nDoctor: Good morning, mom. Can you tell me more about your daughter, please?\nGuest_family: Good morning, doctor. Well, she's thirteen now, but she's had feet problems all her life. \nDoctor: What's been the problem with her feet?\nGuest_family: Well, she had bilateral feet corrections when she was a year old. \nDoctor: Okay, how has she been since that procedure?\nGuest_family: Well, just look at her heel, doctor. \nDoctor: Yes, I see. She has pretty significant calcaneal valgus deformity. \nPatient: What does that mean, doctor? \nDoctor: Your heel is out of alignment, sweetie. Do you have pain?\nPatient: Yes, I have a lot of pain, doctor. \nGuest_family: What can we do about this, doctor? \nDoctor: Well, given all of her symptoms, I think we should do a calcaneal osteotomy and Achilles lengthening procedure. \nGuest_family: What does that procedure entail? \nDoctor: Well, in short, we'll go in there and straighten everything out, and get everything lined back up. \nGuest_family: What's the risk of infection with the surgery, sir? \nDoctor: Actually, it's less than one percent, so it's extremely low.\nGuest_family: How is this possible, doctor?\nDoctor: We use antibiotics to control for infection the entire time. \nGuest_family: That's great. Will she be asleep for this procedure? \nDoctor: Yes, we'll use anesthesia the entire time. She won't feel a thing. \nGuest_family: Okay, that's good too. What about after the procedure? What's the protocol?\nDoctor: Well, I'll need your help. We have to be strict about her being nonweightbearing for six weeks at minimum. \nGuest_family: Will she need a brace too?\nDoctor: Yes, at least for six months, but if she does everything I ask of her, it will be only six months. \nGuest_family: Okay, yes, I think we should do the procedure. What do you think, honey?\nPatient: Yes, I want to get back to playing sports with my friends.\nDoctor: The other risks include bleeding; changes in sensation in most of extremity; hardware failure; need for later hardware removal; possible nonunion; possible failure to correct all the deformity; and need for other surgical procedures. I would not worry about these issues, though. It is quite rare. So, looking at her radiographs, the spinal arch is definitely collapsed. I think you guys are making the right decision.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nsignificant pain in feet bilateral feet corrections at 1 year of age, significant calcaneal valgus deformity since then\n\nASSESSMENT:\ncalcaneal valgus deformity\n\nPLAN:\ncalcaneal osteotomy and Achilles lengthening procedure, strict nonweightbearing for at least 6 weeks, wearing a brace for up to 6 months"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, young man. Are these your parents?\nPatient: Yes. \nDoctor: Good, can you tell me more about your son, please? \nGuest_family_1: Well, he's five now, and he fell onto his right arm on December fifth two thousand seven.\nDoctor: After he fell, how was he treated? \nGuest_family_1: We went to the E D right after he fell, and they said he had complete fractures of both bones in the arm. \nDoctor: Yes, I see that here, he also has shortening bayonet apposition. \nGuest_family_1: What can we do for this? \nDoctor: There's actually a few options here. First we can cast it and see how he heals, generally, children heal up very well from fractures. \nGuest_family_1: That's good, we like that option more than any kind of surgery. \nDoctor: However, surgery is also an option here as well. \nGuest_family_1: Yeah, to be completely sure we fix this, I think we should opt for the surgery, what do you think, honey?\nGuest_family_2: Yes, I agree. What are the risks of infection for this surgery?\nDoctor: The risk of infection is very low, generally less than one percent. We use antibiotics to control for infection. \nGuest_family_1: Will he be asleep for the surgery?\nDoctor: Absolutely, he won't feel a thing. Other risks include bleeding, changes in sensation and motion of the extremity, hardware failure, and need for later hardware removal, and cast tightness. I would not worry about these risks. We have great results with these surgeries. \nGuest_family_1: Then yes, we'd like to do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nrefracture of right forearm fell onto right arm on December 5, 2007\n\nASSESSMENT:\ncomplete fractures of both bones in right arm, shortening bayonet apposition\n\nPLAN:\nsurgery for closed reduction and pinning, with risks including anesthesia, infection, bleeding, changes in sensation and motion of extremity, hardware failure, need for later hardware removal, cast tightness"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello! What brings you back into the clinic today? \nPatient: I came back because I increased my methothrexate as we discussed the last time I was here. A few days later I started getting multiple canker sores in my mouth. They hurt. \nDoctor: I am sorry. It is likely that the increased dosage of your methothrexate is the cause of the mouth sores. Have you experienced a decreased appetite, nausea, abdominal discomfort or diarrhea?\nPatient: No. It is painful to eat with the sores, but I still have an appetite. \nDoctor: Have you had any new rashes, or hair loss? \nPatient: No. \nDoctor: I would like to get some bloodwork done. I would also recommend we decrease your dosage back to your previous amount. I would also like to see you back in two weeks to see how you are doing. \nPatient: Okay.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nmultiple canker sores in mouth, pain while eating increased methotrexate dosage, resulting in mouth sores\n\nASSESSMENT:\nstomatitis, possibly methotrexate related\n\nPLAN:\ndecrease methotrexate dosage back to previous amount, bloodwork, follow-up appointment in two weeks"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How long has she had difficulty swallowing? \nGuest_family: A while now. We scheduled her to see an endocrinologist, but she's not able to get in until Monday. I wanted to see if we could get to the bottom of it now. \nDoctor: It does appear that her thyroids are fairly enlarged. I believe that's where most of her symptoms, if not all, are stemming from. \nGuest_family: Does that mean she'll need surgery? \nDoctor: We'll have to see, but chances are higher since she's experiencing symptoms due to her thyroid. \nGuest_family: When will we find out? \nDoctor: I'd like to get some imaging done and see if we can get a consult in first.",
"note": "ASSESSMENT:\n1. symptomatic thyroid goiter\n2. difficulty swallowing difficulty swallowing for a while, scheduled to see endocrinologist on Monday, enlarged thyroid\n\nPLAN:\nimaging to be done, consult with specialist"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: When was your injury, sir? \nPatient: Um, if I recall, it was on November twentieth two thousand eight. \nDoctor: What do you do for a living, sir? \nPatient: I work at the Purdy Correctional Facility, doctor. \nDoctor: How did you get hurt?\nPatient: Well, an inmate broke some of the overhead sprinklers, and I slipped on all the water and I landed on the back of my head, and then onto my back. \nDoctor: Which side took most of the hit? \nPatient: It was mostly on my left side. \nDoctor: How were you after the fall? \nPatient: Well, I was pretty stunned, mostly. I didn't want to come in, but my employers asked me to just to be sure. \nDoctor: Who has evaluated you to date?\nPatient: Um, I went to Gig Harbor Urgent Care, and then they sent me to Tacoma General Hospital. At Tacoma they said I have a whiplash and concussion.\nDoctor: What did they do at the hospital? \nPatient: Um, they did a C T scan, and they found a dark spot on my brain. \nDoctor: What did they recommend about the spot? \nPatient: They said I should have another M R I and they diagnosed an, um, recurrent acoustic neuroma. \nDoctor: So, you've had this before? How did they know you had it? \nPatient: I used to see a chiropractor, and they suggested that I get a scan and that's how they found it before. \nDoctor: When was this? \nPatient: Um, it was in October of two thousand five. \nDoctor: Did you have surgery on this? \nPatient: Yes, I'm recovering now. \nDoctor: Are they still considering radiation?\nPatient: Yes, it's under consideration but there's no final decision yet.\nDoctor: Okay, what does the chiropractor do for you?\nPatient: You know, the usual, adjustments and massages, stuff like that. \nDoctor: Has there been any improvement? \nPatient: Overall, my spine pain has improved a lot. \nDoctor: That's good. Okay, so after your fall, what other treatments did you have?\nPatient: I went to Prompt Care in Bremerton, and saw Doctor X Y Z. She's an osteopathic doctor. \nDoctor: How did she treat you? \nPatient: She ordered an M R I of my neck, I have the report right here. \nDoctor: Okay, this shows some mild disc bulge at C four C five. Did she let you go back to work?\nPatient: Yes, she released me back to full duty. I was doing fine after the neurosurgical treatment. \nDoctor: Do you have any other treatment planned?\nPatient: Some radiation. \nDoctor: What else has she treated you for?\nPatient: Oh, you know, just general aches and pains on my back and neck. I have been seeing her since two thousand and two.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nmild disc bulge at C4-C5, spine pain improvement injured on November 20, 2008, primarily landed on left side after slipping on water at work, diagnosed with whiplash and concussion at Gig Harbor urgent care and Tacoma General Hospital, brain CT showed dark spot, follow-up MRI showed recurrent acoustic neuroma, initial acoustic neuroma diagnosed in October 2005 after chiropractor suggested scan, receiving chiropractic adjustments and massages since 2002 for general aches and pains, treated by osteopathic physician for spine issues, full duty released after neurosurgical treatment, radiation planned\n\nASSESSMENT:\nwhiplash, concussion, recurrent acoustic neuroma\n\nPLAN:\nundergoing neurosurgical treatment, radiation planned"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: They took some fluid out of your back remember? \nPatient: Yes actually.\nDoctor: We got the results back for that and it looks like it was clear then it turned bloody. \nPatient: They checked my urine and blood too.\nDoctor: Yes, they did. I see the orders for urine culture, B M P, C B C, C R P, and blood culture as well.\nPatient: I got albuterol nebulizer treatment too.\nDoctor: That is good. but did that help you?\nPatient: No, it did not.\nDoctor: Oh I am sorry.\nPatient: It is okay.\nDoctor: I see that they gave you some antibiotics in E R?\nPatient: Yes, Ampicillin and Cefotaxime.",
"note": "ASSESSMENT:\npatient received a lumbar puncture with CSF fluid sent off for culture and cell count. This tap was reported as clear, then turning bloody in nature. The patient also received labs including a urinalysis and urine culture, BMP, CBC, CRP, blood culture.\n\nPLAN:\nThe patient also received 1 albuterol nebulizer treatment, which did not help his respiratory status. Finally, the patient received 1 dose of ampicillin and cefotaxime respectively."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, sir, how are you today? \nPatient: Good afternoon, Doctor, my knees are in a lot of pain today.\nDoctor: Is the pain equal? Or is one knee worse than the other?\nPatient: Um, the left knee hurts more than the right, but there's pretty significant pain with both. \nDoctor: Is it interfering with your ability to walk? \nPatient: Yes, I can walk like, maybe a half a mile a day, then the pain gets too bad. \nDoctor: Are you able to go up and down stairs?\nPatient: I have to take them one at a time. \nDoctor: I see you have degenerative joint disease of both knees, does that ring any bells?\nPatient: Yes, but what does that mean?\nDoctor: You have arthritis in both of your knees, sir.\nPatient: Ah, yes.\nDoctor: Have you had surgery on these knees? \nPatient: Um, I had surgery on both of these knees, let me check my notes. It was an, um, arthroscopy. \nDoctor: When were these surgeries?\nPatient: They were in the nineteen ninety one nineteen ninety two time frame, somewhere in there.\nDoctor: How have you managed this since the surgeries?\nPatient: I've taken antiinflammatories, had injections, and I've even used narcotics. \nDoctor: I see. If those haven't helped, I think you'd be a good candidate for knee replacements. \nPatient: Can we do both at the same time?\nDoctor: No, let's do the left since that one hurts more. Do you have any other conditions I should know about?\nPatient: I've had a lot of back surgeries, I have spinal stenosis. \nDoctor: Do you know what surgeries you've had?\nPatient: Let me check my notes, um, I've had a spinal decompression and epidural steroids injection. \nDoctor: Who has prescribed you narcotics for this pain?\nPatient: The pain is so bad, but Doctor X has handled those.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nLeft knee pain worse than right, significant pain in both knees, limitation in walking (approximately 1/2 mile a day), difficulty going up and down stairs (one at a time). The patient had arthroscopy on both knees in the 1991/1992 timeframe. He has been on a conservative treatment course including nonsteroidal anti-inflammatory drugs (NSAIDs), narcotics, and injections. Due to progressive limitations, he has opted for total joint surgery on the left knee. Additionally, he has had multiple back surgeries for spinal stenosis, including decompression and epidural steroid injections. Significant pain is managed with narcotic medication prescribed by Dr. X.\n\nASSESSMENT:\nSevere bilateral knee degenerative joint disease (DJD), left greater than right. Arthritis in both knees.\n\nPLAN:\nTotal joint surgery planned for the left knee due to persistent limitations. Management of back pain with narcotic medication."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Well, I am looking at your test reports and your blood sugars have been running up and down but nothing to be worried about but yeah, we need to keep monitoring. This morning it was perhaps a bit high at one hundred eighty-eight. Last time it was one hundred fifty and in one report it's around one hundred twenty and in lower teens too which is good. So, tell me how are you feeling?\nPatient: Well, I am doing okay. I am getting treated for hemorrhoids. I am also having some constipation from the past few weeks and I have recently developed this cough which is okay as I kind of get it often.\nDoctor: Oh boy, that's a lot going on!\nPatient: Yeah. \nDoctor: So, tell me are your hemorrhoids painful?\nPatient: No, it's fine.\nDoctor: And are you taking anything for constipation? \nPatient: Well, just prune juice.\nDoctor: Okay, let me write you an order for a laxative that should help. How bout cough? Any pain in the ribs while coughing?\nPatient: Nah, I am not bothered by it.\nDoctor: Any headache or nerve pain or body pain?\nPatient: Um, no I am fine.\nDoctor: Any fall or imbalance problem?\nPatient: No.\nDoctor: Any agitation or any other issues? \nPatient: Well, I am doing okay! Sometimes if I have pain, I take Tylenol and usually it works for me.\nDoctor: That's good!\nPatient: Yeah.\nDoctor: So, you have been seeking psychiatric help from Doctor Hudyncia right?\nPatient: Yes.\nDoctor: She mentioned in her report that you are responding well to her treatment and that your depression is under control and the medicine is working for you. That's good news. Oh, what medicine has she prescribed? Um let me see here in the report, oh okay, got it! It's Cymbalta. \nPatient: Right.\nDoctor: And no side effects, right?\nPatient: No.\nDoctor: And looks like the plan is to treat you for a minimum one year. \nPatient: Yeah.\nDoctor: Lastly, any breathing issues?\nPatient: No.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nconstipation, cough constipation for the past few weeks, recent development of cough\n\nASSESSMENT:\nhemorrhoids\n\nPLAN:\nprescribed laxative for constipation, treated with Tylenol for pain, responding well to psychiatric treatment with Cymbalta for depression, plan to continue Cymbalta for minimum one year"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: So, I think we need to start you on antibiotics for that ulcer on your right foot and possible osteomyelitis. I will send a prescription to your pharmacy. \nPatient: Sure.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nulcer on right foot\n\nASSESSMENT:\npossible osteomyelitis\n\nPLAN:\nstart antibiotics, prescription sent to pharmacy"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello, ma'am. What is the reason for your visit today? \nPatient: I was referred by a doctor to come see you so that you could check up on my nasal problems. Here is my report from my previous doctor who referred me to you. \nDoctor: Thank you. Let me take a look. I see here it says you had severe sinusitis two to three months ago, correct? \nPatient: Is that what they're calling my nasal problems? \nDoctor: Yeah, it is. Sinusitis is the inflammation of your nasal airways. \nPatient: I see. Thank you for describing it to me. \nDoctor: No problem. Would you be able to describe to me what you had been feeling two to three months ago? \nPatient: Yeah, I can. My face would feel uncomfortable, my nose was stuffy, my eyes hurt, and I felt something dropping in the back of my throat.\nDoctor: Have you ever been prescribed any medication? \nPatient: Here's the list of medicine I was taking. \nDoctor: I see you were given antibiotics, correct? \nPatient: I was, but I don't know what those are. Could you explain them to me? \nDoctor: Antibiotics are usually used to fight infections. \nPatient: I had an infection? I thought I just had some nasal problems. \nDoctor: Your report states you had a severe infection. Do you remember if the antibiotics helped? \nPatient: Not really. I felt like my symptoms were the same. \nDoctor: I see. Did your doctor order any advanced imaging's? \nPatient: Yeah. They did a C T scan of my nose. Here is the report from my C T scan. \nDoctor: Let me take a look. It looks like you had some thickening of the mucosal layer in your right paranasal sinus. You also had some obstruction in your right ostiomeatal complex and excess growing of some of the bones in your nose. Uhm. Oh, one more thing. I see your nasal septum was shifted to the left. \nPatient: Oh, wow. Thank you for explaining everything to me. \nDoctor: No problem. Going back to your list of medications, I know you took antibiotics for your infection, but did you take any medication for your sinuses? \nPatient: No, I haven't. I did try this cream for my nose, but that didn't work either. Nothing worked! \nDoctor: I see. Looks like the cream you used was a topical nasal corticosteroid. Are there any other symptoms that you have been experiencing? \nPatient: I've had some trouble with my balance, and I feel like I've lost some of my hearing. I thought this was odd since I'm only fifty years old. I think my ears felt plugged or full of air, so they just needed to pop. \nDoctor: I see. Let's perform an audiogram test to check your ears. \nPatient: Sounds good. \nDoctor: I'm seeing that you have some mild high frequency sensorineural hearing loss. Your tympanometry seems to be normal. Your speech discrimination was also normal. \nPatient: That's reassuring. \nDoctor: I want to ask a few more questions about your ears. Do you feel any fullness or pressure? \nPatient: No, I don't feel anything like that right now. \nDoctor: Do you hear any humming, buzzing, or roaring sounds?\nPatient: Nope. I don't hear anything like that. \nDoctor: We checked your ears and now understand more about the problem, but I wonder why your balance is affected. When did you start noticing your balance was affected? \nPatient: I think it could have been to this one medicine that starts with an A. I forgot the name, but it didn't really help my nasal problems. It just made my balance worse. \nDoctor: Was the medicine called Allegra? \nPatient: Oh, yeah. That's what it was called. I thought I had some sort of allergy, so I thought it would help. \nDoctor: I see. Did you ever feel any dizziness too? \nPatient: Yeah, I did. \nDoctor: I will have you do some movements to see if your dizziness occurs. \nPatient: Sounds good. \nDoctor: Could you look to the left and then look to the right. \nPatient: Oh, wow. That made me very dizzy. \nDoctor: Looks like sudden movements and head turning make your dizziness worse.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nfacial discomfort, nasal congestion, eye pain, postnasal drip, balance issues, hearing loss, dizziness severe sinusitis two to three months ago, minimal improvement with antibiotics, tried topical nasal corticosteroid therapy and Allegra without much improvement, worsened balance with Allegra\n\nASSESSMENT:\nchronic sinusitis, mild high frequency sensorineural hearing loss\n\nPLAN:\nperform audiogram test (results: mild high frequency sensorineural hearing loss, normal tympanometry, normal speech discrimination), further evaluation and treatment for chronic sinusitis, avoid Allegra due to worsening balance, assess dizziness with positional changes"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: And who are we seeing today?\nGuest_family: Hi Doctor, this my son J and that's my wife. \nGuest_family_2: Hi there \nDoctor: Well, hello young man how are you feeling today?\nGuest_family_2: He has been complaining of severe tummy pain and was crying the whole time. We are worried as he is a special child. He has autism. \nDoctor: For how long now?\nGuest_family_2: Autism?\nDoctor: No, I mean when did he start complaining of stomach pain?\nGuest_family_2: It started last night.\nDoctor: Oh okay, let me check him. Did he have any nausea or vomiting?\nGuest_family: Yes, he threw up a lot and is refusing to eat or drink anything.\nDoctor: And then he is complaining of tummy pain?\nGuest_family_2: Yes.\nDoctor: Well, the good part is he is not dehydrated. \nDoctor: Any diarrhea?\nGuest_family_2: Yes, he went three to four times.\nDoctor: Hm, but no blood or anything in the stools or vomit?\nGuest_family: No, nothing like that, we did not notice anything.\nDoctor: Okay good. \nDoctor: Well, let me run some tests but the signs and symptoms sound like he might have a stomach flu, also called as gastroenteritis in medical terms. I will start him on some medicines and hopefully that should help.",
"note": "ASSESSMENT:\n1. Gastroenteritis\nAutism\n2. Severe abdominal pain\n- Crying\n- Nausea\n- Vomiting\n- Refusal to eat or drink\n- Diarrhea The patient, a young boy with autism, has been experiencing severe abdominal pain since last night. He has been crying and exhibiting signs of distress. He has also been vomiting frequently and refusing to eat or drink. Additionally, he has had several episodes of diarrhea, although there is no blood present in the stools or vomit.\n\nPLAN:\nThe doctor suspects gastroenteritis based on the Symptoms described by the family. Tests will be run to confirm the Diagnosis, and the patient will be started on appropriate medications to manage the Symptoms."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: What do you use to treat your asthma? \nPatient: I use my Albuterol inhaler.",
"note": "ASSESSMENT:\nasthma\n\nPLAN:\nAlbuterol inhaler"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Okay, tell me what's going on and what's brought you here. \nGuest_family: I am her mother. She has this blister on the side of her head right above her ear, here. I was just worried and concerned about my baby. \nDoctor: How old is the baby? When did you first notice it?\nGuest_family: She is just fourteen days old. Let me tell you from the beginning. On Friday, when I was taking her for a bath, I noticed a blister near her umbilicus area. We went to our doctor on Saturday, and they did a test. \nDoctor: Did you get the test result?\nGuest_family: I got it today. Here is the report. \nDoctor: Okay, let me have a look. It says she is having a growing M R S A.\nGuest_family: Yeah, I've been diagnosed with that too. And I am on medications. I had it on my buttock area. \nDoctor: Okay, so you know about it, and I don't have to explain it more.\nGuest_family: Yeah. \nDoctor: So how is the blister on the umbilicus now?\nGuest_family: She has been doing good. We put on some bacitracin ointment, and it almost healed up. But today I noticed that another small blister on her head. It really scared me, and I did not want to take any chance. That's why I reached out to the Infectious Disease center. I know it is private. But still, I don't want to take any chance with my baby's health. I called the center directly and they asked me to come to the hospital. \nDoctor: You did good. I will start the treatment. How are her eating and sleeping habits?\nGuest_family: She hasn't missed any of her meals. She is taking around two ounces of milk in every feed. I don't think I have any issues with her eating or sleeping. \nDoctor: Did she have any fever?\nGuest_family: Not that I noticed. \nDoctor: Has she been lethargic or crying more than normal?\nGuest_family: No. \nDoctor: Any other changes in her daily routine that you might have noticed?\nGuest_family: No, I didn't notice any changes.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nblister on umbilicus, small blister on left temporal area blister noticed near umbilicus on Friday, diagnosed with MRSA, treated with bacitracin ointment, another small blister noticed on left temporal area, mother also diagnosed with MRSA on buttocks\n\nASSESSMENT:\nMRSA infection\n\nPLAN:\ntreatment initiated for MRSA infection, monitoring for fever, lethargy, changes in eating or sleeping habits"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, young man. Is this your mother? \nPatient: Hi, doctor. Yes, this is my mom. \nDoctor: Good, can you tell me more about your son, ma'am?\nGuest_family: Sure, well, he's six years old now, and we're here to follow up his A D H D medicines. \nDoctor: He's been taking Adderall, correct? How long has he been taking this?\nGuest_family: It's been about a month now. \nDoctor: How has he responded to the Adderall?\nGuest_family: The first day he took it, truthfully, he was wonderful. There's been a lot of improvement in his behavior, and he's really been doing well, so far. \nDoctor: That's great!\nGuest_family: Yes, but I have two concerns. When he takes the medicine first thing in the morning it seems to take a while to kick in, and then it wears off at about two P M and he has problems in the evening. \nDoctor: Has he had problems with his appetite? \nGuest_family: Um, he did at first, but it's been coming back. It's more of a problem in the morning when he first takes the medicine in the morning, not so much in the afternoon after it wears off. \nDoctor: Have you gotten any reports from his teachers? \nGuest_family: They have seen a dramatic improvement with it. \nDoctor: Has he taken every dose?\nGuest_family: Well, I missed one last weekend, and he was just horrible. \nPatient: Yeah, mommy, I thought I needed it, but you didn't give it to me.",
"note": "HISTORY OF PRESENTING COMPLAINT:\ndelayed onset of medication effectiveness in the morning, medication wearing off in the afternoon, appetite issues initially improving, behavioral problems without medication improvement in behavior with Adderall medication, concerns about medication timing and effectiveness\n\nASSESSMENT:\nADHD\n\nPLAN:\ncontinue monitoring medication effectiveness and side effects, ensure consistent dosing schedule"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, sir. Welcome in. Let's get started, how old are you?\nPatient: Good afternoon, doctor. I'm fifty two years old. \nDoctor: My nurse says that you're here for an independent evaluation, is that correct? \nPatient: Yes sir, that is. \nDoctor: Good, what do you do for a living? \nPatient: Right now, I'm a temporary employee for A B C A B C, I've worked for A B C D, too. \nDoctor: What do you do there?\nPatient: Mainly, I handle the loading and unloading of furniture and appliances for people's houses. \nDoctor: That's hard work. When did you get hurt? \nPatient: It was about two and a half weeks ago now, back in October. \nDoctor: Do you have a history of back problems, like before this injury?\nPatient: Yeah, I've had back pain for a long time. \nDoctor: What happened when you got hurt this time? \nPatient: I was unloading one of the A B C eighteen wheelers, when I bent down to pick up some boxes, and I felt the pain. \nDoctor: What kind of pain did you feel? \nPatient: I felt a sharp pain in my lower back right away when I tried to lift those boxes. \nDoctor: Does your pain go down your legs?\nPatient: Yes, it goes into the right side of my butt, and then all the way down the outside of my right leg, like into the knee. \nDoctor: How have your symptoms progressed since they began?\nPatient: Doctor, they've only gotten worse. \nDoctor: Do you have any pain in your left leg?\nPatient: A little, not as bad as the right. \nDoctor: What other symptoms are you having besides the pain down your leg? \nPatient: The muscles in my butt are spazzing, and it's happening more and more. \nDoctor: Have you seen another doctor for this? \nPatient: Yes, I saw Doctor Z at first. \nDoctor: What did they do for you?\nPatient: He gave me some muscle relaxers, and some, um, Lidocaine patches. \nDoctor: Did this help at all?\nPatient: No, not at all. \nDoctor: Who else have you seen?\nPatient: I saw doctor X Y Z too, through worker's comp. \nDoctor: When did you see them? \nPatient: That was back in April. \nDoctor: What did they recommend? \nPatient: Um, he sent me for an M R I, and I have the report for that right here. \nDoctor: Okay, this M R I report is basically negative, which is good. Did he give you any medications?\nPatient: Yes, he gave me some opioids. \nDoctor: Wow, that's strong stuff. What is your work status right now? \nPatient: Doctor X Y Z put me on restricted duty status, doctor. \nDoctor: I'm reading your notes from doctor X Y Z, he says he released you in June, and that you have reached maximum medical improvement. \nPatient: He told me that, but I still have pain, so I went back to see him. \nDoctor: When you went for follow up, did you still have that pain down your legs? \nPatient: Yes, I did. \nDoctor: What did doctor X Y Z recommend at that time? \nPatient: He referred me to a Pain Clinic, and he recommended I have, um, epidural injections with doctor A B C. \nDoctor: Did you have this done? \nPatient: Yes, I did. \nDoctor: Did this help at all? \nPatient: No, it did absolutely nothing. \nDoctor: Okay, so after that, what treatment did you have? \nPatient: I had an M R I, um, E M G, and nerve conduction study with doctor A B C D. \nDoctor: Do you have the results of that as well? \nPatient: Yes, doctor, they're right here. \nDoctor: Okay, sir, these tests are essentially normal, which is more good news. What aggravates your pain?\nPatient: Well, anything like sitting for a long time. When I do that, I feel it in my legs. \nDoctor: When you sit for a long time, is it in both legs?\nPatient: It's really on my right. \nDoctor: Are you able to sleep at night?\nPatient: No, sir, I'm not able to sleep at all. \nDoctor: Have you been able to return to work?\nPatient: Well, I went back to work in June, after doctor X said I'd reached the maximum medical improvement we talked about.\nDoctor: Finally, have you seen a chiropractor for this pain? \nPatient: Yeah, I saw doctor X about eight or nine times. \nDoctor: Did they do anything to help you feel better?\nPatient: Really, no, it did not. I still have the pain down my legs today.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nSharp lower back pain with radiation down right buttock and leg, muscle spasms in buttocks, worsened pain with sitting and stooping, difficulty sleeping due to pain Work-related injury involving lifting heavy objects, history of chronic back pain, unsuccessful treatment with muscle relaxers, lidocaine patches, opioids, epidural steroid injections, and chiropractic care\n\nASSESSMENT:\nLumbar radiculopathy\n\nPLAN:\nFurther evaluation and treatment options for lumbar radiculopathy, considering alternative therapies for pain management"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, can you tell me more about your son, ma'am. \nGuest_family: Sure, he's forty six, White, and he has Down syndrome.\nDoctor: Great, thank you. Is he still having problems with his hypothyroidism and onychomycosis? \nGuest_family: Yes, that's correct doctor. \nDoctor: Has he remained complaint with his Lamisil? \nGuest_family: Yes, he's taken six weeks of it with no problems. \nDoctor: Good, so we'll do an A L T blood test today.\nGuest_family: Why is that doctor? \nDoctor: Well, at his last appointment in April, he had an elevated T S H level. So, we should recheck that today. \nGuest_family: Yes, I remember that. \nDoctor: Has he been taking his Levothroid daily as well? \nGuest_family: Yes, he has, he doesn't like it, but I help him with it, and he eventually takes it. \nDoctor: Good, thanks for taking care of him, Mom. \nGuest_family: Oh, it's my job. \nDoctor: Does he take any other medications? \nGuest_family: He has some medicated eye drops for his cornea.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nfinished six weeks of Lamisil without problems, elevated TSH in April, started on Levothroid 0.1 mg daily\n\nASSESSMENT:\nhypothyroidism, onychomycosis\n\nPLAN:\nrecheck ALT and TSH levels, continue Levothroid for hypothyroidism, monitor compliance with medications"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, dear, how old are you?\nPatient: I'm fourteen years old. \nDoctor: Good, and what brings you in for a visit today? \nPatient: My left knee hurts really bad. \nDoctor: Oh no, how long has this knee been hurting you? \nPatient: Well, since the fall of two thousand seven. \nDoctor: Have you seen another doctor for this? \nPatient: Mom, can you tell the doctor?\nGuest_family: Yes, actually, we went to another orthopedist in November of two thousand seven.\nDoctor: I see, and what did this doctor recommend?\nGuest_family: We got an MRI, I have a disc with the images, and the report as well right here, if you want to take a look at it. \nDoctor: Thank you, yes, so this shows left patellar chondromalacia. Has she been to P T?\nGuest_family: We got a referral for P T, but they only wanted to do, um, let me look at my notes, patellar tracking exercises. \nDoctor: I see, has she been wearing her brace? \nGuest_family: Yes, she has been. I've been making sure of it. \nDoctor: That's good, and how is your pain today, dear? \nPatient: P T only made the pain much worse, it hurts so much.\nGuest_family: Yes, she's in a lot of pain, is there anything else we can do, besides P T?\nDoctor: Well, we're in a pretty difficult spot here. The majority of my patients get significantly better by just going to P T. \nGuest_family: Is there any surgery to fix this? \nDoctor: Usually, we manage this for six months without surgery, and she hasn't reached that milestone yet. But, because her pain is getting so severe, I can do a lateral capsular release on this knee. \nGuest_family: What is that?\nDoctor: It's a small procedure, minimally invasive, and we can do it outpatient. Her kneecap is partially dislocating, so this surgery will get everything back into alignment. \nGuest_family: Okay, what is the risk of infection?\nDoctor: The risk of infection is actually less than one percent. We use antibiotics to control for infection.\nPatient: Will I be asleep for this?\nDoctor: Yes, you won't feel a thing. \nPatient: Will I need to go back to P T?\nDoctor: Yes, you'll need to go some after the surgery to make sure everything heals up okay. The other risks include bleeding, changes in sensation and motion extremity, failure of procedure to relieve pain, need for postoperative rehab, and significant postoperative swelling.\nGuest_family: I think we'd like to do the surgery. What do you think, honey?\nPatient: Yeah, I think so too, I want to get back to playing soccer.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nleft knee pain. since the fall of two thousand seven, seen another orthopedist in November of two thousand seven, MRI done, referral for P T.\n\nASSESSMENT:\nleft patellar chondromalacia.\n\nPLAN:\nlateral capsular release surgery recommended, outpatient procedure, risks discussed including infection, anesthesia, need for postoperative rehab."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, ma'am. Before we begin, can you confirm your age for me, please? \nPatient: Sure, I'm fifty six years old. \nDoctor: Great, thank you. What seems to be the problem today? \nPatient: Well, I have a history of systemic lupus erythematosus. \nDoctor: How have you been treated for this in the past? \nPatient: Um, I went to a rheumatologist about four months ago, I had discomfort in both of my hands. \nDoctor: Which hand was worse? \nPatient: My left was worse than my right at that time. \nDoctor: Have you seen anyone else for this?\nPatient: Um, I came in on October thirtieth two thousand seven. I was having the same problem. \nDoctor: What did they do for you at that time? \nPatient: They have me a trial of Elavil because they thought it was, um, ulnar or radial neuropathy. \nDoctor: Did they give you any topical creams? \nPatient: Yeah, they gave me a prescription for Zostrix but I couldn't fill it because of my insurance. \nDoctor: I see, have your symptoms gotten worse since they began? \nPatient: Yeah, especially here, at the base of my left hand, like around my wrist.\nDoctor: Which fingers do you feel it in? If any? \nPatient: Right here, doctor. \nDoctor: Okay, these are your second, third, and fourth fingers. Do you have any other symptoms of note? \nPatient: Um, actually yeah, I've been having some respiratory problems for the last three days or so. \nDoctor: What symptoms have you been experiencing? \nPatient: Um, I've had a dry cough and I feel like I've had a fever but I haven't taken my temperature. \nDoctor: Have you had any night sweats or chills? \nPatient: No, not that I can remember. \nDoctor: Have you had any chest pain or discomfort?\nPatient: No. \nDoctor: What about shortness of breath, or G I problems? \nPatient: Thankfully, no.",
"note": "HISTORY OF PRESENTING COMPLAINT:\ndiscomfort in both hands (left worse than right), dry cough, subjective fever bilateral hand discomfort, previous visit on October 30, 2007, trial of Elavil for ulnar or radial neuropathy, prescription for Zostrix cream\n\nASSESSMENT:\nsystemic lupus erythematosus\n\nPLAN:\nroutine follow-up evaluation"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How's the little dude?\nGuest_family: He has fever and bad congestion for the last two days. He has had a fever for one. I try to suck the discharge out through nose. \nDoctor: I am guessing he has some mild problems with breathing while feeding.\nGuest_family: Yes, that is correct. He is drinking milk every couple hours, only for ten minutes instead of twenty minutes.\nGuest_family: He has fever too, so she gave him Tylenol.\nGuest_family2: He is very fussy.\nDoctor: Is he sleeping well? \nGuest_family: Yes, he sleeps. But he is not able to breath well even with albuterol.\nDoctor: How about wet and dirty diapers?\nGuest_family: He is peeing less I think because he used to have eight to ten wet diapers but now it's down to four in a day. And five dirty diapers.\nDoctor: How about any diarrhea?\nGuest_family: No, he doesn't have any diarrhea, they are soft and yellow.\nDoctor: Any rashes or acne?\nGuest_family: No. \nDoctor: How about vomiting?\nGuest_family: No, he did not vomit.\nDoctor: How old is he? And, sorry this is odd, but what ethnicity do you identify as? I need it foe the paperwork. \nGuest_family: Twenty one days old Caucasian male. \nDoctor: Do you notice him getting blue at all? Or does this area sink in when he tried to breathe?\nGuest_family: No, neither. \nDoctor: Is he having any trouble breathing in general?\nGuest_family: No.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nFever, congestion, decreased urine output, decreased feeding duration, fussiness. 21-day-old Caucasian male with 2-day congestion, decreased feeding, fever, reduced urine output, fatigue, and fussiness. No respiratory distress or vomiting.\n\nASSESSMENT:\nUpper respiratory tract infection (URI).\n\nPLAN:\n1. Continue suctioning nasal discharge.\r\n2. Continue Tylenol for fever management.\r\n3. Monitor feeding duration and frequency closely.\r\n4. Monitor urine output and diaper count.\r\n5. Monitor for any signs of respiratory distress.\r\n6. Follow up if Symptoms persist or worsen."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Congratulations on your new baby! How are you doing today?\nPatient: I'm doing well, no headaches, and I'm breastfeeding well. \nDoctor: Have you had any bleeding?\nPatient: Nope, none. \nDoctor: Are you using a mini pad?\nPatient: Yeah, I use it twice a day. \nDoctor: Do you have any cramping or clotting? \nPatient: No, thankfully I don't. \nDoctor: What color is your discharge, ma'am? \nPatient: Well, its turned from red to brown, and now its kind of yellowish. \nDoctor: Okay, have you had sex again yet?\nPatient: No, we're waiting a little longer. \nDoctor: Are you going to the bathroom regularly? \nPatient: Regularly? Yes, but I'm having some pain with it, and then every once in a while I have some bright red bleeding. \nDoctor: Are you constipated?\nPatient: No, I'm not. \nGuest_family: She hasn't been eating her vegetables like she should. \nDoctor: That'll also do it. \nPatient: Okay, well, my seasonal allergies are back too. \nDoctor: What symptoms do you have with your allergies? \nPatient: I get itchy watery eyes, a runny nose, I can't stop sneezing, and I have a lot of pressure in my ears.",
"note": "HISTORY OF PRESENTING COMPLAINT:\n- No headaches reported\r\n- Breastfeeding well\r\n- Minimal bleeding postpartum\r\n- Discharge turning yellowish\r\n- Occasional bright red bleeding with bowel movements\r\n- Seasonal allergies: itchy watery eyes, runny nose, sneezing, pressure in ears - Patient reports minimal bleeding postpartum, with discharge turning from red to brown to yellowish\r\n- Occasional bright red bleeding noted with bowel movements\r\n- Patient also complains of seasonal allergies, presenting with itchy watery eyes, runny nose, sneezing, and pressure sensation in ears\n\nASSESSMENT:\n1. Postpartum recovery\r\n2. Seasonal allergies\n\nPLAN:\n1. Monitor postpartum bleeding and discharge\r\n2. Recommend increasing intake of vegetables for better bowel health\r\n3. Advise on managing seasonal allergies with antihistamines or other appropriate medications"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there! It is good to see you both. How has everything been going for the both of you? \nPatient: Hi Doctor. \nGuest_family: Things have been pretty good. She has been having some new emotional outbursts. I made an appointment with the down syndrome behavioral specialist that you recommended from the last time we were here. \nDoctor: That is great. Keep me updated on her progress. Her bloodwork came back showing an underactive thyroid. This explains the recent weight gain and fatigue. I would like to start her on a medication called levothyroxine. We will need to check her bloodwork again in one month to see how her thyroid respond to the medication. \nGuest_family: Okay. \nDoctor: Is there any other concerns you have today? \nGuest_family: Yes. She has this toenail that looks strange and discolored. \nDoctor: Let me look. Can you remove your socks for me? \nPatient: Yes. \nDoctor: Is it this nail? \nGuest_family: Yes. \nDoctor: This is very common. It is called Onychomycosis. It is nail fungus. Since only one nail is affected, I would recommend starting off with a topical treatment. I will send the drops to your pharmacy. You will put on drop on the affected nail, daily.",
"note": "ASSESSMENT:\n1. Down's syndrome, Onychomycosis, Hypothyroidism\n2. emotional outbursts, recent weight gain, fatigue\n\nPLAN:\nstart levothyroxine for hypothyroidism, check bloodwork again in one month; topical treatment for onychomycosis"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello, it's nice to meet you. \nPatient: It's nice to meet you as well. \nDoctor: My name is Doctor X and I will be taking care of you today. \nPatient: Thank you. \nDoctor: I've been told that you'd like a refill on your Xanax prescription and something to help you break your smoking habit. \nPatient: Yes, I feel like I've tried everything in the book and I still can't break the habit. One of my buddies was telling me about this medicine called Clantix or something like that. \nDoctor: Yes, I've heard of Chantix. We can look into it and see what's best fit. \nPatient: Okay, great. Since moving back home, I've ran out of Xanax. \nDoctor: How long have you been taking it? \nPatient: Almost a year now. I usually take it on days where my anxiety is really bad. \nDoctor: I see here that you also have mesothelioma in the lining of your stomach, is that correct? \nPatient: Yes, I need to find a new cancer specialist that's closer to where I live. \nDoctor: Are you currently experiencing any pain? \nPatient: Not at the moment, but I do get pain when I eat sometimes. Other times it's when I'm not even doing anything. It's been chronic so nothing new. \nDoctor: Do you take anything for the pain? \nPatient: I haven't in a while. \nDoctor: When were you diagnosed with mesothelioma? \nPatient: About six or so months ago.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nchronic pain, pain when eating patient needs refills on Xanax, wants to quit smoking and interested in Chantix, has mesothelioma in the lining of her stomach causing problems with eating and chronic pain, recently moved back to the area and seeking a closer cancer specialist\n\nASSESSMENT:\nmesothelioma\n\nPLAN:\nrefill Xanax prescription, consider prescribing Chantix for smoking cessation, address chronic pain associated with mesothelioma, assist in finding a closer cancer specialist"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Welcome to the clinic. \nPatient: Thank you. It is nice to meet you.\nDoctor: It is nice to meet you to. I hear an accent. Where are you from? \nPatient: I am from Denmark. I speak Danish as my first language. Me and my husband have been in the States for many many years. When we first got here, we did not speak a word of English. \nDoctor: Wow! Your English is excellent now. \nPatient: Thank you. \nDoctor: How old are you? \nPatient: I just turned seventy four last month. \nDoctor: Happy birthday! \nPatient: Thank you. \nDoctor: So, your primary care physician sent you here for possible hydrocephalus. \nPatient: Is that the water on brain thing? \nDoctor: Yes. \nPatient: Then, yes. \nDoctor: Can you tell me about the symptoms that you have been having. \nPatient: I think I have been walking funny lately. I have also been losing my balance.\nDoctor: How do you know that you have been walking funny? \nPatient: My husband noticed that I have been walking funny. He noticed it about over six months ago or so. \nDoctor: What do you notice about the way your wife's walk that has changed?\nGuest_family: She walks wider then she used to, and I noticed that she stooped over. She walks much slower than she did before. She is often losing her balance. I have noticed her touching the walls and furniture to stabilize herself. \nDoctor: Okay. Have you noticed her stabilizing herself all of a sudden? \nGuest_family: No. It has been happening more and more over the last six months or so. \nDoctor: What else have you noticed about the way she walks? \nGuest_family: I noticed that she is having trouble stepping up onto things like a scale. She seems very unbalanced. She also seems to take her time as she walks. She can't be hurried. \nDoctor: That is good that you are taking your time. Do you use any devices to assist you to get around? Like a cane or a walker? \nPatient: No. \nGuest_family: I must help her get in and out of the car. Not every time but sometimes. I am very concerned because she has been falling more and more recently.\nPatient: I have had one emergency room visit. \nDoctor: What happened that you had to go to the emergency room? \nPatient: I fell. I was walking to the bedroom. I lost my balance so I put my hand out to brace myself against the wall and my hand slipped. I fell on my wrist. \nGuest_family: She broke her wrist.\nDoctor: When did this fall happen?\nPatient: March two thousand and seven.\nGuest_family: She has fallen a few times since she broke her wrist. It makes me so nervous. \nDoctor: I can see why that would make you nervous. Have you had any headaches? \nPatient: No. I never get headaches.\nDoctor: Aren't you lucky. \nPatient: Yes, I guess so. \nDoctor: Have you had any problems with your memory or cognitive abilities? \nPatient: I am still able to pay the bills on time. I don't feel as smart as I used to be. I do feel like my thinking has slowed down over the last few months. \nDoctor: What is your perspective on her memory and her cognitive abilities? \nGuest_family: I have noticed some changes. She will occasionally start a sentence and then not know what words to use to finish the sentence. \nDoctor: Has she ever had trouble finishing a sentence the in the past? \nGuest_family: No, she has always been very well spoken never has lost thoughts. \nDoctor: Have you had any fainting or vertigo episodes? \nPatient: I have not fainted. I have had some dizzy spells in the past but not recently. \nDoctor: Have you had and problems with your bowel movements? \nPatient: No. \nDoctor: Any bladder issues or frequent urination? \nPatient: No. \nDoctor: Okey. Let us do some an exam. \nPatient: Okey.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nlosing balance, stooping over, walking wider, walking slower, losing balance frequently, touching walls and furniture to stabilize, trouble stepping up onto things, unbalanced walking, slowing of speed, difficulty getting in and out of car, frequent falls, occasional dizziness, slowing of thinking, occasional difficulty finishing sentences. Patient presents with Symptoms of broadened base, stooped posture, declining balance over the last six months, frequent falls including one in March 2007 resulting in a broken wrist, occasional dizziness, slowing of thinking over the last few months, occasional difficulty finishing sentences.\n\nASSESSMENT:\nPossible adult hydrocephalus.\n\nPLAN:\nExamination indicated."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: I mean, I am so happy to see your report today, your blood pressure looks much better. That's amazing given your past few visits your B P was out of control and even with changing your medications we were having tough time bringing it down. \nPatient: Yeah, I feel much better, I read about my condition and it is called something as um refraction or--\nDoctor: Refractory hypertension.\nPatient: Oh yeah that!\nDoctor: But the good news is that it is getting better. \nPatient: Yes.\nDoctor: Last time we talked about seeing the internal medicine doctor there at your senior center, right?\nPatient: Yes, I made an appointment last week, um, no week before that, but I completely forgot about it.\nDoctor: Hm, okay we need to reschedule that. \nPatient: Yes, I will do it today.\nDoctor: Okay, your reports look fine. G F R is below sixty percent, that's a good sign. Overall, Miss K, you look better, but we need to reschedule your appointment with the Internist. That's kind of important.\nPatient: Okay, I will do that. Thank you!\nDoctor: You are welcome.",
"note": "ASSESSMENT:\n1. Refractory hypertension.\n2. Patient has a history of refractory hypertension, with recent improvement in blood pressure readings. Missed appointment with internist at senior center, GFR below sixty percent.\n\nPLAN:\nReschedule appointment with internist at senior center."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there! How are doing today? \nPatient: I am doing well. \nDoctor: How have you been doing with keeping your hemoglobin levels between four and five point six prercent? \nPatient: I have been doing well. I have been able to keep it within that range.",
"note": "ASSESSMENT:\nDiabetes mellitus, type 1.\n\nPLAN:\nFollow up on maintaining hemoglobin levels between four and five point six percent."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Before we begin today, sir, I just need a few pieces of background information. I see here on my chart that you're thirty years old, is that correct? \nPatient: Yes doctor, that's correct. \nDoctor: Okay, and which hand is your dominant hand? \nPatient: I use my right hand for everything. \nDoctor: Now, take me through the timeline of your symptoms, please. When did everything start?\nPatient: I was doing well until July of nineteen ninety three. \nDoctor: What were your initial symptoms? \nPatient: I began having weakness in my right arm, and there was some neck pain too. \nDoctor: Okay, when these symptoms began, how did you manage them?\nPatient: At first, I went to a chiropractor, but after a while my arm started atrophying, and my right hand felt tight. I couldn't extend all my fingers out. \nDoctor: Once you noticed the atrophy and contractures, that's the tightness you were experiencing, how were you treated? \nPatient: After that, I went to a neurosurgeon close to my house, and he ordered an, um, C T scan of my neck. \nDoctor: Okay, do you have the report of that C T Scan with you today?\nPatient: Yes, doctor, I have it right here. They were one on the twenty fifth of September in ninety two.\nDoctor: Thank you, okay, this shows an intramedullary lesion at C two three, and an extramedullary lesion at C six seven. \nPatient: That means tumor, right?\nDoctor: Yes sir. Did you have neck surgery?\nPatient: Yeah, I have the op notes right here. \nDoctor: Okay, just so you know, you had a C six T one laminectomy, and they decompressed the spinal cord. How did you respond to this surgery?\nPatient: Well, honestly, I improved for about three months following the operation, but after that I just got worse and worse. \nDoctor: Once your symptoms worsened, what happened? \nPatient: Um, I started having this burning sensation on my left side. \nDoctor: Did you have any weakness, sir?\nPatient: Yeah, I had weakness in both my arms.\nDoctor: Was one side worse than the other? \nPatient: Yes, my right side was worse than my left. \nDoctor: In addition to the burning and weakness, did you have any other symptoms? \nPatient: Um, I had really bad balance, I felt nauseous, like I was going to throw up at all times, which I did do some, and, um, my heart was beating really fast, and my blood pressure went up really high. \nDoctor: After all these symptoms began, how were you treated? \nPatient: On, um, August thirty first nineteen ninety three I had an M R I of my neck, and I have that report right here, too. \nDoctor: Thank you, this shows diffuse enlargement of the cervical and thoracic spine and multiple enhancing nodules in the posterior fossa.\nPatient: Sorry to interrupt, what does all that mean?\nDoctor: Well, that's more tumors in the spine. Did you have another surgery for this?\nPatient: Yeah, I had brain surgery. I have those notes right here, too. \nDoctor: Okay, so you had a suboccipital craniotomy with tumor excision, decompression, and biopsy. The biopsy showed hemangioblastoma. \nPatient: That's cancer, right? This was all done on September first of nineteen ninety three. \nDoctor: Well no, not exactly, it's a benign tumor. After this surgery how were your symptoms? \nPatient: I felt good, the doctors said I stabilized out. I went through some radiation procedures from September of ninety three to January nineteenth of ninety four. \nDoctor: How have your symptoms progressed since?\nPatient: I went to the NeuroOncology clinic on October twenty sixth nineteen ninety five because I was having weakness in both arms and both legs, as well as trouble swallowing food. \nDoctor: How much weakness was there?\nPatient: It was so bad I couldn't even put on a shirt, or raise my arms, or even feed myself. \nDoctor: Can you go up and down stairs?\nPatient: No, not really, but I can climb them. \nDoctor: How about going to the bathroom, is everything normal there?\nPatient: Yeah, no problems there. \nDoctor: Good, and what did the doctor at that clinic recommend?\nPatient: They were considering doing chemo.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nRUE weakness, neck pain, atrophy and contractures of right hand, left sided paresthesia, upper extremity weakness (right worse than left), ataxia, nausea, vomiting, hyperreflexia, progressive proximal weakness of all four extremities, dysphagia, difficulty with manual dexterity, difficulty going down stairs. Started experiencing RUE weakness and neck pain in 7/93, initially treated by a chiropractor, developed atrophy and contractures of right hand, underwent C6-T1 laminectomy with exploration and decompression of the spinal cord, Symptoms stabilized post-operatively for 3 months then progressively worsened, developed left sided paresthesia and upper extremity weakness, underwent suboccipital craniotomy with tumor excision, decompression, and biopsy on 9/1/93, underwent radiation procedures from 9/93 through 1/19/94, evaluated in NeuroOncology clinic on 10/26/95.\n\nASSESSMENT:\nintramedullary lesion at C2-3, extramedullary lesion at C6-7, hemangioblastoma.\n\nPLAN:\nConsideration of chemotherapy."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: We were not able to find the cause of your pain right now, but in the future, we will do a few more tests and then we can have a diagnosis.\nPatient: Will you give me some medicine for my stomach pain? And what about that feeling to throw up all of the time?\nDoctor: Yes, I will write a prescription. It will help you both with your pain and nausea.",
"note": "ASSESSMENT:\nSexual dysfunction, decreased desire, difficulty maintaining erection until completion, nausea, abdominal pain. 33-year-old black male presenting with sexual dysfunction, desires longer-lasting erections, took an online quiz on the Cialis website which indicated suboptimal erectile function, reports slight difficulty maintaining erection until completion, experiencing nausea and abdominal pain of uncertain etiology, no significant past medical history, no history of testicular infections or groin injuries, no history of hernias.\n\nPLAN:\nConsidering prescription of Cialis for improved erectile performance. Further evaluation and investigation required for nausea and abdominal pain."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: You had a bad acidity problem?\nPatient: Yes I was vomiting too.\nDoctor: What came out in the vomit?\nPatient: It was all brown colored things like coffee.\nDoctor: But nothing anymore, right?\nPatient: Yes I am all better.\nDoctor: Great!\nPatient: They told me I can go home.\nDoctor: Yes your blood count looks good, I just want you to continue Nexium forty M G once a day.\nPatient: I will do that.",
"note": "ASSESSMENT:\n1. Severe gastritis.\n2. Coffee-ground emesis, vomiting, acidity problem, resolved. Patient experienced coffee-ground emesis and vomiting due to severe gastritis, Symptoms resolved, stable condition at discharge.\n\nPLAN:\nPatient to continue Nexium 40 mg once daily."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How's he feeling today? \nGuest_family: I think this is the worst he's been feeling all week. \nDoctor: I'm sorry to hear that he hasn't been feeling well. What symptoms has he been having? \nGuest_family: He's been very congested as of late and seems to be coughing a lot more than usual. He was also running a fever yesterday. \nDoctor: I see. What was his temperature? \nGuest_family: The thermometer was reading one hundred and one degrees Fahrenheit. Does he need to go to the hospital? \nDoctor: Let me evaluate and see what we can do for him today. \nGuest_family: Thank you, doctor. \nDoctor: I suspect that he has an upper respiratory infection, possible pertussis. Is he still experiencing apnea?",
"note": "ASSESSMENT:\n1. Upper respiratory infection, possible pertussis.\n2. Congestion, increased coughing, fever (temperature of 101\u00b0F). Patient experiencing congestion, increased coughing, and fever; possibility of pertussis indicated by doctor, inquiring about presence of apnea.\n\nPLAN:\nDoctor to evaluate and determine appropriate course of action."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi, how can I help you, ma'am?\nPatient: I have no complaints.\nDoctor: Okay but tell me what is going on and we can figure this out.\nPatient: Okay so my right hand and left foot was very swollen and very painful, and that's why I came to emergency room. \nDoctor: Do you have urine bag?\nPatient: Yes, I could not go so they put it in.\nDoctor: Yes, it looks like five hundred M L came out. So possible urinary obstruction. Also, they started you on steroids and colchicine. How are you feeling now?\nPatient: I am feeling a little better, my pain is improving, and the swelling is getting better.\nDoctor: Okay that is good. Any fever and chills?\nPatient: No, no fever.\nDoctor: Any problem with urination like pain or frequency or blood in urine?\nPatient: No but I am not able to empty my bladder well, the pee has decreased a lot, I could not urinate.\nDoctor: Okay I will evaluate that. How about any cough, blood in sputum?\nPatient: No nothing like that.\nDoctor: Any chest pain, or difficulty breathing?\nPatient: No pain, I can breathe well.\nDoctor: Okay that sounds good.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nSwelling and pain in right hand and left foot, difficulty urinating, decreased urine output. Patient presented to the emergency room with swollen and painful right hand and left foot, difficulty urinating, and decreased urine output. Foley catheter inserted with 500 mL urine output. Started on steroids and colchicine, with improvement in pain and swelling.\n\nASSESSMENT:\nPossible urinary obstruction.\n\nPLAN:\nFurther evaluation for urinary obstruction."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, young man. \nPatient: Good afternoon, doctor. \nDoctor: How old are you, sir?\nPatient: I'm thirteen. \nDoctor: So, what brings you in today?\nGuest_family: Well, at first, we went to Sierra Pacific Orthopedic Group, and he had an M R I that showed, um, O C D in the left knee. \nDoctor: Yes, I see that from the report. \nGuest_family: So, we're here for a second opinion on that.\nDoctor: Yes, we should do surgery on this knee. There's gross instability of the fragment, and we don't want that get worse. \nGuest_family: Okay, that's about what we've heard so far. What are the risks of infection of the procedure? \nDoctor: It's less than one percent. We use antibiotics to control for infection. Other risks include bleeding, changes in sensation of the limb, changes in motion, failure to relieve pain or restore the articular cartilage, the possible need for another procedure, and possible early arthritis. I would not worry, though. These things are rare.\nGuest_family: Okay, will he be asleep the entire time?\nDoctor: Yes, he won't feel a thing. \nGuest_family: Okay, my husband agrees. We want to do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPersistent left knee pain. 13-year-old male initially seen at Sierra Pacific Orthopedic Group, MRI demonstrated unstable OCD lesion of the left knee, presented for a second opinion, surgery recommended due to instability of the fragment, risks and benefits of surgery discussed, risks include anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure to relieve pain or restore articular cartilage, possible need for other surgical procedures, and possible early arthritis, parents agreed to the plan.\n\nASSESSMENT:\nUnstable OCD (osteochondritis dissecans) lesion of the left knee.\n\nPLAN:\nSurgery recommended to address the unstable OCD lesion in the left knee."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Welcome to the clinic, ma'am. I am Doctor Smith. \nPatient: Thank you. It is nice to meet you. \nDoctor: Doctor X referred you to us, is that correct? \nPatient: Yes. He is my primary care doctor. \nDoctor: It looks like you have a birthday coming up. Happy early birthday! \nPatient: Thank you. Yes, I am going to be seventy seven. \nDoctor: Doctor Kim's notes said that you have had pain in the left flank pain. Can you tell me more about the pain? \nPatient: Yes. The pain started four or five days ago. It has been in my stomach and through to my back, on the left side. Right here. \nDoctor: Okay. Have you had any nausea or vomiting? \nPatient: Yes. I had some nausea, and I threw up a few times. \nDoctor: Have you noticed any blood, pain and or burning during urination? \nPatient: No. \nDoctor: Any fever or chills? \nPatient: No. \nDoctor: I have the ultrasound results that Doctor X ordered the other day. The ultrasound found a stone in your left ureteral. The stone is about one point three C M in size. \nPatient: Is there some thing we can do to remove it? I really want this taken care of. \nDoctor: Yes. Let us go over the treatment options.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nleft flank pain, pain in abdomen and back, nausea, vomiting. pain started 4-5 days ago, nausea and vomiting present, no hematuria, dysuria, burning, or pain during urination, no fever.\n\nASSESSMENT:\nleft ureteral stone (1.3 cm in size).\n\nPLAN:\ndiscuss treatment options for removal of the ureteral stone."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, ma'am. You're forty one years old, correct? \nPatient: Good afternoon, doctor. Yes, that's correct. \nDoctor: Thank you, have you followed up with Doctor X since your surgery? \nPatient: Why would I do that? \nDoctor: Oh, just because she referred you to me. \nPatient: Oh, no, I haven't yet. \nDoctor: That's fine. Have you heard the details behind your surgery? \nPatient: I heard it once, but I can't remember anything. Can you remind me? \nDoctor: Well, you had a complicated case, but we did an anterior cervical discectomy, two level corpectomy, with a spinal decompression and fusion with fibular strut and machine allograft in your large cervical plate. \nPatient: Oh, that's a lot, doctor. \nDoctor: Yes, how are you doing today? \nPatient: Well, I've felt good for the last two days.\nDoctor: Have you been able to move your arms and legs for the last few days?\nPatient: Yeah, I can actually move all four. \nDoctor: Good, are you having any issues breathing? \nPatient: No, nothing of note there. \nDoctor: Okay, today, I think you'd be a good candidate for a halo vest placement. \nPatient: Yeah, doctor, I'm not going back to the O R. \nDoctor: Okay, we can do it here. \nPatient: Okay doctor, I'd like to do it here. \nDoctor: Let me get A B C to help me with this. Also, we're going to move you to S I C U room one. \nPatient: Can you tell me the details about what you're going to do? \nDoctor: Well, this is a P M T halo, I like this one better than the Bremer halo vest, and I'll use morphine and Versed.\nPatient: Are you going to use anesthesia? \nDoctor: Yes, I have local anesthetic, it's xylocaine and epinephrine, um, it's somewhere between fifteen and twenty C C.",
"note": "ASSESSMENT:\nsevere cervical spondylosis and myelopathy, post-surgical status following anterior cervical discectomy, 2-level corpectomy, spinal decompression and fusion.\n\nPLAN:\nperformed halo vest placement (PMT halo) using morphine and Versed for anesthesia, local anesthetic (xylocaine and epinephrine) for the procedure, done at bedside in SICU room #1."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How are you feeling after that insulin drip, Miss A B C? \nPatient: I am feeling much better. My sugar levels are normal.\nDoctor: Yes, between one hundred fifteen and one thirty four. So, on the second day after your admission they did laparoscopic removal of your gallstones. You were very difficult to intubate. But everything went well with surgery. There was some swelling and adhesions around your gallbladder, but all is well that ends well.\nPatient: What was my blood sugar during surgery?\nDoctor: Great question. After surgery they were around two thirty three. \nPatient: I am getting a special insulin?\nDoctor: Yes, sliding scale insulin. \nPatient: Can I go home?\nDoctor: Yes, you are all set to go home, everything is stable.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nAdmitted to hospital, insulin drip initiated, laparoscopic cholecystectomy performed due to gallstones, postoperative blood sugar measured at 233.\n\nASSESSMENT:\nChronic cholecystitis, difficult intubation.\n\nPLAN:\nManaged with sliding scale insulin, discharged home in stable condition following surgery."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, ma'am. \nPatient: Good morning, doctor. \nDoctor: Welcome to A B C D General Hospital. My nurse says that you are forty one years old, and you identify as a White female, is that correct? \nPatient: Yes, that's all correct. \nDoctor: Thank you, so, what seems to be the trouble today?\nPatient: Well, I'm having some pain in this foot, it's right over this bone. \nDoctor: Is your pain right here?\nPatient: Yes, it really hurts right there. \nDoctor: Okay, this is known as your navicular bone. What makes the pain worse? \nPatient: Usually wearing shoes makes it worse. \nDoctor: Do you have any past history of problems with this foot?\nPatient: Well, I have a history of multiple osteochondromas. \nDoctor: Do they know what caused these? \nPatient: No, no one ever figured it out, they just said it was hereditary. \nDoctor: Have they done surgery on these in the past? \nPatient: Yeah, I had a surgery for this a while ago. \nDoctor: Have you ever had this problem in your feet or spine?\nPatient: No, this is new. Can we do that surgery again? I can't take this pain.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nextreme pain over the navicular bone with shoe gear. pain in the foot, multiple osteochondromas of unknown origin, desire for surgical treatment.\n\nASSESSMENT:\nhereditary osteochondromas, previous dissection of osteochondromas.\n\nPLAN:\nsurgical treatment for pain in the foot caused by osteochondromas."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, sir, welcome to A B C D General Hospital. \nPatient: Thank you, doctor. I hope you can fix me up quickly. \nDoctor: We'll do our best. Um, before we begin, I just need some background information. So, how old are you?\nPatient: I'm forty seven years old. \nDoctor: Good, and what race do you identify with?\nPatient: I identify as white, sir. \nDoctor: Thank you, so, what seems to be the problem today?\nPatient: Well, I have this, um, mass of my left foot, it's been getting worse too.\nDoctor: I see it. How long has this tissue mass been there on that foot?\nPatient: It's been about two weeks now, but it's getting worse way faster now. \nDoctor: Do you have any history of cancer?\nPatient: No, but I've had an, um, shave biopsy in the past. \nDoctor: I see. \nPatient: Is there any surgery we can do for this to cut it off? I really want it gone.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nmass on the left foot, worsening over two weeks\n\nASSESSMENT:\ntissue mass on the left foot, history of shave biopsy\n\nPLAN:\nsurgical excision of the tissue mass on the left foot"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Just to debrief, we will rule out angina related heart problems while evaluating your jaw pain. \nPatient: Oh can that be related to each other?\nDoctor: Yes they might be.\nPatient: What else?\nDoctor: Pardon?\nPatient: I am asking anything else?\nDoctor: We have discussed this before, but keep track of your high cholesterol and hypothyroid.",
"note": "ASSESSMENT:\n1. Hypercholesterolemia, hypothyroidism\n2. Jaw pain, musculoskeletal; angina equivalent\n\nPLAN:\nRule out angina-related heart problems, monitor high cholesterol and hypothyroidism"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello, sir. How are you feeling today? \nPatient: Very itchy. I just keep scratching myself. \nDoctor: Oh, wow. I can see the rashes all over your arms. Are there rashes anywhere else? \nPatient: Yeah, it's all over my back and stomach. \nDoctor: I see it on your torso. When did this all start? \nPatient: I woke up this morning and started itching my back. After a few minutes, I noticed the rash was on my arms, chest, back, and stomach areas. \nDoctor: I'm going to take a look at the rashes and the rest of your body. \nPatient: Sounds good. \nDoctor: It looks like your face and lips are not swollen. Could you say ah for me? \nPatient: Ah. \nDoctor: It looks like your tongue isn't swollen either. \nPatient: That's good to hear. \nDoctor: Have you been feeling a shortness of breath, wheezing, or other related symptoms?\nPatient: Not that I know of. \nDoctor: Sounds good. I wonder why this happened. Did you do anything the night before? \nPatient: Uh. A few days ago, I was working and had to remove some insulation. Other than that, I don't know what else could have given me these rashes. \nDoctor: I see. Do you remember being itchy after that? Did you try any new foods? \nPatient: Nope I was not itchy. Also, my diet has been the same. \nDoctor: Are you taking any new medications? \nPatient: I haven't. \nDoctor: You don't recall being exposed to any other substances? \nPatient: Not that I know of.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nVery itchy, rashes all over arms, back, stomach, torso; no facial, tongue, or lip swelling; no shortness of breath or wheezing Itchiness started this morning, rash appeared on arms, chest, back, and stomach areas; no changes in foods, medications, or exposures; worked on insulation a few days ago but didn't feel itchy that day.\n\nASSESSMENT:\nItchy rash, cause unknown.\n\nPLAN:\nExamine rashes, investigate potential triggers, monitor for any additional Symptoms."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there, sir! How are you doing today? \nPatient: I feel out of it. \nDoctor: Have you been using any substances? \nPatient: I did a little heroin and some coke earlier today. I still feel high. \nDoctor: Okay. Any shortness of breath, chest pain, abdominal pain or back pain?\nPatient: No. \nDoctor: Are you having any headaches, hallucinations or visual disturbances? \nPatient: No. \nDoctor: Do you have any open sores or wounds? \nPatient: No.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nFeels \"out of it\" after using heroin and cocaine, no headache or visual complaints, no hallucinations, no chest pain, shortness of breath, abdominal pain, back pain, or open sores/wounds\n\nASSESSMENT:\nSubstance use (heroin, cocaine)\n\nPLAN:\nMonitor for any changes or complications related to substance use"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How old are you, sir? \nPatient: I'm sixty five years old. \nDoctor: Are you right handed or left handed? \nPatient: I'm right handed. \nDoctor: When was your last stroke? \nPatient: Well, it was on January seventeenth. I had these episodes where I was like always so confused and looks like I lost everything. All my memory and everything. And then they did a scan. It was verified that I was having a stroke on the same day. \nDoctor: Did they put you on some medications? \nPatient: They gave me an anticonvulsant and aspirin. \nDoctor: Are you taking them regularly? \nPatient: There have a few times like one or two days that I forgot to take my, uh, dyphenhydramine, but even when I'm taking it regularly, I'm still having all those symptoms or forgetfulness, confusion, and everything. \nDoctor: Do you feel anything else along with these episodes like a urine urgency, tendency to bite your tongue, headaches, any visual change, or your heart is beating very fast? Any kind of weakness or numbness or shortness of breath? \nPatient: No nothing else, just the confusion and forgetfulness. \nDoctor: How frequent are these episodes? \nPatient: Well, they occur like two or three times in a week. Each one of the episodes lasts for like one or two minutes.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nEpisodic confusion and memory loss lasting several minutes, forgetfulness, confusion, no other associated Symptoms\n\nASSESSMENT:\nStroke on January 17, 1992, anticonvulsant and aspirin medication, episodes occur 2-3 times per week\n\nPLAN:\nMonitor medication adherence, evaluate for potential underlying causes of ongoing Symptoms"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Do you have any major medical conditions that I should know about? \nPatient: Actually, I have a whole list of conditions. I have them written down here. \nDoctor: Thank you, so I see congestive heart failure, chronic renal insufficiency, azotemia, hyperglycemia, coronary artery disease, and a history of paroxysmal atrial fibrillation. Oh, and azotemia.\nPatient: Yes, I told you I have a lot going on. \nDoctor: Are you taking any medications? \nPatient: Well, they wanted me to take Coumadin but I had, um, a subdural hematoma so they would let me. \nDoctor: I see, what about any neurological or psychological conditions? \nPatient: Well, I have depression, and I've had panic attacks while taking Doxepin before. \nDoctor: I see here that you also have perioperative anemia, does that sound familiar? \nPatient: Yes, another doctor told me about that. \nDoctor: Do you have any other symptoms you'd like to report today? \nPatient: Um, I'm having some difficulty swallowing.",
"note": "PAST MEDICAL HISTORY: Difficulty swallowing\n\nASSESSMENT:\nCongestive heart failure, chronic renal insufficiency, azotemia, hyperglycemia, coronary artery disease, paroxysmal atrial fibrillation, remote history of subdural hematoma precluding the use of Coumadin, depression, panic attacks on Doxepin, perioperative anemia, swallowing difficulties\n\nPLAN:\nEvaluate difficulty swallowing and address underlying medical conditions"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How are you, Mary? \nPatient: I am okay, I have got this ulcer on my right hip again. \nDoctor: Oh, is it like the one you got last time?\nPatient: Pretty much.\nDoctor: Oh, I remember that one. It took almost three treatment cycles to get resolved.\nPatient: Yeah. They keep saying I have some hidden split in my spine still. \nDoctor: Yeah, it looks like you have residual spina bifida.\nPatient: I am just so frustrated sitting in my wheelchair. I am spending around sixteen hours a day in this wheelchair. \nDoctor: I think, that is the reason you developed this pressure ulcer. It appears to be on the right trochanter area. In simple terms you have developed a pressure sore on the outer part of your hip. \nPatient: Yeah, I recently celebrated my thirtieth birthday just sitting in my wheelchair the whole day.\nDoctor: Oh, I am sorry dear. So, how long since you have had this ulcer?\nPatient: It's been several weeks, so I thought I should get it checked.\nDoctor: Yeah, good thing you came. We need to treat it. Did you experience any chills or fever? \nPatient: No.\nDoctor: Any other symptoms?\nPatient: No.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nUlcer on right hip, spending around sixteen hours a day in wheelchair History of similar problem last year, spending most of time in wheelchair, developed pressure ulcer on right trochanter area several weeks ago\n\nASSESSMENT:\nResidual spina bifida, pressure sore on outer part of hip (trochanter area)\n\nPLAN:\nPresenting for evaluation and management of pressure ulcer, denies chills or fever, no other Symptoms reported"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Your chest x ray showed diffuse pulmonary edema. This means that you have fluid in your lungs. That would explain your chest pain and the difficulies with your breathing. I would like to start you off with a course of antibiotics to prevent any possible infection. I will also send in a prescription for Furosemide. It will reduce the fluid accumulation in your lungs. Do you have any questions? \nPatient: When should I start to feel better? \nDoctor: You should start to feel better within three to five days.",
"note": "ASSESSMENT:\nDiffuse pulmonary edema (fluid in lungs).\n\nPLAN:\nPrescribed antibiotics to prevent infection and Furosemide to reduce fluid accumulation in lungs. Patient should start feeling better within three to five days."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Alright. So this is going to be a complex case. Your wound is complicated by methicillin-resistant staphylococcus aureus cellulitis. \nPatient: Is there a treatment for my right leg?\nDoctor: There is. It will be more aggressive, but we can do it.",
"note": "ASSESSMENT:\nComplex open wound right lower extremity complicated by methicillin-resistant Staphylococcus aureus cellulitis.\n\nPLAN:\nAggressive treatment for the wound."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Welcome to the clinic, Miss A. \nPatient: Thank you. \nDoctor: Let's start with your medical history. What medical conditions do you have? \nPatient: Okay. I have high blood pressure, asthma and sleep apnea. I had blood clots in my left leg about six months ago. I also have cancer. \nDoctor: What kind of cancer do you have? \nPatient: I have stomach cancer. They also did a total abdominal hysterectomy. \nDoctor: Did they put you on an anticoagulant medication for the blood clotting? \nPatient: Yes. I took it for six months. I stopped taking it and then I had the stroke. \nDoctor: Have you had any other surgeries? \nPatient: Yes. I had a colonic resection to remove benign polyps. I had another benign lump removed from my breast. \nDoctor: How are you feeling today? \nPatient: I am still having weakness in my left leg. That is why I still have to us my walker, but I have been able to get around easier. \nDoctor: Have you been experiencing any daytime fatigue? \nPatient: No. I have been falling asleep at work. I think it is from looking at my computer screen all day. My supervisor caught me snoring one day and forgot where I was at. My supervisor offered to give me a coffee. This has happened more than once. \nDoctor: This could be due to your sleep apnea. Who is treating you for your sleep apnea? \nPatient: Doctor X did a consult and had me do one of those sleep test about two years ago. I only get sleepy when I look at my computer screen. \nDoctor: Did Doctor X recommend a C P A P machine to use at night? \nPatient: Yes, but I never used to use it. I had another follow up visit with her and she told me that I need to use it every night. I have been using it every other night. \nDoctor: How much uninterrupted sleep do you think that you get per night? \nPatient: Maybe two to five hours, on a good night. \nDoctor: That is not enough sleep. No wonder you are falling asleep at work. I recommend following up again with Doctor X regarding your sleep apnea. You are at a much higher risk for obesity and high cholesterol if you continue to not address the issues you have been having with the lack of sleep and sleep apnea. \nPatient: Okay. I will make a follow up visit with her.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nWeakness in left leg, daytime fatigue, falling asleep at work Patient reports continued left leg weakness and improvement in motor functioning. She acknowledges falling asleep at work, which she attributes to looking at a computer screen. She experiences snoring and forgetfulness at work, with a supervisor offering her coffee. Patient receives 2-5 hours of sleep per night.\n\nASSESSMENT:\nHypertension, asthma, sleep apnea, residual left leg weakness, obesity, hypercholesterolemia\n\nPLAN:\nPatient to follow up with Dr. X regarding sleep apnea treatment. Advised on risks of untreated sleep apnea, obesity, and hypercholesterolemia."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello. How are you doing? \nPatient: Not doing that good. I'm here so that you can help me. \nDoctor: Tell me how can I do that? What's bothering you? \nPatient: I have gestational diabetes and I'm here for consultation related to my diet. No matter what I eat, I'm kind of scared that it will spike up my numbers. \nDoctor: Hold on, hold on. First, tell me how old are you? \nPatient: Sorry. I am thirty eight. \nDoctor: Okay, now tell me what are you afraid of? \nPatient: No matter what I eat, my number goes up and I just, I'm so afraid of eating anything now. \nDoctor: Do you work? \nPatient: I do, at Walmart. I try not to eat anything whenever I'm on the third shift. \nDoctor: Tell me about the eating habits. Do you prepare meals at home, or do you order from outside? \nPatient: Well, before all this, I mean this gestational diabetes and pregnancy, I used to eat out a lot. Almost like every day. I like to eat rice a lot. It is like the staple food for me. \nDoctor: You said you don't try to eat, so are you facing any symptoms because of not eating? \nPatient: Yeah, whenever I'm on my late shift, I work from ten in the night to seven in the morning. I try to avoid eating. And then I feel very fatigued and tired all the time. I also have young kids at home, so after finishing my duty here at in the morning I go home and then there are young children who keep me busy. \nDoctor: What is your sleeping pattern? How much are you sleeping throughout the day? \nPatient: Around two to four hours at a time. \nDoctor: When do you test for ketones? \nPatient: Normally, it is the first thing that I do when I reach back home from my shift in the morning.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nFatigue, tiredness. Patient is scared to eat due to fear of blood sugar spikes. Works third shift at Walmart, avoids eating during late shift, leading to fatigue and tiredness. Previously ate out frequently and enjoys rice as staple food. Sleeps two to four hours at a time throughout the day. Tests for ketones upon returning home from work.\n\nASSESSMENT:\nGestational diabetes.\n\nPLAN:\nDietary consultation for gestational diabetes, advice on meal planning and timing to manage blood sugar levels."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there, how are you dear?\nPatient: I am fine, thank you.\nGuest_family: Hi Doctor, I am her mother.\nDoctor: Nice to meet you. So I see you have been referred by Doctor X.\nGuest_family: Yes, she is our family doctor.\nDoctor: Okay, so you noticed some behavioral problems with your daughter and reported to her, is that right?\nGuest_family: Yes, I have been noticing them for a while. She loses her focus quickly. We also got a few complaints from school regarding her behavior. We also met a couple of other doctors but they diagnosed her with Attention Deficit Hyperactivity Disorder.\nDoctor: Well, looking at her reports I am afraid it looks like she does have A D H D, but the good news is we can treat her, so don't worry.\nGuest_family: Okay. \nDoctor: I am going to prescribe her some medicines which will help her deal with this.\nGuest_family: Thank you. \nDoctor: So, I will write her a prescription for Adderall and Clonidine. They have some really good results in treating A D H D. Which pharmacy do you go to?\nGuest_family: We go to Costco pharmacy by the X Y Z corner.\nDoctor: Okay, I will send it there.\nPatient: Thank you doctor, it was nice meeting you.\nDoctor: Nice meeting you too, take care.",
"note": "MEDICATIONS: Patient experiencing behavioral problems, difficulty focusing, and complaints from school. Previously diagnosed with ADHD by other doctors.\n\nASSESSMENT:\nAttention Deficit Hyperactivity Disorder (ADHD).\n\nPLAN:\nPrescription of Adderall and Clonidine for treatment of ADHD."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, sir. You're sixty one years old, correct? \nPatient: Good morning, doctor. Yes, that's correct. \nDoctor: Great, and you identify as Caucasian, right? \nPatient: Yes, that's correct as well. \nDoctor: Thank you, do you have any medical conditions that I should know about? \nPatient: Yes, I have diabetes. \nDoctor: How are you handling your diabetes?\nPatient: Well, I've had diabetes for a long time but had never been treated for it.\nDoctor: Okay, thank you for telling me. What seems to be the problem today? \nPatient: I've been working in my garage over the past few days, and I have this redness and swelling in my right foot. \nDoctor: Do you have any itchiness or pain?\nPatient: Yes, and it's getting worse. \nDoctor: Have you seen any other doctors about this? \nPatient: Um, yes. I went to the A B C D General Hospital E R and they gave me an evaluation there. \nDoctor: Do you have any images from this visit? \nPatient: Um, yes. I have them right here. \nDoctor: Okay, these show a foreign body in the foot. \nPatient: But what about all the stuff on the outside of my foot?\nDoctor: Well, that's consistent with cellulitis. \nPatient: What's that?\nDoctor: It's a skin infection we clean it up in surgery.\nPatient: What kind of procedure can we do? \nDoctor: We should do an irrigation debridement for the cellulitis, and remove the foreign body. I think that will really help. \nPatient: Yes, I agree, doctor.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nRedness, swelling, itching, pain in right foot. Patient, a 61-year-old Caucasian male with uncontrolled diabetes mellitus, noticed redness and swelling in right foot after working in garage. Presented to ABCD General Hospital ER where evaluation revealed cellulitis and a foreign body in foot. Recommended irrigation debridement and removal of foreign body.\n\nASSESSMENT:\nCellulitis, foreign body in foot.\n\nPLAN:\nIrrigation debridement and removal of foreign body from right foot to address cellulitis."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: I see here that you're in for a med refill. Is that correct? \nPatient: Yep. I ran out of Klonopin one or two days ago. \nDoctor: What are you taking it for? And how long have you been on it? \nPatient: Panic attacks. I have really bad episodes without it. Um I think I started it about four months ago. I could be wrong though. I've lost track of time.\nDoctor: Who usually prescribes it to you? \nPatient: My doctor back in Georgia. \nDoctor: Do you happen to have their name or contact info on hand? \nPatient: No, unfortunately. \nDoctor: How much Klonopin do you take for your panic attacks? \nPatient: I take a pretty low dose. I think I'm on zero point five milligrams a day. Is there any way you could verify the dosage? \nDoctor: I can try to look it up online. When were you last prescribed Klonopin? \nPatient: Over two months ago I think. \nDoctor: Let me pull up the page and see if we can figure out your dosage and when you're due for a refill based on your doctor's orders. \nPatient: Okay, thank you. \nDoctor: Are you experiencing any symptoms currently, such as headache, nausea, vomiting, shortness of breath or chest pain?\nPatient: Not right now, no. I did have some nausea yesterday. Oh and I guess I had a slight headache when I woke up this morning, but that's about it.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nnausea, slight headache\n\nASSESSMENT:\npanic attacks\n\nPLAN:\nRefill Klonopin medication, verify dosage and refill schedule online"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi, how are you doing?\nPatient: I'm good. Thank you.\nDoctor: How old are you, young lady? \nPatient: Eighty four.\nDoctor: What brings you here?\nPatient: I had a fall. And I was told to consult you for my heart conditions.\nDoctor: Okay. Um? Can you tell me a little detail about anything you experienced before or diagnosed before?\nPatient: Yeah, I have high blood pressure. And they also diagnosed me with other heart diseases. I cannot pronounce all the names I don't remember.\nDoctor: That's fine. Let me go through your medical record first. \nDoctor: Let's see what we have here. Looks like you have your plate full. Your record says you had hypertension I mean, high blood pressure. Also, you have a history of severe tricuspid regurgitation with mild pulmonary hypertension, mild aortic stenosis, and previously moderate mitral regurgitation. \nPatient: Wow! Those are a lot of fancy words that I can never remember. \nDoctor: Ha ha. So, it says here they they want me to check you for atrial fibrillation. Yet another fancy word to add to your list. \nPatient: What does it mean?\nDoctor: It means I must check if you have faster than normal heartbeat after your fall. In simple words, just to check if there are any irregularities in your heart beating, okay?\nPatient: Hm, okay.\nDoctor: So tell me what happened? How did you fall?\nPatient: I'm not sure about how it happened, but yeah, I fell yesterday on my driveway and kind of hit a rock.\nDoctor: Which side did you hit the rock?\nPatient: Um I think it was left side.\nDoctor: What happened in the emergency room?\nPatient: They gave me some medicine. And they put something on my finger. They said that my heart rate was very high. \nDoctor: Yeah, in the record it says that they found rapid atrial tachyarrhythmia. So, according to this, they have given you Cardizem and they stopped it when your heart rate came to fifties.\nDoctor: Let me review your electrocardiogram from emergency. It says that there was rapid heart rate. Your heart was really beating very fast and then there was one more electrocardiogram which showed that your pacemaker is acting weird. \nPatient: They also did the same test this morning. \nDoctor: One they did this morning shows normal rate with frequent early heartbeats. Looks like they also tested your blood. Your potassium level is three point one. \nDoctor: How was your heart feeling when you fell yesterday?\nPatient: I felt that I just ran in a race. I could feel all the pain after that fall. It was ugly. My heart was pounding so fast it was ready to come out, I never felt like that before in my life. \nDoctor: Did you feel the same way afterwards as well?\nPatient: No, it was just after fall. It did not stay like that for long, I was normal later. I never felt it again after that incident. \nDoctor: That is good. Do you have any pain or discomfort in your chest?\nPatient: I don't think so.\nDoctor: How about before the fall? Did you have any pain or discomfort in your chest before the fall?\nPatient: Nope.\nDoctor: how about shortness of breath?\nPatient: No, not even before the fall. I'm able to walk and I'm sure I can climb stairs. Maybe two floors without any problems.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nrapid heart rate, palpitations (after fall), pain (after fall) Fell on driveway, hit left side on a rock, found to have rapid atrial tachyarrhythmia in emergency room, treated with Cardizem, subsequent EKGs showed multifocal atrial tachycardia followed by wandering atrial pacemaker, ECG this morning showed normal sinus rhythm with frequent atrial premature contractions (APCs), palpitations resolved after fall, no chest pain or shortness of breath before or after fall, able to walk and climb stairs without difficulty\n\nASSESSMENT:\nhypertension, severe tricuspid regurgitation with mild pulmonary hypertension, mild aortic stenosis, previously moderate mitral regurgitation (not seen recently), multifocal atrial tachycardia, wandering atrial pacemaker, elevated potassium level (3.1)\n\nPLAN:\nPerform cardiology consultation to assess for atrial fibrillation, monitor potassium levels, further evaluation and management as needed"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, sir, I hear you're a patient of Doctor A. \nPatient: Yes, that's correct. \nDoctor: Did she refer you to me?\nPatient: Yeah, I'm fifty five, so I'm not too young anymore, but I have developed iron deficiency anemia with blood in my stool. At least, that's what she's told me so far. \nDoctor: Are you having diarrhea?\nPatient: Yeah, I am.\nDoctor: How would you describe the frequency?\nPatient: I'd say it's chronic at this point. \nDoctor: How long have you known you have anemia? \nPatient: Um, it's been a few months now. \nDoctor: What markers were evaluated in order to diagnose this? \nPatient: I had, um, an unusual pruritus, and I had a C B C. \nDoctor: Do you have the results of that? \nPatient: Yes, right here. \nDoctor: Thank you, so this shows a hemoglobin of nine, and M C V of sixty five. \nPatient: Are those high? \nDoctor: Well, actually, both of those are low. \nPatient: Oh, okay. \nDoctor: How long have you had blood in your stool?\nPatient: Um, it's been about five months now.\nDoctor: What has the color been like?\nPatient: Well, it's been both dark and bright blood, actually? \nDoctor: When was your last colonoscopy?\nPatient: It was about three years ago, I had it with Doctor X. I did it in Las Cruces. \nDoctor: Was there any abnormality found? \nPatient: Yeah, I had polyps removed. \nDoctor: Were those polyps evaluated?\nPatient: Yeah, the doctors said they were, um, hyperplastic. They diagnosed me with, um, lymphocytic colitis. \nDoctor: I see, when was the last time you were treated for diarrhea? \nPatient: At this point, it's been more than three years.",
"note": "HISTORY OF PRESENTING COMPLAINT:\niron deficiency anemia, blood in stool, chronic diarrhea, unusual pruritus Anemia diagnosed months ago with CBC showing hemoglobin of 9 and MCV 65, blood in stool for the last 5 months, last colonoscopy performed 3 years ago by Dr. X in Las Cruces with removal of hyperplastic polyps and Diagnosis of lymphocytic colitis\n\nASSESSMENT:\nhyperplastic polyps, lymphocytic colitis\n\nPLAN:\nFurther evaluation and management of iron deficiency anemia, investigation and treatment of chronic diarrhea and blood in stool, consider repeat colonoscopy for surveillance and evaluation"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello. How are you both doing today? \nGuest_family: We're doing great. The E D told us to come here. We're here to see if we could get the stuff in his leg taken out. \nDoctor: I see. Did he have a fracture before? \nGuest_family: Yeah, he did. Here's the report from the surgery from October two thousand and seven. \nDoctor: Great. Let me take a look. It looks like he had a distracted left lateral condyle fracture. He then underwent screw compression to fix the fracture, correct? \nGuest_family: That's correct. \nDoctor: Perfect. So, now we just have to remove the hardware that was used to fix the fracture, right? \nGuest_family: Yeah, that's correct. What are the risks of the surgery? \nDoctor: The risks include the risk of anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure of removal of hardware, failure to relieve pain or improved range of motion. \nGuest_family: Oh, wow. That's a lot. Could you go over the benefits?\nDoctor: Of course. Before I do, I just need to confirm your son's age. \nGuest_family: He can tell you. \nPatient: Hi. I'm five years old. My birthday is in four months. \nDoctor: Thank you. Happy almost birthday. \nGuest_family: He gets excited about birthdays. I just have a few more questions, but it looks like we're going to go through with the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nUnderwent screw compression for the fracture in October 2007, now presents for hardware removal\n\nASSESSMENT:\ndistracted left lateral condyle fracture\n\nPLAN:\nRisks and benefits of surgery discussed, including risk of anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure of removal of hardware, failure to relieve pain or improve range of motion; family agreed to the plan"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: We've been following you for several conditions for a while now. What seems to be the problem today, sir? \nPatient: Um, I was peeing blood, it's back again. \nDoctor: Did you do anything that could have provoked it to come back?\nPatient: No, not that I know of. \nDoctor: Have you been taking the Flomax for your B P H? \nPatient: Yes, I have been. \nDoctor: What about the Coumadin?\nPatient: Yes, I've been taking that too. It has been held recently, but I ususally take it.\nDoctor: Remind me, I don't have my chart with me. What conditions have you been taking the Coumadin for?\nPatient: I have A F I B and stroke.\nDoctor: Thank you. Isn't this your second occurrence of gross hematuria this month?\nPatient: Yes, doctor. \nDoctor: Are you sure you haven't experienced any falls or anything recently? \nPatient: Yeah, actually I fell about a week ago. \nDoctor: Where is your pain from that fall? \nPatient: It's in my butt and leg. \nDoctor: Have you had your x rays taken yet? \nPatient: Yeah, the x ray tech just brought me back. \nDoctor: Okay, these x rays of the hips, knees, and ankles show severe degeneration in all areas. \nPatient: What does that mean, doctor? \nDoctor: I see some pretty significant arthritis in these areas. \nPatient: Can you tell me some good news, please? \nDoctor: Well, I don't see any fractures. \nPatient: I guess that's something. \nDoctor: When is your pain worst?\nPatient: It's so severe, and it's worst first thing in the morning. \nDoctor: Okay, I know you are, but be sure to keep taking the Coumadin, that helps with the stroke and A F I B. \nPatient: Yeah, I will. I'm having problems with my sinuses today too. Can I get some nasal spray too?",
"note": "HISTORY OF PRESENTING COMPLAINT:\ngross hematuria, buttock and leg pain, sinus problems Developed gross hematuria twice this month, Coumadin held, fell a week ago resulting in buttock and leg pain, x-rays showed significant degenerative disease in hips, knees, and ankles with no fractures noted, pain worse in the morning\n\nASSESSMENT:\nBPH, atrial fibrillation, stroke, severe degeneration in hips, knees, and ankles\n\nPLAN:\nContinue monitoring, consider nasal saline spray for sinus problems"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Alright, I am looking at your urine report and it confirms what I was suspecting. You have a urinary tract infection.\nPatient: I kind of knew it was a U T I. I have had it before, but nothing this painful and severe. I feel like I am going to die!\nDoctor: Oh yes, it is because you got something called as acute cystitis and its usually very painful and can cause some serious complications. \nPatient: Well, is it because of my diabetes?\nDoctor: I am afraid I don't have better news for you, but your diabetes is out of control. It's way too high and you must be really careful. Are you taking your medicines?\nPatient: Yes!\nDoctor: How bout diet?\nPatient: Yeah, sometimes I don't care about my diet.\nDoctor: Well, you must watch your diet, you can't just be careless. I am going to change your diabetes medication. And let's start you on the antibiotic that should give you relief. Also stay hydrated drink plenty of fluids it will help you flush the infection out.\nPatient: Alright, thank you!\nDoctor: Take care.",
"note": "ASSESSMENT:\nDiabetes type II uncontrolled, acute cystitis\n\nPLAN:\nChange diabetes medication, start antibiotic for acute cystitis, advise patient to watch diet, stay hydrated, and take medications"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: So, I understand that you had a fall. \nPatient: Yes. I did fall. \nDoctor: What happened? \nPatient: I don't really know. I have balancing problems. I have been to my P C P for this issue a few days ago. I saw her about a week and a half ago because I had another fall. Maybe around late December since today is January seventh. I have been having trouble with my right hand. It is like I am clumsy on my right side. I ended up falling because my right hand missed the railing when I grabbed it to head up the stairs. \nDoctor: Are you left or right handed? \nPatient: Right. \nDoctor: Can you tell me a little bit more about the trouble that you are having with the right hand? Is it localized to the right hand? \nPatient: Yes, it is only on my right side. It is like the right side of my body is weak and it has been getting worse. \nDoctor: How long has this issue been progressing for? \nPatient: About two years.\nDoctor: Have you experienced any blurred vision or visual disturbances?\nPatient: Yes. Every once and a while. \nDoctor: How old are you? \nPatient: I just turned fifty eight last week. \nDoctor: Happy belated birthday! \nPatient: Thank you!\nDoctor: Did your P C P have any bloodwork or imaging done? \nPatient: Yes, she did. She did both. She said she would send my records over. \nDoctor: Oh. I see it here! Did Doctor Madison discuss the results of your H C T and the M R I yet? \nPatient: No. \nDoctor: Okay. The results showed clinoid masses. This explains that problems that you have been having with your right side, your balancing problems, and the visual disturbances. With only the M R I I cannot tell if the masses are malignant or not. \nPatient: So, are the masses cancer? \nDoctor: I don't know yet. I will have to run some more tests and potently have to do a biopsy. \nPatient: Okay.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nGait difficulty, clumsiness of right hand, falling, occasional visual obscurations 58-year-old right-handed female with 2-year history of increasing gait difficulty, clumsiness of right hand, falling, and occasional visual obscurations\n\nASSESSMENT:\nBilateral posterior clinoid masses\n\nPLAN:\nFurther tests and potentially a biopsy to determine nature of masses"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: What brings you back into the clinic today?\nPatient: I have been having some severe bruising. I have been taking Coumadin for three months now. Am I taking to much Coumadin? \nDoctor: You are taking a normal start dose. Some people do not metabolize the medication as well as others. I would like to get you tested for hypersensitivity. After we get the test results back, we will be able to adjust your dosage accordingly. \nPatient: Okay.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nSevere bruising Taking Coumadin for three months, concerns about dosage\n\nASSESSMENT:\nProbable Coumadin hypersensitivity\n\nPLAN:\nTesting for hypersensitivity to Coumadin, dosage adjustment pending test results"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi, how old are you madam?\nPatient: I am ninety three. I am a super duper old Swedish woman.\nDoctor: Ha! Not so old okay!\nPatient: I had vomiting episodes and I am feeling very nauseous.\nDoctor: Oh I am so sorry to hear that.\nPatient: I have pain in urination too, I think I might have the U T I?\nDoctor: Let's see here. So you already have a right hip issue, bone disease, hypertension, depression, and heart rhythm disorder for a long time.\nPatient: Yes that is correct.\nDoctor: Let me see what we can do here.\nPatient: Thank you doctor.",
"note": "ASSESSMENT:\nUrinary tract infection (UTI)\n\nPLAN:\nVomiting, nausea, pain in urination Chronic right hip pain, osteoporosis, hypertension, depression, chronic atrial fibrillation"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, how old are you? \nPatient: Hello Doctor, I'm fifty four years old. \nDoctor: What gender do you identify with? \nPatient: I identify as a female. \nDoctor: Thank you. What symptoms are you experiencing in your right hand? \nPatient: I have numbness and tingling in my right hand. \nDoctor: Are there any specific fingers that you feel it in?\nPatient: I really feel it in my fifth, fourth, and third fingers.\nDoctor: What kind of treatments have you done for this pain? \nPatient: I've taken antiinflammatories, stayed away from sports and stuff like that, and rested. \nDoctor: Has this helped at all?\nPatient: No, not at all, its still numb and tingling. \nDoctor: This sounds like carpal tunnel, there's a quick, minimally invasive surgery I can do on this hand, since it hasn't responded to nonoperative treatments. I think that'll really help. \nPatient: I'd like to do that, what's the name of the procedure? \nDoctor: Its called a carpal tunnel release.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nNumbness and tingling in right hand, particularly in fifth, fourth, and third fingers Failed conservative management including anti-inflammatories, rest, and avoiding sports; elected for carpal tunnel release surgery\n\nASSESSMENT:\nCarpal tunnel syndrome\n\nPLAN:\nCarpal tunnel release surgery"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Can you confirm your age for me, ma'am? \nPatient: Sure, I'm fifty six years old. \nDoctor: Great, so what brings you in to see me today? \nPatient: Um, I'm peeing a lot, and I'm having a little bit blood in that urine as well. \nDoctor: Have you ever had a cystoscopy? \nPatient: Yes, it was unremarkable, that's what they told me. \nDoctor: When are your episodes for the most part? \nPatient: Um, usually during the day. I don't usually have them at night.\nDoctor: Are you having any pain with urination? \nPatient: No, no pain. \nDoctor: Aside from the little bit of blood, can you tell if there's any pus in your urine? \nPatient: No, I don't have any of that, it's just the little bit of blood. \nDoctor: Have you taken any medications for this? \nPatient: Um, I had Ditropan, and it didn't do very well. \nDoctor: Well, this ultrasound of the kidney is also unremarkable, so at this time I think we should try a different medication.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nfrequent urination, microscopic hematuria (blood in urine), episodes mostly during the day, no pain or pus in urine cystoscopy was unremarkable, previous medication (Ditropan) did not work well, renal ultrasound unremarkable\n\nASSESSMENT:\noveractive bladder with microscopic hematuria\n\nPLAN:\ntrying a different medication for overactive bladder"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How old is your son? \nGuest_family: He is almost five and a half years old now. \nDoctor: What seems to be the problem? \nGuest_family: He has a lot of pain about both feet, and if you look at it, it looks like his feet rotate inwards. \nDoctor: Okay, let me see, okay, um, he has rocker bottom feet. \nGuest_family: Okay. \nDoctor: I believe he would benefit from a subtalar arthrodesis, possible autograft, and lengthening of the Achilles. I'll go over the details of that procedure right now. \nGuest_family: Can we do the surgery soon?\nDoctor: Yes we can. But we'll probably need to do another procedure until his foot matures some more. This is a stabilizing measure.\nGuest_family: What are the risks of infection if we do the surgery? \nDoctor: Historically, the risk of infection is very low, usually less than one percent. \nGuest_family: How do you get the risk so low? \nDoctor: We use prophylactic antibiotics to minimize the infection risk. \nGuest_family: Will he be able to walk again right after the surgery? \nDoctor: No, he'll need to stay off it for a while, we call this nonweightbearing. It will only be for some time after the procedure, it's not permanent. \nGuest_family: What are the rest of the risks?\nDoctor: The total risks of surgery include risks of anesthesia, infection, bleeding, changes in sensation and motion of the extremity, hardware failure, need for other surgical procedures, need to be nonweightbearing for some time. I would not worry about these risks, though. The risk is low. \nGuest_family: Okay. Let's do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nsignificant feet pain, planovalgus deformity, flexible vertical talus pain and deformity in both feet, feet appear to rotate inwards, 5-year-old male\n\nASSESSMENT:\nrocker bottom feet, flexible vertical talus\n\nPLAN:\nsubtalar arthrodesis, possible autograft, Achilles lengthening, stabilizing measure, potential need for additional surgery when foot matures, risks discussed including anesthesia, infection, bleeding, changes in sensation and motion of extremity, hardware failure, need for other surgical procedures, need to be nonweightbearing for some time"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Looking at your medical history now. Any changes since your last visit? \nPatient: No changes.",
"note": "PAST MEDICAL HISTORY: N/A, Stable cancer, undergoing chemotherapy, no new Symptoms,\n\nASSESSMENT:\nHeavy alcohol and tobacco use, rare form of cancer in remission,\n\nPLAN:\nContinue with current treatment regimen"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, young man.\nPatient: Good morning, doctor. \nDoctor: Who is this young lady, is this your grandmother, or sister?\nGuest_family: Oh doctor, yes, I am his grandmother. \nDoctor: Good, my chart says that you're fourteen years old. Is that correct? \nPatient: Yes sir. \nDoctor: Good, so what seems to be the problem today? \nPatient: I've been having pain in this knee for about a month now. \nDoctor: Can you remember a specific injury to this knee?\nPatient: Um, yeah, I was playing basketball when I jumped, and then when I landed I felt this knee pop. \nDoctor: Do you remember the date of your injury, young man?\nGuest_family: Um, it was on December twenty second two thousand seven. \nDoctor: Good, so how have you been treated for this so far? \nPatient: We went to another clinic first, and they put me in a splint. \nGuest_family: Yeah, and then they referred us over to Children's. \nDoctor: Have they taken x rays yet?\nPatient: Yes, I got back a few minutes ago. \nDoctor: Let's have a look. Well, you broke your leg. \nPatient: What, where? Can you show me?\nDoctor: Right here, this is a tibial tubercule avulsion fracture with patella alta. \nGuest_family: What does that mean, doctor? \nDoctor: Well, he's broken his leg, and pulled some bone off by doing so. We'll need to do surgery on this.\nGuest_family: Oh no, what's the name of the procedure? \nDoctor: It's called an O R I F. We'll go in there with some hardware to put everything back together, and he can get on the road to healing. \nGuest_family: Let me call his father while we discuss this. What's the risk of infection from this surgery? \nDoctor: Historically, it's less than one percent. We use antibiotics to control for infection. \nGuest_family: Okay, will he be asleep for this? \nDoctor: Yes, he won't feel a thing.\nGuest_family: That's good too. Will he need this hardware out in the future?\nDoctor: We can remove everything once he has healed up nicely. Other risks include bleeding, changes in the sensation of the leg, hardware failure, need for post op rehab, need for hardware removal, and failure to restore extensor mechanism tension. But I would not worry about these things. I have been doing these surgeries for years and things like this rarely happen. \nGuest_family: Yes, his father agrees. We're going to do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nknee pain for 1 month, pain and popping sensation in knee after playing basketball, difficulty bearing weight on affected leg knee pain started after basketball injury on December 22, 2007, initial splinting at another clinic, referred to Children's for definitive care, confirmed fracture on x-rays\n\nASSESSMENT:\ntibial tubercule avulsion fracture with patella alta\n\nPLAN:\nopen reduction and internal fixation (ORIF) surgery recommended, risks discussed including anesthesia, infection, bleeding, changes in sensation, hardware failure, need for later hardware removal, failure to restore extensor mechanism tension, and need for postoperative rehab, father and grandmother agreed to surgery"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there, what's going on?\nGuest_family: I am her daughter. I brought her to the emergency. She lives in a skilled nursing home. Today, when I went to meet her, I found her with the right side of her face drooping. I immediately rushed her here. \nDoctor: Oh, you did the right thing. Ma'am, how are you feeling?\nGuest_family: She has dementia, most of the time she doesn't even remember me. \nDoctor: Oh, okay.How old is she?\nGuest_family: She is eighty three. She also has a history of stroke after which she developed this condition where she knows what she wants to speak but is unable to make the word or sentence.\nDoctor: Oh, I see. She has expressive aphasia, correct? \nGuest_family: Yes, that. \nDoctor: Okay, let me check her. She does have a droop to her right side of the face. Ma'am, do you feel any weakness on the right side of your body?\nGuest_family: She says yes. \nDoctor: She had her C T scan earlier today and I have the report. It does not show any acute attack or anything. \nGuest_family: Okay!\nDoctor: But it does show that she has a new onset of a stroke.\nGuest_family: Is there anything to worry?\n Doctor: I think we need to admit her for observation. We need to monitor her. We will also get her a proper treatment for her urinary infection which is not getting better due to resistance to the oral medicines. \nGuest_family: Yeah, sounds good!\nDoctor: Yeah, let me talk to the nurse.\nGuest_family: Thank you.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nright-sided facial droop, right-sided upper extremity weakness, expressive aphasia found with right-sided facial droop and weakness, transferred to ER for evaluation, CT scan showed new-onset stroke, recommended admission for observation and treatment of UTI\n\nASSESSMENT:\nnew-onset cerebrovascular accident (stroke), dementia, urinary tract infection resistant to oral medications\n\nPLAN:\nadmission for observation and treatment of urinary tract infection"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good evening, and welcome to A B C D General Hospital E D. \nPatient: Thank you, Doctor, I've really messed up this ankle. \nDoctor: Before we begin, how old are you? And which gender do you identify?\nPatient: Thank you for asking, Doctor, I'm a fifty year old man. \nDoctor: Thank you, what happened? \nPatient: I fell off my liner, and I landed right onto my left foot. \nDoctor: How far did you fall? \nPatient: Um, it was really about ten feet. \nDoctor: Oh, yes, I see. I have some good news for you, there's no gross deformity in this ankle.\nPatient: What does that mean, exactly? \nDoctor: I don't see any ankle dislocation, which is good. \nPatient: Oh, that's good news. \nDoctor: Have you had your x rays taken yet?\nPatient: Yeah, the tech just brought me back. \nDoctor: Great, let me pull them up here. Okay, um, if you look here, you'll see a fracture of your talus. \nPatient: Which bone is that?\nDoctor: That's your heel, to be specific, it's a grade I V Hawkins fracture of the left talus. You are still neurovascularly intact in the distal region. \nPatient: What are we going to do about this? \nDoctor: Do you have any other pain from the fall, aside from the ankle?\nPatient: No, the ankle really took all of the weight of the fall. \nDoctor: Okay, I think we should do surgery in order to repair this ankle. \nPatient: Why is that?\nDoctor: There is very weak blood flow to the body of this bone, there's a risk for avascular necrosis, which is bone death. \nPatient: Okay, you're right. What are the risks of this infection with this surgery?\nDoctor: Overall, the risks of infection are less than one percent. We'll use antibiotics to keep everything clean. \nPatient: Will I be asleep for this?\nDoctor: Yes, you'll be under anesthesia.\nPatient: Okay, yes, um, I'd like to go forward with the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nleft ankle pain, disfigurement 50-year-old male, fell from approximately 10 feet onto left foot, no other injuries reported, distal neurovascularly intact\n\nASSESSMENT:\ngrade IV Hawkins fracture of left talus\n\nPLAN:\nsurgery recommended due to risk of avascular necrosis, risks of infection discussed and antibiotics planned"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How's this little guy doing today? \nGuest_family: I think he might have another ear infection. \nDoctor: Oh, I'm sorry to hear that. Let's have a look see. \nGuest_family: He's been telling me over and over again that his left ear is hurting him. He was here on April fourteenth and prescribed Amoxicillin. \nDoctor: Did that seem to help? \nGuest_family: It did at first, but the pain is back again. \nDoctor: Has he been running any fevers? \nGuest_family: No, no fevers. \nDoctor: He sounds a bit congested. \nGuest_family: He is. When he blows his nose, he brings up really thick mucous. This never really went away even with antibiotics. He's also been coughing a fair amount. \nDoctor: Is his cough productive? \nGuest_family: Yeah. \nDoctor: Does it seem to be keeping him up at night? How does the mucous look?\nGuest_family: No, I don't think so. It is pretty thick and viscous. The cough isn't constant or anything. \nDoctor: And no shortness of breath or wheezing that you've noticed? \nGuest_family: No.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nleft ear pain, congestion with thick mucous, loose and productive cough previously treated with amoxicillin for left otitis, temporary improvement, Symptoms reappeared\n\nASSESSMENT:\npossible ear infection, unresolved congestion\n\nPLAN:\nfurther evaluation for ear infection, assessment of respiratory Symptoms, consideration of alternative treatment options"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: What brings you in today? \nPatient: I've had a lot of discomfort in my private area. \nDoctor: When did it start? \nPatient: It's been going on for about two weeks now. \nDoctor: Have you noticed any abnormal discharge? \nPatient: Not really, no. But it's been super itchy down there. \nDoctor: Any abdominal pain, nausea, vomiting? \nPatient: Uh no, but I'm having some pain here. \nDoctor: Near your pelvis? \nPatient: Yeah. \nDoctor: Have you started any new lotions or products? \nPatient: No. \nDoctor: Have you tried anything for the pain or itching? \nPatient: No, not yet. I thought it'd go away on it's own. \nDoctor: If it's okay with you, I'd like to do a pelvic exam. \nPatient: Fine with me. \nDoctor: Have you been sexually active prior to or after noticing these concerns? \nPatient: Uh once this past week, but it was pretty painful. \nDoctor: I see. You may have an infection, which is why I'd also like to send out samples to the lab. Did you use protection? \nPatient: Yeah, I take birth control. But I've been struggling a bit with my mood and I'm wondering if it's because of the new birth control pills. \nDoctor: We can look into that as well. Hang tight while I grab the nurse for the pelvic exam.",
"note": "HISTORY OF PRESENTING COMPLAINT:\ndiscomfort in private area, itchiness, pain near pelvis, painful sex, mood swings Symptoms started about two weeks ago, no abnormal discharge, no abdominal pain, nausea, vomiting, no new lotions or products used, sexually active with pain during intercourse, taking birth control and experiencing mood swings\n\nASSESSMENT:\ninfection (possible), pelvic pain\n\nPLAN:\npelvic exam to check for infection, send samples to lab, investigate possible correlation between Symptoms and birth control pills"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, ma'am. My nurses tell me that you're thirty nine years old, is that correct? \nPatient: Good morning, Doctor. Yes, that's correct. \nDoctor: So, what seems to be the problem today, ma'am?\nPatient: I hurt my knee while on the trampoline back in late August. \nDoctor: Do you remember the mechanism of injury to this knee? \nPatient: What do you mean? \nDoctor: Well, was it a twisting, pulling, snapping kind of injury?\nPatient: Oh, I twisted my knee. \nDoctor: Okay, have you seen another doctor for this?\nPatient: Yeah, and I got an M R I. \nDoctor: Can I see the report?\nPatient: Yes, here you go. \nDoctor: This M R I shows an A C L tear. Do you have any instability in this knee?\nPatient: Yeah, I feel like my knee joint has been unstable for years. \nDoctor: Have there been any dislocations? \nPatient: Yeah, there have been. What can be done about this?\nDoctor: Well, there's surgery to fix this. I can repair that A C L. \nPatient: What are the risks of infection with the procedure?\nDoctor: Historically, it's less than one percent. We use antibiotics to control for infection. \nPatient: Will I go under for this?\nDoctor: Yes, you won't feel a thing. \nPatient: Okay, yes, I'd like the surgery done.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nknee pain, instability in knee joint, history of multiple dislocations in knee twisted knee on trampoline in late August, diagnosed via MRI, multiple episodes of instability and dislocations in patellofemoral joint\n\nASSESSMENT:\nanterior cruciate ligament (ACL) tear\n\nPLAN:\nsurgery to repair ACL and possibly plicate medial retinaculum to prevent further dislocations, risks and benefits discussed and patient agreed to treatment plan"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, who's the victim today, sir? Is it you, or your daughter? \nGuest_family: Good afternoon, doctor. It's my daughter today. \nDoctor: Remind me, how old is she? \nPatient: I'm thirteen, sir. \nDoctor: So, what happened? My nurses tell me she fell today.\nPatient: Yeah, I fell off the swing at school earlier this afternoon at about one thirty.\nDoctor: Where does it hurt, young lady?\nPatient: It's really bad here on my left elbow. \nDoctor: Which hand do you write with?\nPatient: I use my right hand for everything, thank goodness for that. \nDoctor: Before seeing me, have you seen anyone else?\nGuest_family: Yeah, we went to an Urgent Care and she had an x ray there. \nDoctor: What else did they do?\nGuest_family: They said her arm was broken, and they tried to do a reduction.\nDoctor: Do you have those x rays with you right now?\nGuest_family: Yeah, I have them right here, take a look, please. \nDoctor: Well, these x rays show an incarcerated medial epicondyle fracture, as well as a mildly angulated radial shaft break. \nPatient: What does that mean?\nDoctor: Well, in short, you broke the inside part of your elbow. In addition to the pain, do you have any burning or tingling feelings in that arm?\nPatient: Yes, I do. \nDoctor: Did you have this before they tried to do a reduction?\nPatient: No, I didn't, this is new. \nDoctor: Is this feeling getting worse? \nPatient: Yes, it is. \nDoctor: Okay, guys, there is a lot of pressure on that ulnar nerve because of the break and the attempted reduction. \nGuest_family: What should we do?\nDoctor: We need to do an O R I F procedure A S A P. I'll reduce that radial shaft fracture at the same time.\nGuest_family: O R I F? What's that\nDoctor: I'll put some pins in the elbow, in order to stabilize the break, and we can start the healing process. \nGuest_family: Will this not heal on its own? \nDoctor: No, we need to do the surgery. \nGuest_family: Okay, what are the risks of infection with the surgery? \nDoctor: Historically, its less than one percent. \nGuest_family: How is this possible?\nDoctor: We use prophylactic antibiotics, this helps us control for infection the entire time. \nGuest_family: Will she be asleep for this?\nDoctor: Yes, she won't feel a thing. \nGuest_family: Will she need this hardware taken out in the future?\nDoctor: Yes, in about a year or two, after everything is healed up nicely. The other risks include bleeding, changes in sensation and motion of the extremity, and hardware failure. I see good results from my surgeries so I would not worry about these things, but I must disclose.\nGuest_family: Okay, yes, we'd like to do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nfell off a swing, pain in left elbow, burning or tingling feelings in left arm fell off swing at school, initially seen at Urgent Care with attempted closed reduction, increased ulnar paresthesias post-procedure\n\nASSESSMENT:\nincarcerated medial epicondyle fracture, mildly angulated radial shaft break\n\nPLAN:\nurgent open reduction and internal fixation to relieve pressure on ulnar nerve, reduce radial shaft fracture, explained risks of surgery including anesthesia, infection, bleeding, changes in sensation and motion, hardware failure, need for later hardware removal, and possible continuous nerve Symptoms, father agreed to surgery"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Your bloodwork came back from the Coumadin sensitivity test. The results showed a high level of sensitivity. I am going to adjust your dosage of Coumadin to a much lower dose. This will help reduce the bruising and the bleeding episodes. Do you have any questions?\nPatient: No.",
"note": "ASSESSMENT:\nhypersensitivity to Coumadin\n\nPLAN:\nadjust dosage of Coumadin to a much lower dose to reduce bruising and bleeding episodes"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello Miss Jane, how are you?\nPatient: I am good, thank you for asking.\nDoctor: So, tell me what brings you here?\nPatient: I have so many issues and problems, where do I start?\nDoctor: Start by telling the one troubling you the most. \nPatient: I have this pain in my toes on the right side and I also feel this numbness there.\nDoctor: Okay and do you feel any tingling sensation? Or feeling like your leg is giving away?\nPatient: Yes, I feel the tingling and sometimes. I feel like my leg has fallen asleep.\nDoctor: Hm, tell me about your pain. Is it mild, moderate, or severe?\nPatient: Well, I will say it's moderate. \nDoctor: Would you define it as sharp shooting pain or dull kind of radiating pain? \nPatient: Maybe sharp pain but I am not sure how to describe it. But it radiates up the leg.\nDoctor: Okay. How long have you had this problem?\nPatient: It's been there for almost one year but now it started to get worst. \nDoctor: I see, does it get worse when you walk?\nPatient: No, mostly when I am in bed. And sometimes I feel it on my left toe as well.\nDoctor: It looks like you have paresthesia in the toes of your right foot and I feel your left toe also has the same problem.\nPatient: Yeah, I thought so. I read over the internet. But anyways, I am also having this shoulder pain on both sides, plus I am not able to sleep at night.\nPatient: I have high blood pressure and hypothyroidism. \nDoctor: Well-\nPatient: Well, that's not it. I have thrombo-\nDoctor: Thrombocythemia.\nPatient: Yeah, that. \nDoctor: How are your allergies by the way?\nPatient: I have no sinus allergies, thankfully.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nNumbness, tingling, and pain primarily in the toes of the right foot (moderate, sharp quality pain), mild paresthesias in left toe, pain worsens when in bed, some radiation of pain up the leg, bilateral shoulder pains Symptoms present for about a year, worsening recently, pain not exacerbated by walking, worsens when in bed\n\nASSESSMENT:\nHypothyroidism, thrombocythemia, insomnia, hypertension\n\nPLAN:\nFurther evaluation of foot pain and numbness, consideration of imaging or nerve studies if warranted, assessment and management of shoulder pain, evaluation and management of insomnia, monitoring and management of hypothyroidism, thrombocythemia, and hypertension, reassurance regarding sinus allergies"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How are you feeling? You have been sick?\nPatient: Yes, I am not feeling well for the last three days. I have bad body aches, cough and a sore throat. \nDoctor: Do you get wet cough or it's dry? What color sputum comes out?\nPatient: It is wet and green colored stuff comes out.\nDoctor: Okay we will need to send it out to culture, maybe an infection.\nDoctor: How about fever, chills, nausea, vomiting, diarrhea anything like that? Are you sleeping well?\nPatient: Everything is fine except some chills? I am sleeping okay.\nDoctor: Do you need anything for cough?\nPatient: I don't need anything for the cough. I did call yesterday and got a refill of my Keflex. Then I took two Keflex this morning and I am feeling little bit better now. \nDoctor: Okay then why are you crying, ma'am?\nPatient: I am just tired of feeling like ran down.\nDoctor: I am so sorry.\nPatient: Hm.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nBody aches, cough, sore throat, productive cough of green colored sputum, chills, tearfulness Patient has been feeling unwell for the last three days with body aches, cough, sore throat, productive cough of green sputum, chills, tearfulness, no vomiting or diarrhea, sleeping okay, obtained refill of Keflex yesterday and took two doses this morning, feeling slightly better\n\nASSESSMENT:\nPossible respiratory infection\n\nPLAN:\nSend sputum for culture to assess for infection, monitor Symptoms, provide supportive care, address emotional distress"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, sir. Is this your mother? \nPatient: Good afternoon, doctor. Yes, this is my mom. \nDoctor: Great, please, give me some background information on your history. \nPatient: Well, I used to live here in the city when I went to college, but I wanted to get away from a bad crowd, so I came back to live with my mom. \nDoctor: What do you mean, bad crowd? \nPatient: Well, I got addicted to drugs out there, and I used to inject heroin. \nDoctor: Did you see a doctor for this addiction? \nPatient: Yeah, I saw another doctor in the city. \nDoctor: How did they treat you at that time? \nPatient: They prescribed me methadone for a while. \nDoctor: Did that help at all?\nPatient: Honestly, no, it didn't help at all. \nDoctor: Do you remember the dosage that you were given? \nPatient: Um, it was ten M G. \nDoctor: How long did you take methadone for? \nPatient: Um, it was for three or four months. \nDoctor: Did you ever try to decrease your dosage? \nPatient: Yeah, um, I tried to wean off it for a while, but I was never really successful. \nDoctor: Have you been using heroin since? \nPatient: Um, yeah, I've been using it occasionally. \nDoctor: Were you roommates at school using drugs? \nPatient: Yeah, so it's hard to get away from the stuff, it was all over the house. \nGuest_family: Well, he can now, especially because he lives with me. \nDoctor: Good, when was the last time you used heroin? \nPatient: Um, it's been about eight days now. \nDoctor: Good, congratulations. When was the last time you had methadone? \nPatient: Um, it's been about a week for that now, too. Am I able to get more today?\nDoctor: We can discuss that. Have you had any feelings of depression recently? \nPatient: Yeah, I feel down and sad a lot. \nDoctor: What about your energy? \nPatient: I really don't have much. \nDoctor: What about your enthusiasm for the foods or activities you enjoy? \nGuest_family: He hasn't had much enthusiasm for anything, either. \nDoctor: Are you having any suicidal or homicidal thoughts or actions at this time?\nGuest_family: No, nothing like that, doctor. \nDoctor: Good, what about delusions, hallucinations, or disorganized thoughts or behaviors? \nPatient: No, nothing like that either, doctor. \nDoctor: Do you have any medical conditions in the past that I should know about? \nPatient: No, not that I know of. \nGuest_family: No, he hasn't been treated for anything before, doctor. \nDoctor: You completed your family and social history earlier with the nurses, is there anything you want to add to that? \nPatient: No, everything there is complete. \nDoctor: Do you have any allergies? \nPatient: No, I don't have any. \nDoctor: Good, and do you take any medications right now? \nPatient: No, doctor. I don't take anything. \nDoctor: Have you had any surgeries in the past?\nPatient: I voluntarily donated my left kidney.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nDepression, sadness, low energy, lack of enthusiasm Patient previously lived in the city and became addicted to drugs, specifically heroin, received methadone treatment which was not effective, attempted to wean off methadone unsuccessfully, currently living with mother to avoid drug environment, last heroin use approximately eight days ago, last methadone use approximately one week ago, presenting today requesting methadone, denies suicidal or homicidal ideations, denies Symptoms of bipolar disorder, no significant past medical history except for voluntary left kidney donation\n\nASSESSMENT:\nHistory of heroin addiction, history of methadone use, depression\n\nPLAN:\nFurther evaluation and discussion regarding methadone treatment, assessment and management of depression, referral to appropriate resources for addiction treatment and mental health support"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hi there, how is it going?\nGuest_family: Hi doctor, I am his son Ethan.\nDoctor: Nice to meet you. \nDoctor: So, I see your father has a history of drug abuse, right?\nGuest_family: Yes.\nPatient: Not abuse, I just used to do drugs. The last time I really made a big mistake I injected the heroine directly into both of my thighs and unfortunately, I got these ulcers which are not going away.\nDoctor: Yeah, this is really unfortunate. I can see these open wounds, it's because of the chronic abscesses.\nGuest_family: The right thigh looks worse than the left one.\nDoctor: Yeah, I see that. How old is your father?\nGuest_family: He is sixty two. \nDoctor: Does he have any other medical issues like sugar or blood pressure?\nGuest_family: No. \nDoctor: Okay, I think we need to surgically remove this whole area and then do a reconstruction.\nGuest_family: And is that the only way?\nDoctor: According to me, yes! I mean the wounds are not healing and it is only getting worst. \nGuest_family: Okay then we will follow whatever you suggest. \nDoctor: Okay.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nChronic abscesses, open wounds on bilateral thighs Patient has a history of drug use, specifically injecting heroin into bilateral thighs, resulting in chronic abscesses and open wounds, worse on the right thigh\n\nASSESSMENT:\nChronic abscesses with open wounds, likely resulting from injection drug use\n\nPLAN:\nRadical excision followed by reconstruction surgery recommended due to non-healing wounds and worsening condition"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Nurse, did you get the documents from the patient?\nGuest_clinician: I did. Here is her full history and notes from her physical examination. She also completed the patient questionnaire before arriving. You can review that. \nDoctor: Thank you, Nurse. What is she here for today?\nGuest_clinician: She came in for a consultation because she's been experiencing difficult headaches, tunnel vision, and dizziness. \nDoctor: Sounds good. Was there anything else? \nGuest_clinician: Oh, yeah. These are the results from her tests. She brought them so you could refer to them. \nDoctor: Thank you, Nurse. I'll go see her now. \nPatient: Hello Doctor. I've been waiting a long time. I'm getting impatient as I get older. \nDoctor: What? You don't look old at all, ma'am. \nPatient: Oh, wow. That's a nice compliment for a sixty year old lady. \nDoctor: How can I help you today?\nPatient: I have these super bad headaches. Help me, please. \nDoctor: When did they start?\nPatient: I had them since I was twenty five years old. \nDoctor: Oh, wow. That long? Did you get them every day since then?\nPatient: Not every day. That's crazy. I did get them more when my husband died in nineteen ninety six. I was heartbroken. \nDoctor: I'm sorry to hear that. How did the headaches feel? \nPatient: It felt like a drum in my head. \nDoctor: I haven't heard that description before. Would you say it was pulsating? \nPatient: Something like that. Yes. \nDoctor: Did you take any medication? \nPatient: Lots of it. My son wrote it on a paper so that I could give you the names. Here you go. \nDoctor: I see you were given papaverine. Did that help? \nPatient: They did. My headaches would vanish. \nDoctor: How long did you take it for? \nPatient: I think six months. My headaches stopped for a while, but they came back in two thousand and four. \nDoctor: How often would you say you get headaches now? \nPatient: I think more than before. Like one to two per week. I also get some dizziness too. It says for two hours. \nDoctor: Do you take the papaverine when you feel it? \nPatient: I do. My headaches vanish after thirty minutes of taking it. \nDoctor: I see. Did you ever experience any problems with your vision too? \nPatient: Yes. A lot. There were zig zag lines coming out of nowhere. I thought I was going to die. \nDoctor: Oh, wow. I will do a test right now to check your vision. \nPatient: Will you use a bright pen? \nDoctor: I will. Does it give you any discomfort? \nPatient: The bright light hurts my eyes. \nDoctor: I see. I'll only do it to the side then. Just look forward for me, please. \nPatient: Thank you. \nDoctor: Are you able to see the light? \nPatient: What light? \nDoctor: It looks like you have trouble seeing things in your peripheral vision. The discomfort you experience with bright lights is also called photophobia. \nPatient: That sounds scary. Will I be fine? \nDoctor: Yeah. You don't have to worry. Are you experiencing any dizziness or lightheadedness right now? \nPatient: Now that you mentioned it, I am. \nDoctor: Have you ever fainted before? \nPatient: I think one time. My son was there to help. \nDoctor: That's good to hear. I'll write down that you experienced a syncope. Did you take any medication for this?\nPatient: I took some Russian medicine.\nDoctor: Oh, wow. Are you from Russia? \nPatient: No. I'm from Ukraine. \nDoctor: That's wonderful. How did the medicine help? \nPatient: It helped me a lot.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nDifficult headaches, tunnel vision, dizziness Experienced headaches since age 25, worsened after husband's death, treated with papaverine initially, recurrence of headaches in 2004, headaches occur once to twice per week, last for two hours, relieved by papaverine within 30 minutes, experienced zig-zag lines in vision, peripheral vision problems, photophobia, occasional syncope, treated with Russian medication\n\nASSESSMENT:\nHeadaches since age 25, worsened after husband's death in 1996, pulsating headaches, photophobia, dizziness, occasional syncope\n\nPLAN:\nPerform vision test, monitor Symptoms, consider further evaluation and treatment options based on examination and test results"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, ma'am. My chart says that you're forty nine years old, and White, is that correct? \nPatient: Yes, that's all correct. \nDoctor: What do you do for a living? \nPatient: I'm a secretary. \nDoctor: Great, welcome back to the Dermatology office, do you remember when your last appointment was? \nPatient: Um, I think it was on August tenth two thousand four. \nDoctor: Good, that's what I have here as well, so has your acne improved since your last visit? \nPatient: Well, not really, and I think I have a rash too. \nDoctor: How long have you been dealing with this? \nPatient: Um, at this point it's been about two months. \nDoctor: Where do you see this rash? \nPatient: Um, it's right here, on my chest, stomach, neck, and back, it's all over my upper body. \nDoctor: I see, it appears that your acne is flaring, and there are small lesions on the follicles as well. Have you been taking your Amoxicillin and using your Tazorac? \nPatient: Yeah, I taken five hundred M G of amoxicillin twice a day, and I use the cream as well. \nDoctor: Good, the acne on your face appears to be clearing. \nPatient: Thank you, I've been out of medicine for about three days now though. \nDoctor: Okay, we might refill that. Have you had any other treatments aside from what I've done? I\nPatient: Um, my husband drove me to Healing Waters and they did, um, photofacials. Is there anything that can be done in the office today, like, um, cosmetic procedures, or do you have any skin care products? I want to keep up my appearances since I work the front office as a secretary.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nFlaring of acne with small folliculitis lesions, rash on chest, stomach, neck, and back Patient experiencing acne flare for the past two months, currently taking amoxicillin 500 mg b.i.d. and using Tazorac cream 0.1, out of medication for three days, has been receiving photofacials at Healing Waters\n\nASSESSMENT:\nAcne with folliculitis flare, rash\n\nPLAN:\nRefill prescription for amoxicillin and Tazorac, discuss cosmetic procedures and skin care products for maintaining appearance, potential in-office treatments for acne"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: It looks like your Xrays show bronchitis. \nPatient: Is there anything I can take for it? \nDoctor: Yes, I'm going to prescribe you something that will help clear your lungs.",
"note": "ASSESSMENT:\nBronchitis/URI (Upper Respiratory Infection)\n\nPLAN:\nPrescribing medication to clear lungs"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How's it going X Y Z? I see you're in a walking boot. What happened? \nPatient: I hurt my foot pretty bad yesterday. \nDoctor: How'd it happen? \nPatient: Basketball. I play for the University of Houston. I went up for a three and came down and landed on this guy's foot. I was so pissed. \nDoctor: Dang, that sucks. Were you guys playing a home game? \nPatient: We were traveling to Duke. We could've won the game if I didn't get hurt. \nDoctor: You'll get them next time. Did you keep playing? \nPatient: Yeah, I did. I got taped up by the trainer, and I went back into the game. \nDoctor: I see. Who was the trainer that helped you? \nPatient: His name is John Houston. Do you know him? \nDoctor: Oh, John! He's a good friend of mine. \nPatient: Yeah, he told me to come see you. He checked my foot. Here's the notes he wrote. \nDoctor: It looks like you have some tenderness around your navicular, which is a bone in your ankle. \nPatient: Dang, that's whack. \nDoctor: Which way did you twist your ankle? \nPatient: My foot twisted inwards. Kind of like this. \nDoctor: I see. Your foot inverted. Did it swell up right away? \nPatient: Aw, man. My foot was huge right after it happened. It hurt so much too. \nDoctor: Continue to keep that tape on. Are you limping or anything? \nPatient: Yeah, I am. I can't really put weight on my foot because it'll hurt a lot. \nDoctor: I see. Well, I examined your foot, and it looks like the pain is around the top, back and middle of your foot.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nSwelling, pain onset immediately after injury, pain with weightbearing activities, limping Injured foot during basketball game while traveling to Duke, landed on another player's foot, taped by trainer John Houston, continued playing after injury\n\nASSESSMENT:\nInversion injury, tenderness around the navicular\n\nPLAN:\nPatient has been in a walking boot, foot taped firmly, advised to continue wearing the tape, continue monitoring for pain and swelling"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Okay, so it looks like your blood work shows that your sodium levels are very low. This could explain some of the symptoms you've been having lately. \nPatient: What does that mean? Why are my sodium levels so low? \nDoctor: It could be due to a number of- \nPatient: Should I start eating more salt? \nDoctor: Not necessarily. But I believe it's partly due to the diuretic that you've been taking these past few weeks. Your blood work also shows anemia. I'd like to start you on some iron supplements for now and get you back in for another eval. The front desk has access to your orders and they can print you out a lab slip. \nPatient: Do you think the iron will help with my tiredness? I've been so exhausted and caffeine hasn't been helping one bit.",
"note": "ASSESSMENT:\n1. Anemia of unknown etiology, acute hyponatremia Anemia of unknown etiology, acute hyponatremia\n2. Acute tiredness Acute tiredness\n\nPLAN:\nDoctor suggests starting iron supplements for the anemia and reevaluation, attributes low sodium levels partially to diuretic use. Doctor suggests starting iron supplements for the anemia and reevaluation, attributes low sodium levels partially to diuretic use."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, ma'am. \nPatient: Good afternoon, doctor. \nDoctor: Remind me, how young are you?\nPatient: Oh doctor, you flatter me. I'm sixty two years old. \nDoctor: Great, and you've had a rotator cuff repair before, correct? \nPatient: Yes, that's correct. \nDoctor: Good, well, what seems to be the problem today?\nPatient: I'm still having a lot of pain in this shoulder. \nDoctor: Oh no, have you had any recent imaging done on this shoulder? \nPatient: Yes, I had an M R I not too long ago, can you take a look? I have it right here. \nDoctor: Thank you, yes, um, this M R I shows that you've torn that rotator cuff again. \nPatient: Oh no, can we do another surgery to repair it again?\nDoctor: Yes, we'll have to. \nPatient: What's the risk of infection of the surgery?\nDoctor: Its less than one percent. We'll use antibiotics to control for infection the entire time. \nPatient: Will I be asleep again?\nDoctor: Yes, you won't feel a thing. \nPatient: Great, yes, I'd like to go forward with the surgery. I need to get back to playing tennis.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nshoulder pain 62-year-old female with previous rotator cuff repair, continued shoulder pain, repeat MRI confirmed re-tear of rotator cuff, patient wishes to proceed with repair after discussion of risks and benefits\n\nASSESSMENT:\nre-tear of rotator cuff\n\nPLAN:\nSurgery discussed and agreed upon to repair re-tear of rotator cuff, risks including infection addressed with assurance of antibiotic use, patient consented to surgery"
},
{
"source": "mts_dialog",
"dialogue": "Guest_clinician: Hello, doctor. Let me give you a run down as to what we are dealing with today. This patient was last seen in January two thousand and four. She is coming for a follow up on interstitial disease secondary to lupus pneumonitis. I will let her tell you more about what happened yesterday. \nDoctor: Thanks, nurse. How are you feeling today, miss? Welcome back to the Pulmonary Medicine Clinic. What happened yesterday?\nPatient: Well, I was doing fine since last time. My respiratory issues have been great and I have had no major difficulties breathing. \nDoctor: That's good to hear. What happened yesterday that caused you to want to come in so urgently?\nPatient: Yesterday I noticed that I have some back and joint pain. When I breathe deep my back hurts. \nDoctor: Are you experiencing any coughing?\nPatient: No, coughing at this moment. \nDoctor: Have you been producing any mucus the times that you do cough?\nPatient: No, I already said I didn't cough. \nDoctor: Okay. Any fevers or chills?\nPatient: Nothing so far. \nDoctor: Do you have any other symptoms currently? \nPatient: I do notice that I am more tired than usual. \nDoctor: During physical activity do you seem out of breath or more tired than usual? I want to see if your pulmonary system is inhibited. \nPatient: No. I don't have issues with breathing when I do daily activities.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nincreasing back and joint pain, back discomfort with deep breath, fatigue Since last visit in January 2004, patient's respiratory status has been good with no major difficulties, recent onset of increasing back and joint pain, back discomfort with deep breath starting yesterday, no cough or sputum production, no fevers or chills, increased fatigue\n\nASSESSMENT:\ninterstitial disease secondary to lupus pneumonitis\n\nPLAN:\nFollow-up evaluation for interstitial disease secondary to lupus pneumonitis, assess back and joint pain, evaluate respiratory status and pulmonary limitations to activity"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello sir, it's been a while since your last visit. How have you been? \nPatient: Hello doctor, yes, I have come a long way. I guess last time I was here was in two thousand and two if I am not wrong. Was does your system say?\nDoctor: You are right! It was August second of two thousand and two to be very precise. \nDoctor: Please confirm for the records, you are a white married man and must be forty nine years old now. Am I right?\nPatient: You got it all right doctor!\nDoctor: Are you still working in that airplane company?\nPatient: Yes sir, still with Alaska Airlines but I have been promoted and work as a plane mechanic. \nDoctor: That is so nice! Good for you man! So, tell me how can I help you today? What brought you to our dermatology department today?\nPatient: I'm having pain in my stomach on the right side and down here. \nDoctor: Is it only on the right side or anywhere else? \nPatient: It is on both sides and now I can feel it on the middle part of my left thigh as well.\nDoctor: Tell me more about it. How did it start? When did you first notice it? \nPatient: It's been going on and off. It was not there for a while, but now it is like back again mainly on my tummy, down here. It is painful when I touch it. At first, I thought maybe I'm having shingles.\nDoctor: When did you notice it? \nPatient: It all started before the holidays, I think one and a half months before the holidays. It is still going on for the past eight days in my tummy and the hips mainly on the right side.\nDoctor: Did you get any treatment for this? Any over the counter medicines?\nPatient: No, as I told you I thought it was shingles, but then there was no change in the skin, no rashes, nothing. I was not sure what to take.\nDoctor: Okay, do you bathe every day?\nPatient: Yes, I do but I try to use as little soap as possible. \nDoctor: Okay, here is what I think, all your symptoms are pointing towards hyperesthesia. I would like to run some tests to find the underlying cause and then we will start the treatment. A nurse will come and take you to the lab. Does this sound good to you?\nPatient: Yes.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nhyperesthesia on right abdomen, left abdomen, and left medial thigh, intermittent problem, more pronounced in the past eight days on abdomen and right hip area, painful when touched Symptoms started six weeks before the holidays, cleared for a while, then recurred mainly on right lower abdomen, no treatment received, no skin changes observed, bathes daily with minimal soap use, married, works as an airplane mechanic\n\nASSESSMENT:\nhyperesthesia\n\nPLAN:\nFurther tests to find underlying cause of hyperesthesia, followed by treatment"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Do you smoke? \nPatient: Yeah. I smoke about a pack a day. \nDoctor: Do you have any plans of quitting? \nPatient: Eh not really. \nDoctor: As your doctor, I'd advise that you consider nicotine patches and find ways to break your smoking habit. \nPatient: Okay. I'll see what I can do. \nDoctor: Do you drink? \nPatient: Socially. \nDoctor: Are you married? \nPatient: No, but I have two littles ones. \nDoctor: Aw, how old are they? \nPatient: I have a four year old and a six year old. \nDoctor: That's great. I'm sure they keep you busy. Any hobbies? \nPatient: They really do, especially the four year old. As for hobbies, I like fixing up computers. I also like fishing, hiking, and camping with the family.",
"note": "SOCIAL HISTORY: Patient is a 79-year-old female with disabling bilateral knee degenerative arthritis unresponsive to conservative measures. Agreed to proceed with surgery.\n\nASSESSMENT:\nbilateral knee degenerative arthritis\n\nPLAN:\nKnee replacement surgery discussed and agreed upon. Risks, complications, anticipated benefits, and postoperative course were discussed with patient."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good morning, ma'am. Before we begin today, can you confirm your age for me? \nPatient: Good morning, doctor. Sure, I'm seventy nine years old. \nDoctor: Great, thank you. What seems to be the problem today, ma'am? \nPatient: Well, I have this arthritis, as you know. \nDoctor: Yes, how would you describe your arthritis? \nPatient: Well, at this point I'd say it's debilitating. \nDoctor: I see, so the antiinflammatories and rest haven't helped at all? \nPatient: No, I haven't had any improvement, doctor. It's still so bad. \nDoctor: I see, I believe you'd be a good candidate for a knee replacement. \nPatient: Yes, I thought so. What are the risks of infection for the surgery? \nDoctor: Um, it's less than one percent, we use prophylactic antibiotics to control for infection the entire time. \nPatient: That's great, what about anesthesia, will I be asleep for this? \nDoctor: Yes, you won't feel a thing.\nPatient: Great, yes, I'd like to do the surgery, doctor.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nPatient is a 79-year-old female with disabling bilateral knee degenerative arthritis unresponsive to conservative measures. Agreed to proceed with surgery.\n\nASSESSMENT:\nbilateral knee degenerative arthritis\n\nPLAN:\nKnee replacement surgery discussed and agreed upon. Risks, complications, anticipated benefits, and postoperative course were discussed with patient."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: How old are you? \nPatient: I'm eighty six years old. \nDoctor: What gender do you identify with? \nPatient: I identify as a female. \nDoctor: How long have you had this back and buttock pain? \nPatient: Its been a while, now. I know I have a fracture in my lower back. \nDoctor: How have you been managing this? \nPatient: Another doctor called this conservative treatment. I've been resting a lot, and using antiinflammatories. \nDoctor: Has there been any improvement?\nPatient: Its been several months at this point, and honestly no, there's been no improvement. I'm still in a lot of pain. \nDoctor: This C T Scan you had recently shows sclerosis, with some healing of a L five compression fracture, but if you look here, the healing is not complete. \nPatient: What can we do about this? I'm in so much pain. \nDoctor: I believe you'd be a candidate for a bilateral L five kyphoplasty. \nPatient: What's that? \nDoctor: It's a small procedure on that L five vertebra. Its minimally invasive, and we can actually do it as an outpatient procedure. \nPatient: Oh, wow, that's good to hear. What are the risks of infection?\nDoctor: Very low, historically, they're less than one percent. \nPatient: How is this possible? \nDoctor: We'll use antibiotics in order to control for infection. \nPatient: That's great, will I be under anesthesia?\nDoctor: Yes, you'll be asleep for the whole thing. \nPatient: Great, yes, I'd like to have this done, I can't keep living in this pain. \nDoctor: Awesome, I agree. Do you have control over your bladder and bowel movements? \nPatient: Yes, thankfully, I have complete control over everything like that still. \nDoctor: Do you wear a brace or corset normally?\nPatient: Yes, I usually wear both. \nDoctor: Okay, last question, can you notice any weakness in your body? \nPatient: No, I'm still very strong, even at my age.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nback and buttock pain 86-year-old female with history of back and buttock pain, conservative treatment unsuccessful, CT scan shows incomplete healing of L5 compression fracture\n\nASSESSMENT:\nL5 compression fracture with sclerosis, incomplete healing\n\nPLAN:\nbilateral L5 kyphoplasty scheduled, patient denies bowel or bladder incontinence, wears back brace and corset, no weakness reported"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello, Nurse. Could you give me a run down on the eleven month old patient? \nGuest_clinician: The patient was presented with stage two neuroblastoma on the left when he was six weeks old. It was completely resected. It was shown not to be N Myc amplified and had some favorable Shimada histology. \nDoctor: Great. Did he have a follow up after?\nGuest_clinician: He did. There was a second primary in his right adrenal gland. They performed a biopsy, which was consistent with neuroblastoma with favorable Shimada histology. \nDoctor: Did he receive any chemotherapy?\nGuest_clinician: He is now being treated with it per protocol P nine six four one and not on study. His last chemotherapy appointment was on May twenty first two thousand and seven. They used carboplatin, cyclophosphamide, and doxorubicin.\nDoctor: What did they do after chemotherapy? \nGuest_clinician: He received G C S F daily because he had neutropenia that delayed his second cycle. \nDoctor: Thank you, Nurse. I'll go talk to the mother. \nGuest_clinican: No problem, Doctor. \nDoctor: Hello, ma'am. It's nice to see you again. How is your little boy doing?\nGuest_family: Not so well. Since out last visit, he had a stuffy nose for a couple of days. \nDoctor: Is it getting worse?\nGuest_family: I think it's getting better now. It isn't as stuffy. \nDoctor: That's good to hear. Has he been sick or had any fevers?\nGuest_family: Nope. Just the stuffy nose.\nDoctor: Has he been able to eat anything?\nGuest_family: At times, he didn't want to eat. It seemed like he wasn't hungry. \nDoctor: Does he still have a reduced appetite?\nGuest_family: Not anymore. He's starting to eat again.\nDoctor: Did he have any nausea or vomiting after he ate?\nGuest_family: Thankfully, no. I would have made my husband clean up the vomit. \nDoctor: That's great. Is he able to pee and poop fine? No diarrhea, right?\nGuest_family: His poop has been solid. I haven't seen anything bad about his pee either. \nDoctor: Great. Would you be able to open his mouth for me? I just want to check if everything's fine inside. \nGuest_family: Of course. Say ah. \nPatient: Ah. \nDoctor: Thank you. Oh, wow. It looks like he's showing some symptoms of thrush again. \nGuest_family: Oh, no. Should we restart fluconazole?\nDoctor: It's just a fungal infection inside the mouth. I'll prescribe him fluconazole. It should get rid of it. \nGuest_family: Thank you so much. You all have been so helpful. My little boy is slowly getting better.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nnasal congestion (improving), diminished appetite (improving), thrush nasal congestion improving, diminished appetite improving, normal urination and bowel movements, no diarrhea, no nausea or vomiting reported, recently restarted fluconazole for thrush\n\nASSESSMENT:\nstage 2 neuroblastoma (initially left, then right adrenal gland), not N-Myc amplified, favorable Shimada histology, receiving chemotherapy per protocol P9641 (carboplatin, cyclophosphamide, doxorubicin)\n\nPLAN:\ncontinue chemotherapy per protocol, prescribe fluconazole for thrush"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: So, how are long have you had pain in this hip? \nPatient: It's been about eight or ten years now. It began while I was working in construction. \nDoctor: How old are you now? \nPatient: I'm thirty two now, so I've been in pain since I was in my twenties. \nDoctor: Have you seen another doctor for this, or am I the first? \nPatient: Yeah, um, I've actually seen several doctors before, the last I saw was Doctor A B C a few weeks ago.\nDoctor: What did those doctors tell you?\nPatient: They thought it was low back pain, and something called, um, radiculopathy. \nDoctor: Does your pain radiate into your legs? \nPatient: Yes. \nDoctor: Has your pain been present for the eight years, or did it come and go? \nPatient: It's been persistent, and I've had difficulties on and off since then. \nDoctor: Okay. The x rays from Doctor A B C show severe degenerative changes as well as avascular necrosis of the femoral head. What else did the Doctor do for you? \nPatient: He gave me some pain medicine, and we talked about going to another specialist for surgery.\nDoctor: Do you remember the names of the procedures suggested? \nPatient: Something about resurfacing the hip, or a hip replacement. I'm here for another opinion on that. \nDoctor: I saw you come in with a cane, do you have groin pain as well? \nPatient: Yes, and I can't do any of the activities I used to. \nDoctor: Besides the pain medication, have you had anything else? \nPatient: I've taken antibiotic steroids before. \nDoctor: Okay. Do you drink? \nPatient: Yes, a lot.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nhip pain, difficulty with activities, groin pain 32-year-old male with eight to ten year history of left hip pain, initially thought to have low back pain with radiculopathy, previous evaluation by multiple specialists, previous antibiotic steroid use, heavy drinking history\n\nASSESSMENT:\nsevere degenerative changes of left hip joint, avascular necrosis (AVN) of left femoral head\n\nPLAN:\ndiscussion of hip resurfacing versus conventional total hip replacement, seeking second opinion"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Hello, miss. Doctor X and I will be going over your medical history with you. Before we begin, could you confirm your age for me?\nPatient: I'm twenty five years old. \nDoctor: Thank you. Doctor X, could you go over the diagnosis of erythema nodosum?\nDoctor_2: She was diagnosed in two thousand and four after a biopsy was done that confirmed erythema nodosum, but the detail from the Netherlands is not that specific. \nDoctor: What kind of procedures were done to address it? \nDoctor_2: She had undergone a colonoscopy to address secondary diseases that may have been present because of the erythema nodosum, correct miss?\nPatient: Yeah, that's correct. \nDoctor: Were there any findings, Doctor X? \nDoctor_2: The findings were uncertain if the terminal ileum had abnormal biopsies. However, the skin biopsy mentioned some fibrosis, basal proliferation, and inflammatory cells in the subcutis.\nDoctor: I see. Her report states something about a tibia and fibula fracture on her right leg before the erythema nodosum. Are these skin lesions due to the fracture? \nDoctor_2: The skin lesions are not associated with the fracture, correct ma'am? \nPatient: That's correct. The cuts in my skins are on both legs too. Not just the right.\nDoctor: Thank you. Did anything occur before the skin lesions? \nDoctor_2: She had cosmetic surgery done on her jaw. \nDoctor: Ma'am, I see you visited our clinic and the Dermatology several times, correct? \nPatient: Yeah, that's correct. I had a rash that I wanted to get checked. \nDoctor_2: I remember that. I was here when she presented the rash. We suggested the rash in her lower extremities and ankles was erythema nodosum. She also had discomfort, which could have been inflammatory arthritis. \nDoctor: Doctor X, did you confirm with any tests? \nDoctor_2: Yes. There was an initial S E D above one hundred and ten and her C P R was increased. \nDoctor: Great. In the visits after, were there any other problems found? \nDoctor_2: The reports says that no other abnormalities were found. However, I do see something about her first visit. \nDoctor: Could you explain what it says?\nDoctor_2: She has some M T P detected, which could have been signs of erythema nodosum. However, the Dermatology did not agree, and they believed it to be venous stasis. \nDoctor: The venous stasis could have been related to the fracture, right? \nDoctor_2: That is correct. \nDoctor: Her initial visit reports suspicion of I B D, sarcoid inflammatory arthropathy, and lupus. Why was that? \nDoctor_2: She had a questionable rheumatoid fracture even though her C C P was negative. Her A N A was positive at one to four zero. There was a persistent speckled pattern. However, the rest of the lupus serologies were negative. \nDoctor: What lupus serologies were used? \nDoctor_2: Double stranded D N A, R N P, Smith, R O, and L A were used. \nDoctor: How did her cardiolipin antibodies panel look? \nDoctor_2: They were all negative. We made sure I g M, I g G, and I g A were less than ten. \nDoctor: I see. Was there anything else in the report? \nDoctor_2: She had her beta 2 glycoprotein one or R V V T tested. \nDoctor: That seems important because of the livedo pattern. \nDoctor_2: Exactly. That's why they concluded it was an onset of lupus and not rheumatoid arthritis because the arthritis couldn't be associated with erythema nodosum. \nDoctor: Why did she undergo a C T scan?\nDoctor_2: We feared she had lymphoma. The scan of her chest, abdomen, and pelvis were done to rule out sarcoid. \nDoctor: I see. The results came out normal, right?\nDoctor_2: That's correct. \nDoctor: Did you change some of you habits to help your bowels, ma'am? \nPatient: I tried my best to. \nDoctor: That's good. What was found Doctor X? \nDoctor_2: There was evidence of B twelve deficiency with a high methylmalonic and high homocystine levels along with a low normal B twelve in addition to iron studies consistent with iron deficiency and an initially low M C V.\nDoctor: That gives the possibility of inflammatory bowel disease, right?\nDoctor_2: Correct. That's stated in the report. \nDoctor: Were there any tests done to confirm this? \nDoctor_2: She underwent a colonoscopy, which showed nothing. Her endoscopy was also normal. Recently, she underwent a second coloscopy, and no evidence of inflammatory bowel disease was seen after viewing it microscopically. \nDoctor: Nothing was seen microscopically? \nDoctor_2: Actually, we determined there were aggregates of eosinophils. \nDoctor: That sounds important. That could be due to an allergic reaction or an emergence of Crohn Disease. I will have to discuss with Doctor Y from Gastroenterology to see the significance. \nPatient: Could I interrupt for a second? I don't think my B twelve and iron deficiency were looked at while I stayed in the United States. \nDoctor: Is that correct, Doctor X?\nDoctor_2: That is. I think these details were from somewhere else. \nDoctor: At least we are aware of it. What medication was provided during her first visit? \nDoctor_2: It looks like she was placed on forty milligrams of prednisone. The strength was reduced over time. \nDoctor: This may be a reason to her acne. Was she taken off this medication?\nDoctor_2: Yes, she was. There were too many adverse effects. \nDoctor: What was she places on after?\nDoctor_2: It looks like she started a point six m g colchicine, which she took daily. \nDoctor: How were her inflammatory markers after taking it? \nDoctor_2: Her markers were under control and positive. She also didn't have any evidence of erythema nodosum. \nDoctor: That is great. How did you like that medication, ma'am? \nPatient: My ankle would swell up and hurt. There were also some sensitive rashes on the skin of my legs. \nDoctor: I see. Is that stated on the report, Doctor X? \nDoctor_2: It is. I also see that she was reevaluated by Dermatology. \nDoctor: Did they find anything apparent? \nDoctor_2: No, they didn't. They didn't find any evidence of erythema nodosum. \nDoctor: What was the plan following that? \nDocotr_2: It looks like we proceeded with a D E X A scan and checked her vitamin D levels. \nDoctor: Was there any medication prescribed? \nDoctor_2: We ordered vitamin D and calcium to be bought over the counter so that her bones were protected. However, they use of them was stopped until we figured out the underlying cause of her disease. \nDoctor: I see. Other than the fracture and jaw surgery, was there anything else? \nDoctor_2: It shows she had Varicella and Mononucleosis, correct ma'am? \nPatient: Yeah, that's correct. \nDoctor: That's good. Our recent physical exam with you from last August showed changes in your venous stasis and diffuse periarticular ankle edema. Fortunately, we did not find any erythema nodosum, but the livedo patter was still present. \nPatient: I see. Did you find anything else? \nDoctor: We did find a heart murmur, so we will conduct an echocardiogram. Doctor X, could you confirm all the details form the workup, please?\nDoctor_2: Of course. Her A C E levels were normal. Her sed rate was around 30, which was high. Before that, it was around one ten, which is even higher. Her R V V T was normal. The rheumatoid factor was negative. The urinalysis was also normal. She had a C R P level of two point three, which was high. Her C C P came out negative. Her C B C displayed microcytosis and hypochromia with hematocrit levels of thirty seven point seven. Her hematocrit levels improved to forty point three later on, and she did not have any hypochromia, microcytosis, or anemia present. \nDoctor: Thank you for all that information. Does all this information and history seem to be correct, ma'am? \nPatient: Yes. Thank you for going over that in front of me. \nDoctor: No problem. I see you're here today regarding some mild but intense skin rashes. You mentioned that you thought it was erythema nodosum, correct? \nPatient: Yeah, that's correct. I think it's on my ankles. I also feel some joint stiffness. \nDoctor: I will take note of that. You also mentioned something about a rash before. Did you have a rash that was sensitive to U V light, like sunlight? \nPatient: That's right. I had it twice when I was in Europe. \nDoctor: When did you notice the rashes? \nPatient: I was skiing, and my face started to swell up. \nDoctor: I see. Do you think it had to do anything with your acne? \nPatient: No. My acne was stable after I stopped taking that one medicine and started the other. \nDoctor: The prednisone and colchicine we mentioned earlier, correct? \nPatient: That's correct. \nDoctor: Is there anything else you would like to ask? \nPatient: I am trying to get pregnant and would like to know if the medication has any effects on pregnancy. \nDoctor: I'll discus that with you right now. \nPatient: Actually, could you provide me with a pamphlet? I need to go study for my psychology classes. I have a big test tomorrow.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nmild skin rash, arthralgias in ankles, photosensitivity rash diagnosed with erythema nodosum in 2004 after biopsy, extensive workup including colonoscopy, prior tibia-fibula fracture unrelated to skin lesions, jaw cosmetic surgery, recurrent skin rash with description suggestive of erythema nodosum, initial high sed rate and CRP, subsequent visits showed no evident abnormality, suspicion of IBD, sarcoid inflammatory arthropathy, and lupus raised, positive ANA, negative lupus serologies, concern for lymphoma led to CT scan (unremarkable), evidence of B12 and iron deficiency, initial prednisone treatment followed by colchicine, skin rash persisted, reevaluation by Dermatology, ongoing investigation for underlying cause of disease, history of varicella and mononucleosis, diffuse periarticular ankle edema, heart murmur detected\n\nASSESSMENT:\npresumptive erythema nodosum (based on biopsy), possible inflammatory arthritis\n\nPLAN:\nechocardiogram for heart murmur, further discussion on significance of eosinophil aggregations with Gastroenterology, DEXA scan, check vitamin D level, order vitamin D and calcium (deferred), consideration of photosensitivity in rash treatment, discussion on effect of colchicine on pregnancy"
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Okay I am looking at you for multiple issues today. One of the biggest being swelling on your left leg. Can you tell me more about that?\nPatient: Yes sure. I got this swelling for almost three years now, and it has been worse for the past two to three months. Sometimes it gets better in the morning when I get up, but then throughout the day it begins to swell again. Lately it is staying bigger, and it feel uncomfortable with it being so large. The right leg also swells, but not nearly like the left leg.\nDoctor: How old are you, miss?\nPatient: I am forty four. My biggest problem is this pain in my left shoulder. I feel as if this low back pain is due to a poor mattress. \nDoctor: Did you hurt your shoulder?\nPatient: No, I don't remember hurting shoulder, but gradually I am losing some mobility. It is hard for me to get my hands behind my back or behind my head. I am losing strength in the left shoulder gradually for the last year.\nDoctor: Ok let's look at your labs.\nPatient: So far white counts are high. In April two thousand five Doctor X Y Z was asked to look at my high white count, but she thought it wasn't a problem and asked me to come for follow up.\nDoctor: Any other complaints?\nPatient: I have a lot of frequency with urination, and I get up to pee at night at least two to three times. Also, I have gained weight, I think about twelve pounds since March. Right now, I am two eighty four pounds.\nDoctor: Okay. So, I can see that your blood pressure is staying stable. You do take Atenolol twelve point five M G per day and Lasix as needed. \nPatient: Yes, that's correct. It makes me pee so much. I do not take it.\nDoctor: How about chest pain or shortness of breath?\nPatient: No chest pain, but I am gradually feeling short of breath.\nDoctor: What work you do?\nPatient: I work for the city of Wichita as bus dispatcher. My work demands sitting a lot, and just really does not move around much. But towards the end of the day my leg swells up.\nDoctor: Okay that's okay.\nPatient: I need cholesterol check right?\nDoctor: Yes, you do, but all the other labs are normal.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nSwelling in the left leg, swelling in the right leg to a lesser extent, pain and loss of mobility in the left shoulder, low back pain, increased frequency of urination, nocturia, weight gain, shortness of breath. The patient, a 44-year-old white female, presents with swelling in her left leg for the past three years, worsening over the past two to three months. The swelling improves in the morning but worsens throughout the day, causing discomfort. Her right leg also swells, though not as severely. She also complains of pain and decreased mobility in her left shoulder, with associated low back pain. She denies any history of shoulder injury but has experienced gradual loss of strength and mobility over the past year. She reports increased frequency of urination and nocturia, along with weight gain of approximately 12 pounds since March, currently weighing 284 pounds. She notes stable blood pressure, takes Atenolol 12.5 mg daily, and Lasix as needed but dislikes it due to increased urination. She denies chest pain but reports gradually increasing shortness of breath. She works as a bus dispatcher for the city of Wichita, involving prolonged sitting, which exacerbates leg swelling towards the end of the day. Laboratory findings show an elevated white count, with previous consultations regarding leukocytosis deemed non-problematic. The patient requests a cholesterol check.\n\nASSESSMENT:\nElevated white count, leukocytosis.\n\nPLAN:\nFurther evaluation and management of leg swelling, left shoulder pain, leukocytosis, increased urinary frequency, and weight gain. Cholesterol check warranted."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Good afternoon, sir. Did you see the nurse already? \nPatient: Yes, I just saw her. \nDoctor: Great, you're seventy eight years old, correct? \nPatient: Yes, I'm not as young as I used to be.\nDoctor: Who is? What seems to be the problem today, sir? \nPatient: I have right hand pain, and it's been there for a while now. \nDoctor: Are you having numbness sir? \nPatient: Yes, and I can't move it very well, either. \nDoctor: Which fingers are you having these symptoms in? \nPatient: Well, I told you it's all in the right hand, but it's in the index and middle fingers. \nDoctor: Are your fingers catching? \nPatient: What does that mean, doctor?\nDoctor: Are you having any problems extending your fingers?\nPatient: Yes, they seem to lock up when I try to extend my fingers. \nDoctor: Have you seen another doctor for this? \nPatient: Yes, I had an E M G and it showed, um, carpal tunnel on both hands. \nDoctor: It's in both hands, but the right is worse than the left, correct? \nPatient: Yes, that's correct. \nDoctor: What treatments have you had for this? \nPatient: I only had an injection so far. \nDoctor: Did this help at all?\nPatient: Well, some, but it was really only temporary relief. Is there surgery for this? \nDoctor: Yes, I think you'd be a good candidate for surgery. \nPatient: What are the risks of infection from the surgery?\nDoctor: It's less than one percent. We use prophylactic antibiotics to control for infection the entire time. \nPatient: Even though it's on my hand, will I be asleep for this procedure? \nDoctor: Yes, you won't feel a thing. \nPatient: Okay, yes. I'd like to do the surgery.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nRight hand pain, numbness, decreased range of motion in the middle and index fingers, catching and locking of the right middle finger.\n\nASSESSMENT:\nCarpal tunnel syndrome diagnosed on bilateral hands, with the right hand being worse than the left. Positive EMG findings as well as clinical findings.\n\nPLAN:\nThe patient underwent an injection which provided temporary relief. Due to the temporary relief from the injection, the patient has consented to undergo surgery for the above-named procedure. All risks and complications were discussed with the patient, and consent was obtained."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Are you going to visit rehab?\nPatient: Yes, what choice do I have?\nDoctor: Yes, please do visit Mercy Manor for P T and Rehab.\nPatient: Yes, I will.\nDoctor: That will help your right side hip pain.\nPatient: I think so too.",
"note": "ASSESSMENT:\nRight hip pain.\n\nPLAN:\nPatient to undergo physical therapy and rehabilitation at Mercy Manor to address right side hip pain."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: Welcome back to the clinic. How are you feeling today? \nPatient: Thank you. I am doing better. \nDoctor: It looks like we are following up on your severe osteoarthritis in both knees. And you also have been experiencing some flexion contracture limitations. \nPatient: Um hum.\nDoctor: How is your physical therapy going? \nPatient: It is going really well. She kicks my butt but it seems to be helping. Doing my exercises at home is really helping. \nDoctor: Were you not doing them in the beginning? \nPatient: No, I wasn't. She got on me to start doing them and I have definitely seen the difference. \nDoctor: Have you experienced any worsening of pain since you were last seen? \nPatient: Well, the right knee is worse than the left? It mostly hurts after physical therapy. \nDoctor: Can you describe what the pain feels like? \nPatient: It feels achy. \nDoctor: Is it a continuous pain, or? \nPatient: No. It is not all the time. Every once and a while. It feels stiff all the time. \nDoctor: Any weakness or instability? \nPatient: No. \nDoctor: Any burning sensations associated with the pain? \nPatient: No. \nDoctor: How long have you been dealing with this? \nPatient: Several months. \nDoctor: Have you had any trouble sleeping? \nPatient: No. When I sit down or lie down at night there's no pain.\nDoctor: So, the pain is when you are weight bearing, right? \nPatient: Yeah. And it hurts when I move around. It makes it difficult to do things. \nDoctor: Have you noticed any pain with the cold weather change? \nPatient: No, I have not noticed anything. \nDoctor: I am just going to take a look here. \nPatient: Okay. \nDoctor: I don't see any swelling or redness. And I don't feel any warmth coming from the area. Have you noticed any of these symptoms? \nPatient: Nope. \nDoctor: Any radiating pain through the knees here? \nPatient: No. \nDoctor: Any pain any where else in the body? \nPatient: No, just the knees. \nDoctor: So, no pain in the hips or back? \nPatient: Nope.",
"note": "HISTORY OF PRESENTING COMPLAINT:\nLocalized pain to the bilateral knees, right worse than left, described as occasional aching, associated with stiffness and weakness. Pain worsens after physical therapy, mainly when weight-bearing and with ambulation. No swelling, redness, or warmth observed. No burning sensations. Duration of Symptoms is several months. No sleep loss or instability reported. No hip or back pain. No radiating pain. No pain with weather changes. Patient reports improvement with physical therapy exercises, especially after being encouraged to perform them regularly. Pain is primarily felt in the right knee, occasionally aching and causing stiffness. Symptoms have persisted for several months, mainly aggravated by weight-bearing and movement. No associated Symptoms such as swelling, redness, or warmth. No sleep disturbances or instability noted. No pain reported in the hips or back. No radiating pain or pain with weather changes.\n\nASSESSMENT:\nGrade IV osteoarthritis of bilateral knees with flexion contracture.\n\nPLAN:\nContinue with physical therapy exercises. Monitor pain and assess response to treatment. Consider additional interventions if necessary."
},
{
"source": "mts_dialog",
"dialogue": "Doctor: I think you have a muscular strain. \nPatient: Yeah.\nDoctor: So right side shoulder strain and maybe a little bit of nerve compression.\nPatient: Oh really!\nDoctor: Maybe. I will do further evaluation and treatment.\nPatient: Okay.",
"note": "ASSESSMENT:\n1. very mild evidence of impingement\n2. Right shoulder pain, most likely secondary to muscular strain\n\nPLAN:\nFurther evaluation and treatment will be done."
}
]