diff --git "a/test.csv" "b/test.csv" new file mode 100644--- /dev/null +++ "b/test.csv" @@ -0,0 +1,1738 @@ +ID,dialogue +0,"Doctor: Good afternoon, sir. Did you just have a birthday? I don't have my chart with me right now, the nurse is bringing it. +Patient: Good afternoon, sir. Yes, I just turned fifty five. +Doctor: You identify as African American, correct? +Patient: Yes, that's right. +Doctor: When was your last visit, sir? +Patient: Um, it was on July twenty ninth two thousand eight. +Doctor: Yes, I see. Did we go over your M R I results? +Patient: No, I was having those new seizures, remember? +Doctor: Yes, I do. Well, the M R I demonstrated right contrast temporal mass. +Patient: What exactly does that mean, doctor? +Doctor: Well, given this mass, and your new seizures, I am concerned that this could be a high grade glioma, we'll need to do more tests." +1,"Doctor: Any medical issues running in your families? +Patient: Oh yes, stroke. +Doctor: Anything else? +Patient: Sleep apnea." +2,"Doctor: Any pain in your muscles? +Patient: No, no pain. +Doctor: How about joint pain? +Patient: Um no, I don't feel any joint pain. +Doctor: Okay, good. +Doctor: Do you feel any stiffness or weakness in your muscle? +Patient: Um, nothing like that. +Doctor: Do you have any back pain? +Patient: No. +Doctor: Okay." +3,"Doctor: Anyone in family with any blood or heart issues? +Patient: No. +Doctor: Anyone diabetic or with any other issues in family? +Patient: No." +4,"Doctor: Can you tell me about your family? Did anyone in your family have any medical problems? +Patient: Oh yeah. My father died of thoracic aortic aneurysm. He was seventy one years old at that time. +Doctor: Anything for anyone else? +Patient: Yeah, my mom died of stroke. She was around eighty one." +5,"Doctor: It is good to see you again. How have you been? +Patient: It is good to see you too. I have been good. +Doctor: Have anything changes to your medical history or social history since the last time I saw you? +Patient: No. No changes." +6,"Guest_clinician: How old is the patient? +Doctor: Seventy seven. +Guest_clinician: She was sedated with Ativan, correct? +Doctor: Yeah, we had to sedate her. She wasn't doing so well upon arrival and appeared short of breath. She couldn't give us a history and we immediately had Xray come in to scan her lungs. +Guest_clinician: Did they find anything? +Doctor: The report showed what we believe to be free air under her right diaphragm." +7,"Doctor: What is your family medical history? +Patient: My parents do not have any health conditions. I have two half brothers that are in good health as well. +Doctor: How old are your brothers? +Patient: Twenty six and twenty eight. My grandmother on my mom's side had D V T in her leg. I think she was in her forty's. +Doctor: Any family history of diabetes? +Patient: I think my aunt from my dad's side of the family and my cousins on my mom's side of the family are diabetic? Oh. My great grandfather had bone cancer. He was in his eighties. My mom's brother was recently diagnosed with leukemia. He is around fifty years old. Then my dad's dad had colon cancer at seventy three. He had it since he was sixty eight, though. I think that is it." +8,"Doctor: Are you still working, sir? +Patient: No, I am retired now. I worked for twenty years in social security administration. +Patient: Now I just enjoy my life with my wife, we travel a lot. I like to be extremely active. +Doctor: That's awesome. +Doctor: Do you drink? +Patient: Yes, but only socially. +Doctor: How about smoking or any drugs? +Patient: No, I don't smoke or do any kind of drugs or anything. +Doctor: Okay." +9,"Doctor: Do you know about any allergies from any medications? +Patient: No." +10,"Doctor: Good afternoon, ma'am. Can you tell me more about yourself, please? +Patient: Well, I'm seventy nine, and I'm an African American women. +Doctor: Did the nurses get your height? +Patient: No, they didn't. +Doctor: How tall are you? +Patient: I'm five foot three inches. +Doctor: Thank you, and how much do you weigh? +Patient: Um, I'm about one hundred ninety seven pounds. +Doctor: Great, and do you have any major medical conditions that I should know about? +Patient: I've had type two diabetes since nineteen eighty three. +Doctor: Thank you, and do you have any allergies to any medicine? +Patient: No, not that I know of." +11,"Doctor: Did he get his B C G vaccine? +Guest_family: Yes, he did back in the Philippines before starting his elementary school. +Doctor: Okay, did you have his immunization records? +Guest_family_2: Yes, we submitted it at the front desk. +Doctor: Okay, how long has he been complaining of uneasiness in his stomach? +Guest_family_2: For a few days. +Doctor: Any history of liver problems or gallbladder stones? +Guest_family: No, he had his physical and blood tests and everything came out normal. +Doctor: Okay, good. Any fever or chills? +Guest_family: No. +Doctor: Any history of ulcers? +Guest_family_2: No." +12,"Doctor: What's your living situation like? +Patient: I uh live alone, but I can count on my family and friends to keep me company. +Doctor: Do they serve as a good support system for you? +Patient: Yeah, I'd say so. +Doctor: And as for drinking and drugs, do you drink or use tobacco products? +Patient: I smoke, but I don't drink. +Doctor: You know smoking is bad for you, right? +Patient: Yeah, yeah. I've heard this talk one too many times. I'll try to quit eventually." +13,"Doctor: How've you been feeling lately? +Patient: Good, I guess. +Doctor: How've you been managing your anxiety? +Patient: I recently started therapy and I'm scheduled to see a psychiatrist sometime next week. +Doctor: Good, good. And any problems with your blood pressure? +Patient: I've been taking my blood pressure meds so it's been fine." +14,"Doctor: Hello, how are you today? +Patient: I am doing well. +Doctor: Great. What would you like to bring up today? +Patient: I have some questions about my liver. +Doctor: Alright. Let's start with the basics. Do you drink? Excessive drinking can cause issues with the liver. +Patient: No, I do not. I take a lot of Tylenol for pain and I am worried it is effecting my liver. +Doctor: Okay, that is a common concern. We can address that today. Do you happen to smoke? +Patient: No, I do not smoke." +15,"Doctor: Hello, I will ask you a few questions. +Patient: Hm. +Doctor: Any headaches or breathlessness? +Patient: Nope. +Doctor: Any skin problems? +Patient: Nope, nothing new. +Doctor: Any pain in the chest or anywhere else? +Patient: Nope. +Doctor: Any other problem that I should know. +Patient: I can't think of any." +16,"Doctor: Did you ever see that your skin is turning blue or greyish in color? +Patient: Not that I notice. +Doctor: Any swelling like there is water filled inside? +Patient: Nope. +Doctor: Have you ever noticed any kind of swelling in your fingers or toes? +Patient: No." +17,"Doctor: Any health problems or health conditions? +Patient: No. I have never had any health issues. Other than why I am why I am her today. +Doctor: Lucky you. No prior surgeries? +Patient: I know right? No, I have never had any surgeries." +18,"Patient: I am always tired, I don't know what to do. +Doctor: Yeah, your fatigue can be due to so many reasons. You have many underlying conditions. You have hypertension, high cholesterol, and osteoarthritis. All this can add up and lead to fatigue. I think you need to really take care of your health." +19,"Doctor: Nice to see you again, miss. I see your last visit was back on August tenth two thousand and four. How are you? +Patient: Hi, doctor. Nice to see you again as well. I've been doing fine. +Doctor: How is your husband doing? +Patient: He's doing fine. Just working a lot. +Doctor: Great! I hope the work isn't getting him too stressed out. Also, I need to fill out the ethnicity section in your paperwork; it seems to be missing. What ethnicity do you identify as? +Patient: Oh, yes. I am white. +Doctor: Thanks! Are you still working too? +Patient: Yeah, I am. My secretary position has been super stressful lately. +Doctor: I understand. How is your acne doing? +Patient: I think it's been getting better, but I've had this rash for the last two months on my chest, stomach, neck, and back. +Doctor: I see. Let me take a look at this rash. I see you have these small folliculitis lesions that are pus filled bumps centered on your hair. +Patient: Oh, no. Is that bad? +Doctor: It's treatable. It seems like it's happening because your acne is flaring up. +Patient: Oh, really. Is it because I stopped my medication for the last three days? +Doctor: I forgot what I prescribed you. Let me take a look at my notes. Oh, I see. I prescribed you five hundred milligrams of Amoxicillin to take twice a day and a point one Tazorac cream. Have those been working? +Patient: Yeah, they have. I noticed my face started to get better. +Doctor: Continue to take those and try not to stop it. Have you been trying anything else? +Patient: I actually started going to Healing Waters to get photofacials. +Doctor: I see. Has that been helpful? +Patient: Yeah, it has, but I want a faster treatment. I'm only forty nine and want to look younger. Are there any procedures or skin care products that can be used to help my face look better?" +20,"Doctor: Hello! How are you doing today? +Patient: Hi! I am stuck in here, so I am not doing great. +Doctor: How long have your legs been swollen like this? +Patient: They swell up like this from time to time but it has been happening for a long time. I also can't feel my toes. +Doctor: How long has the numbness of your toes been going on? +Patient: A long time. +Doctor: Are you able to get up and move around? +Patient: I can't walk because of my weight. It is too much for me. When I try to get up, I get short of breath. I have C O P D. I can't do much but sit here. I am in a lot of pain all the time. +Doctor: When you get up and try to walk around, do you experience any chest pain or visual problems? +Patient: No. I just feel out of breath. +Doctor: Do you take anything for your pain? +Patient: I take OxyContin for my back pain. +Doctor: Do you ever experience any constipation, diarrhea, abdominal pain, nausea or vomiting? +Patient: No. I have these sore on my legs, that ooze. +Doctor: Okay. Let me look." +21,"Doctor: Is this chest pain new for you? +Patient: For the most part, yeah. It's been happening the last few nights. +Doctor: How would you describe the pain? +Patient: Like a gnawing sensation. +Doctor: How long does each episode last? +Patient: Few seconds I think. +Doctor: How would you rate the pain out of ten with ten being the worst? +Patient: I'd say it's about a five or six outta ten. +Doctor: Have you tried taking anything for pain relief? +Patient: No. +Doctor: And are you having any other symptoms that I should know about? Like shortness of breath or leg swelling? +Patient: No, mainly just the chest pain, and of course, everything else I follow up with you about." +22,"Doctor: And how long have you been married? +Patient: I have been happily married for forty five years. +Doctor: Wow, that's remarkable. +Patient: Yes, we have a small house by the bay just two miles away from your office. This is my dream house. I always dreamt of living in a house with a waterfront and when I retired, I moved here with my wife. It's nice and peaceful. +Doctor: That's amazing! Okay so tell me something do you drink or smoke? +Patient: Oh, I quit smoking long time ago. Was it ninety six or ninety seven? Hm I think I quit smoking in nineteen ninety seven. I do enjoy a glass of wine or beer but very occasionally. +Doctor: Okay." +23,"Guest_clinician: Hello, my name is Mary. I will ask you a few questions about your medical and family history and then Doctor Smith will come and check you. Okay? +Patient: Okay. +Guest_clinician: Do you have any other previously diagnosed medical issues? +Patient: I have sinus. I also had a stroke around two years ago. +Guest_clinician: Do you smoke or drink? +Patient: Nope, never did any of those. +Guest_clinician: Do you have any kind of allergies? +Patient: No, no known allergies. +Guest_clinician: Thank you for answering all my questions, I will let Doctor Smith know that you are ready." +24,"Doctor: Do you know what foods have a high level of salt? +Patient: Do you mean like chips and junk food? +Doctor: Yes mostly. And pickles.. I want you to avoid them. +Patient: Okay. Why? +Doctor: Because it is harmful for your current condition. +Patient: Okay I will cut it. +Doctor: Yes, so follow a low salt diet. +Patient: Okay." +25,"Doctor: Please, tell me more about your family's medical history. Are there any conditions I should know about? +Patient: I know that my grandma had arthritis. +Doctor: Good to know, did you have arthritis as a child? +Patient: No, I didn't have anything like that. I thought only old people got that. +Doctor: Generally, but it can happen in children as well. What about psoriasis, is there any history of that anywhere? +Patient: Yes, my dad has that. I see the commercials for the medicines all the time." +26,"Doctor: Hello, sir. Welcome back. Looks like we are going to revaluate your heart issues. You have a history of ischemic cardiac disease, correct? Can you also state your age? +Patient: Sixty eight. Yes. I saw doctor X Y Z in February two thousand four and he made me walk on a treadmill for eight minutes. Do you have the results from that? +Doctor: I do. The scan showed some wall scarring but also that the amount of blood leaving your heart per contraction was normal. Do you experience any chest pain, palpitations, difficulty sleeping at night, leg or arm swelling, or shortness of breath while lying flat? +Patient: I do not have any issues like that." +27,"Doctor: Any nausea, vomiting diarrhea, or fever? +Patient: Yes, all of the above. +Doctor: Okay." +28,"Doctor: So, Doctor Pai how is your patient that you told me about? +Guest_clinician: Oh, we discharged her, she went home. +Doctor: That's great! +Guest_clinician: Yeah." +29,"Doctor: What type of cancer again? +Patient: I had prostate cancer. +Doctor: Did it travel anywhere in your body? +Patient: Yes, it was metastatic." +30,"Doctor: Do you have any major medical conditions that run in your family that I should know about? +Patient: What exactly do you mean by that, doctor? +Doctor: Well, it could be anything from depression to high blood pressure, to cancer. +Patient: Oh, yeah, my dad also has arthritis in both of his hips." +31,"Doctor: Hi there! I am Doctor Jones, sir. +Patient: Hello! It is nice to meet you. +Doctor: What brings you into see me today? +Patient: I have had this weakness in my right leg for quite some time now. +Doctor: How long has this been going on and do you know how you injured yourself? +Patient: I think that it was about six months ago that the weakness in my leg started. I don't really remember how it happened. +Doctor: Can you tell me what you do remember? +Patient: I was reaching to get something from a cabinet, and I noticed that I was unable to stand on my right toe. Ever since then I have had difficulty pushing off when walking. My toes were tingling and numb. +Doctor: Was the numbness and tingling mild, moderate, or severe? +Patient: It was a mild feeling, but this has been an ongoing problem that has been the same since the weakness started. +Doctor: Have you had any other pain any where else in your body? +Patient: I have had back pain, but this has been going on for many years and has not changed. +Doctor: Is the back pain been mild, moderate, or severe? +Patient: I would say mild. I have also been having cramping in both calves. +Doctor: How long has that been going on? +Patient: For the past year but it stopped about two months ago. +Doctor: Have you had any weakness in the left leg? +Patient: No. I don't think so. +Doctor: Have you had any pain around right leg and the area of numbness and tingling? +Patient: No. Everything that is going on with my right leg has pretty much been the same since it started six months ago. I have not gotten worse or better. +Doctor: Have you had any bowel or bladder incontinence? Any radicular pain? +Patient: No. +Doctor: When did you first see a doctor for the issue? I remember that you told me you saw a different provider prior to coming to see me. +Patient: I saw the other doctor in October. That was a couple of months before I came to see you. +Doctor: I see in your chart that we did a CT scan that shows degenerative changes, but nothing obviously abnormal. Remind me why we did not do a MRI of your spine? +Patient: I cannot have an MRI because of my ear implant. +Doctor: That is unfortunate. It looks like we were able to do an EMG and nerve conduction studies. What medications are you taking currently? +Patient: I had an elevated CK before I started taking stat medications. +Doctor: What medications are those? +Patient: I am not taking Lipitor anymore. I think I took it for about fifteen months. +Doctor: Do you know what your levels of your CK were before you started taking medication? +Patient: I thought that my CK was in the five hundred or six hundreds prior to starting it. Once I started it, my levels increased to about eight hundred and then came down to about five hundred again when it was stopped. I recently stopped taking Lipitor because my levels were up to the thousand's and then my CK apparently has returned to about the five hundreds or six hundreds. +Doctor: I don't see any labs in your chart. Did your primary do labs for your CK levels? +Patient: Yes, he did. +Doctor: Okay. Have you started any other medications? +Patient: Yes, I just started Zetia. +Doctor: Have you experienced any weakness or pain after starting Zetia? +Patient: No. +Doctor: Can you remind me how old you are? +Patient: I am fifty-five." +32,"Doctor: I spoke with Poison Control regarding the possible ingestion of the liquid. They let me know that it is actually a relatively small amount and is likely to be a nontoxic ingestion of the liquid, if she did end up ingesting it. It is not likely to be the case as she is behaving as if she did not ingest any of the liquid. +Guest_family: Thank god! Thank you." +33,"Doctor: Do you smoke cigarettes? +Patient: No, I do not. +Doctor: Good, no one should. +Patient: Yeah, it's a bad habit. +Doctor: Okay. How about alcohol? +Patient: No, I don't drink either. +Doctor: Okay. +Patient: Yeah." +34,"Doctor: How are your sugar levels these days, sir? +Patient: Well, it is well under control. +Doctor: That's good. Do you have any other medical condition? +Patient: Yes, I have hepatitis C. I also have HIV." +35,"Doctor: And how about any allergies? Are you allergic to any drug or anything? +Patient: Ah, yes I am very allergic to Bactrim. +Doctor: It causes you side effects? +Patient: Yes, It causes me nausea and vomiting. +Doctor: I see. +Patient: I think I am also allergic to adhesive tape. I get this skin rash almost immediately if I use adhesive tapes. +Doctor: Interesting." +36,"Doctor: Good afternoon, ma'am. +Patient: Good afternoon, doctor. +Doctor: Before we get started, I just need some background information. How old are you? +Patient: I'm fifty six, doctor. +Doctor: Good, what's a young lady like you doing in my office? I hear you got hurt, what happened? +Patient: I don't remember exactly what happened, but my foot twisted and there was so much pain right away. +Doctor: When did this happen? +Patient: Um, it was on November twenty sixth two thousand seven. I think it was around eleven thirty in the morning. +Doctor: Okay, do you have any other injuries I should know about? +Patient: No, just this one right now." +37,"Doctor: Have you ever smoked? +Patient: Yes, I've been smoking around one pack. +Doctor: Each day, is it? +Patient: Yes. +Doctor: For how long? +Patient: Around fifteen years. +Doctor: Do you take any other drug or consume alcohol? +Patient: Yeah, I'm an addict. I take oxy and a few more narco stuff, which I get from the street, and I drink a lot. I need help." +38,"Doctor: Good morning, ma'am. Did you have a good thirty-sixth birthday? +Patient: Yes, thank you. It was a nice day, despite the knee pain. +Doctor: That's good, we'll get back to that knee in a moment. Just to confirm, you identify as white, correct? +Patient: Yes, I do. +Doctor: Thank you. I just needed to make sure my chart was correct. So, is this left knee still bothering you? +Patient: Yes, unfortunately, it still is. +Doctor: You've had three Synvisc injections, correct? When was your last one? +Patient: Yes, that was about five days ago, right before my birthday. +Doctor: Did that provide any relief at all? +Patient: Well, I'd say there's been, um, thirty-five or forty percent improvement. +Doctor: Are you still having the pinching pain? +Patient: Yes, it's so bad when I try to put my full weight onto this knee. +Doctor: Can you bend this knee at all? +Patient: Ow, no, please stop. I can't handle that bending, doctor. +Doctor: Can you straighten the knee out for me, please? +Patient: No, not all the way, look. +Doctor: Yes, that's not out all the way. +Patient: It hurts really bad, doctor. +Doctor: With ten being the worst pain ever, how would you rate your pain today out of ten? +Patient: Oh, it's easily a ten out of ten. +Doctor: Have you used ice or heat? +Patient: Yes, I use both. I alternate the two. +Doctor: What medicines are you taking? +Patient: I'm using that Tylenol with codeine you gave me and then some ibuprofen I got from the grocery store. +Doctor: Have those helped at all? +Patient: I'd say they helped pretty minimally." +39,"Doctor: Hello, how are you doing today? Before we get started, I am going to do a basic review of your medical and social history. +Patient: Sounds good. Nothing has changed from last visit. +Doctor: On your chart we have that you are a non smoker, non drinker, and do not use drugs. We also have written that you do not have any past surgeries or medical conditions. Does that check out? +Patient: Yes. That's all the same as last time." +40,"Doctor: So I talked to Doctor X about your problems. +Patient: And? +Doctor: And he said your recent intestine infction is resolved. Which is C Diff colitis. You saw him two weeks back right? +Patient: Oh Thank God! Yes thanks, recently i saw him. +Doctor: Yeah. +Patient: Ok alright. +Doctor: And we have Hypertension and high Cholesterol as well which we talked about. +Patient: Thanks doc." +41,"Doctor: How can we help you today? +Patient: Oh doctor, I have congestion, and I think I might have a fever. When I touched my forehead earlier it felt much warmer than usual. +Doctor: Oh sorry to hear that. Let me see what we can do. +Patient: Thank you!" +42,"Doctor: How are you? +Patient: I am well, I have a bad cough and some green, grey things are coming out. +Doctor: Oh I am sorry, is it causing any shortness of breath? +Patient: No, I don't feel short of breath. +Doctor: How about fever? +Patient: No I do not have any fever. +Doctor: Any chills? +Patient: Nope. +Doctor: Okay so that's why you came to E D? +Patient: Yes I have been having this for three days and with this sputum I got scared. +Doctor: I am sorry, we can help you. How old are you? +Patient: Sure, I am sixty eight years old." +43,"Guest_clinician: Is there any notable intra abdominal pathology? +Doctor: None whatsoever. +Guest_clinician: Well, that's good news." +44,"Doctor: Do you have any health conditions that I should be aware of? +Patient: Well, as you can see, I'm obese, and I also have high blood pressure. +Doctor: Have you ever had surgery? +Patient: Yeah, I've fractured my right knee before, and they fixed it with a pin, that was in, um, nineteen ninety. +Doctor: Thank you, anything else you can remember? +Patient: Oh yeah, I have a history of blood clots." +45,"Doctor: You were placed on nasogastric tube for decompression, right? +Patient: Yes. +Doctor: And how do you feel after that? +Patient: I am feeling bit better." +46,"Doctor: Any medical problems? +Patient: Yeah, I've been suffering from congestion for a few years now. +Doctor: Have you seen an ENT for this? +Patient: I did a year or so ago. They think it could be due to enlarged adenoids or just my anatomy. +Doctor: Do you have plans to see the ENT in the near future? +Patient: No, not as of right now. +Doctor: If it's causing you discomfort, then I recommend scheduling another follow-up visit. Is there anything else that's bothering you today? +Patient: Um my toenail has been bothering me a lot. +Doctor: Mind if I take a look? +Patient: I don't mind. +Doctor: It looks like you have an ingrown nail. It seems to be improving on its own." +47,"Doctor: I hear she hasn't been doing so well. +Guest_family: My poor two-month-old baby girl has been congested for a whole week. I'm so worried about her. +Doctor: I completely understand. It's never easy to see your baby sick. Have you taken her temperature recently? +Guest_family: Yes, I've been using an anal thermometer. She's been running a fever for the past two days. +Doctor: I'm glad you brought her in today. I'll go ahead and take her temperature again. Is she experiencing any other symptoms, such as difficulty breathing or wheezing at all? +Guest_family: Not that we've noticed. +Doctor: Is she taking down milk? +Guest_family: Barely. Not as much as she used to the week before she started to feel bad. +Doctor: How often have you been changing her diapers? +Guest_family: Hm three or four times. I should've kept better track." +48,"Doctor: Hello, miss. How are you doing today? +Patient: I was doing fine until my head started to hurt. +Doctor: Oh, no. When did it start? +Patient: Earlier today. I got really stressed because my husband was bothering me, and my kids kept running around. +Doctor: I see. Do you smoke to relieve the stress? +Patient: Nope. I've never smoked before." +49,"Doctor: Good morning, ma'am. You're here for a follow up, correct? +Patient: Yes, doctor. Guess what, I just had my seventy seventh birthday. +Doctor: Happy birthday! +Patient: Thank you, doctor. +Doctor: Just to confirm, ma'am, you identify as White, correct? +Patient: Thank you. Yes, doctor. That's correct. +Doctor: Okay, walk me through this. So, you've seen doctor X Y Z before, correct? +Patient: Yes, that's right. I saw him for low back pain and lumbar scoliosis post laminectomy syndrome, lumbar spinal stenosis, and symptomatic right L two radiculopathy. +Doctor: You were having right leg pain when you saw him? +Patient: Yes. +Doctor: Have you ever had surgery on your back? +Patient: Yes, I had spinal stenosis, so they did, um, a laminectomy. +Doctor: How did you respond to the procedure? +Patient: Well, I had lower back pain and some arthritis in my spine after. +Doctor: How have you been treated for these following the surgery? +Patient: Um, Doctor X Y Z did some injections into my lower back. +Doctor: Do you remember which side it was in? +Patient: It was in the right side, L2-L3. +Doctor: When was the last time you had these injections into the lower back? +Patient: The last one was in March of two thousand five. +Doctor: How did your symptoms progress following the injections? +Patient: Well, I went back to Doctor X Y Z, and then he thought that the symptoms I was having were coming from my right hip. +Doctor: Did he do any imaging on this hip? +Patient: Yes, I had some done when I saw him on, um, August fourth two thousand four. +Doctor: Okay, the x rays we took today show marked degenerative changes, and a progression since the x rays taken back in August when you saw Doctor X Y Z. +Patient: Oh no. Oh, he also did the injections into my right hip. +Doctor: When was that? +Patient: Um, it was on April seventh two thousand five, and the last time I saw him was April fifteenth. +Doctor: Is that when you had the last injections? +Patient: Correct. +Doctor: Has anyone talked to you about doing a hip replacement? +Patient: Yes, but right now I'm not sure if I want to do it. +Doctor: Are you still having pain in that right hip today? +Patient: Yes, it still hurts. +Doctor: What makes the pain worse? +Patient: Well, anything that puts weight on this hip hurts really bad. +Doctor: Okay, if it hurts that bad you should be using a cane. Did you ever get one? +Patient: Yes, I used one to come in here today, in fact. +Doctor: Good. Do you have any other appointments scheduled? +Patient: Yeah, I made an appointment with an orthopedist in Newton. It's closer to my house. +Doctor: That's fine. What medicines are you taking? +Patient: Um, I take the generic for Ultracet. Sometimes I take as many as four times a day. +Doctor: Does this help the pain? +Patient: No, I'm still in pretty significant pain, doctor." +50,"Doctor: Hello, sir. How are you doing today? +Patient: I hurt my left wrist again. +Doctor: Oh, no. Again? Did you hurt it before? +Patient: Yeah, I did. I've actually hurt it a lot. The most recent one was probably the worst pain of my life. +Doctor: I see. How did you hurt it? +Patient: I was lifting some things out of the trunk of my car, and it started hurting. +Doctor: Did it hurt before that? +Patient: Yeah, it did. It was sore and stuff, but the pain wasn't bothering me too much. I kind of just lived with it. Some days it would be fine, but other days it would hurt a little more. +Doctor: The recent injury made it worse? +Patient: Yeah, it did. The pain after the incident got worse. I kind of feel it now more near my pinky area than my thumb area. +Doctor: I see. So, near your ulnar side and not as much the radial side. You said earlier your wrist was already sore, right? Why was that? +Patient: Remember how I told you about the time I had the worst pain of my life? That's how. I have some old notes you can see. Here you go. +Doctor: Thank you. Oh, wow. It says here you have chronic scapholunate problems and other problems too. +Patient: My scapho- what? +Doctor: It's just some ligament damage in your wrist. I'll see what we can do to get your wrist feeling better." +51,"Doctor: So, just to confirm, no current medications? +Patient: Yes, that's right." +52,"Doctor: Any allergies to medicine he might have? +Guest_family: No, no allergies that we know of. +Doctor: Okay." +53,"Doctor: I will ask you a few questions about your social history, sir. +Patient: That's okay. I have nothing to hide. +Doctor: Are you married? +Patient: I was, but I lost my wife six months ago. I live alone now. +Doctor: Do you smoke or drink? Have you ever tried any illegal drug? +Patient: No, none of these. +Doctor: Are you working? +Patient: I'm retired now. +Doctor: How active will you call yourself? +Patient: Hm, I'll say very active. I walk around four miles every day." +54,"Doctor: Have you been checking your blood sugar regularly? +Patient: Yes, I check it twice a day and I make sure to record the readings each time. +Doctor: That's great to hear. Do you mind if I take a look at the readings you brought with you today? +Patient: No, it's not a problem. Here, let me get my bag. +Doctor: Have you been experiencing any dizziness, excessive urination, fatigue, weight loss, or any other symptoms? +Patient: No. +Doctor: I have a copy of your blood work right here and it looks like your cholesterol is still pretty high. I'd like you to continue taking the cholesterol medication I prescribed and monitoring your cholesterol intake. +Patient: I need to do a better job of watching my cholesterol. +Doctor: For this reason, I'd like to schedule another follow up appointment and get you in in a few weeks after another blood draw. +Patient: I'll make an appointment today before I leave. +Doctor: Great, good. And how are your sinus symptoms since starting the Z Pak? +Patient: Much better. I feel almost as good as new. +Doctor: Wonderful. Okay then. Let me have a look at your sinuses and you'll be on your way." +55,"Doctor: What brings you into the office today? +Patient: I have been having some stomach problems. +Doctor: What has been going on with your stomach? What are your symptoms? +Patient: I have been having diarrhea. +Doctor: When did the diarrhea start? +Patient: Several weeks ago. +Doctor: How many times of day do you have diarrhea? +Patient: About five to six times a day." +56,"Doctor: Any problems with your eyesight? Like blur or double vision? +Patient: Um, no. +Doctor: Any partial loss of vision or blind spot? +Patient: Um, no. +Doctor: So, no loss vision, right? +Patient: Right." +57,"Doctor: What brings you into the office today? +Patient: I have been feeling strange lately. +Doctor: Strange, in what way? +Patient: Well, the other day I was driving and suddenly, I didn't know where I was or where I was driving to. +Doctor: That must have been very scary for you. How long did you feel disoriented? +Patient: It seemed to last about ten or fifteen minutes. +Doctor: Has anything like this happened before? +Patient: It has happened two times before this, but I was not driving. +Doctor: I would like to send you to a specialist to get some cognitive tests done. +Patient: Okay." +58,"Doctor: I'm going to run through a list of symptoms and if you're experiencing one or more of these, please let me know. +Patient: Okay. +Doctor: You had previously mentioned that you sometimes experience an overactive bladder. Are you having any pain with urination or other urinary symptoms along with it? +Patient: No. Just occasionally, when I am really stressed, I start having trouble controlling my bladder. +Doctor: How about abdominal pain, excessive thirst or eating? +Patient: No. +Doctor: And no constipation, diarrhea, or heartburn? +Patient: No. +Doctor: How about chest pain or tightness, shortness of breath, headaches, or fever? +Patient: No. +Doctor: Any problems with your skin, muscles, or joints? +Patient: No. +Doctor: I see. I'd like to order an ultrasound of your kidneys and run a urine test here in our lab." +59,"Doctor: Anyone have asthma at home? +Patient: Yes, my mother and her two sisters have long term asthma. +Doctor: Okay. +Patient: Yes. +Doctor: Any other diseases like kidney problems? +Patient: No kidney problems. +Doctor: Any rheumatological disorders? +Patient: Oh, no, no. Nothing like that." +60,"Doctor: Your E K G looks good. Rhythm is normal. Your axis is somewhat leftward, but this is a normal variation. It is not an abnormal finding and in most cases does not need any further treatment. +Patient: How about blood tests? +Doctor: Your CBC and BMP came back normal and your cardiac enzymes were negative x1. +Doctor: Do you know what they are? +Patient: Yes, I can understand." +61,"Doctor: What are your current medications? +Patient: None, except the Amoxil and Aldex that I started on Monday. " +62,"Guest_clinician: How old is the patient? +Doctor: She's seventeen years old. +Guest_clinician: Did they determine what was obstructing her airways? +Doctor: Yes, they found a two millimeter fishbone lodged in her throat. She had to be intubated and taken straight to the O R." +63,"Doctor: Hello there, how are you doing? +Patient: I'm doing good. Thank you. How about you? +Doctor: Yeah, same old, same old. +Doctor: So, looks like we're here to discuss your diet. Is that right? +Patient: Yep. That's right. +Doctor: Okay, let me look through your chart. It looks like you have high lipid levels, high blood pressure and a possibility for a metabolic syndrome. +Patient: That looks like my chart. I'm kind of struggling here and I need your help. +Doctor: Yeah, tell me did you follow the meal plan that we gave to you? +Patient: I tried for many weeks to follow that meal plan that you gave me. +Doctor: Okay, did it help? +Patient: I don't know. I felt like I was still gaining weight instead of losing it. +Doctor: Did you follow it exactly as you are, as you were asked to do? +Patient: I tried my best. But I feel like I am not doing it correctly or something. +Doctor: Okay, tell me what kind of activities are you doing? How much physical activity are you doing on a regular basis? +Patient: I try to walk around one and a half to two miles like every other day, but I'm spending more time in my garden and doing the yard work by myself. +Doctor: That's good. Gardening gets-- can get hard and it helps you keep active. +Patient: Oh yes, picking up all those pots from here to there and knowing that backyard of mine, it's a hard job. +Doctor: Tell me what brings you here today? Like how can I help you? +Patient: So, I think the meal plan that you gave was not working for me and there was definitely some weight gain, so I went back to my old South Beach Diet. +Doctor: Okay. What were the results with your South Beach Diet then? Was it effective? +Patient: I was able to get some pounds off. I felt pretty good about it. +Doctor: That's good. Then what's the issue? +Patient: Well, you see, deep in my heart I know this South Beach Diet is not a healthy diet for me and that's why I'm back to you. +Doctor: I appreciate your honesty. You don't know how happy you made me by saying that. +Patient: Yeah. You know, I'm here. So, tell me what to do to lose all this extra weight and how to enforce a low fat diet? What are your recommendations for that? +Doctor: Let's set a plan for you." +64,"Doctor: How're you feeling today? +Patient: Honestly, I've had way better days. +Doctor: I'm sorry. Why is that? +Patient: I've been getting short of breath a lot more than I'm used to. +Doctor: How long has this been going on? +Patient: Past three days. +Doctor: Are you experiencing any leg pain or swelling? +Patient: Eh no. +Doctor: How about chest pain or anything like it? +Patient: No to that either. +Doctor: I must say, this is concerning. I'd like you to get a C T scan of your chest so we can see what's going on. For now, your pulse ox is in the high nineties so you won't be needing supplemental oxygen at this moment in time. Do you notice the shortness of breath getting worse when you're moving around? +Patient: Yeah, mostly when I exert myself. +Doctor: Okay, I see. And the frequency by which your're short of breath is new for you, correct? +Patient: Yes. +Doctor: Do you happen to have a history of asthma? +Patient: No asthma." +65,"Doctor: Hi, how are you? +Patient: I am well. I am feeling a much better. +Doctor: That's good. I gave you cycle seven ifosphomide, mesna and VP 16 chemotherapy. +Patient: Okay I don't understand what that means." +66,"Doctor: You have hypothyroidism, correct? +Patient: Yes. +Doctor: Have you been watching your blood sugar? +Patient: Yes. It's been fine lately so has my anemia. +Doctor: Good to hear. I see here you were diagnosed with I B S and bowel abnormalities a few years ago. +Patient: My most recent bouts of diarrhea were likely due to C diff and they seem to have gotten better. +Doctor: I see my nurse didn't have the chance to go through the review of systems with you, so I will go through them now. +Patient: Okay. +Doctor: Any fever, chills, or night sweats? +Patient: Nope. +Doctor: Any unusual weight gain or loss? +Patient: No, my weight has been stable. +Doctor: Any visual changes, in one or both eyes? +Patient: No. +Doctor: Any hearing changes or ear problems? +Patient: Nope. +Doctor: I know I already asked you about your hypothyroidism, but I wanted to check if you are having any excessive thirst or frequent urination? +Patient: Nope, none of that. +Doctor: Any shortness of breath, cough, coughing up excessive mucus or blood, or breathing problems? +Patient: Thankfully none of that. +Doctor: Okay, how about any kind of chest pain or discomfort, trouble breathing at night or when lying down, palpitations or heart attacks? +Patient: No, none of that. +Doctor: Any urinary problems, anything with your kidneys? +Patient: No. +Doctor: Any abnormal vaginal bleeding or discharge? +Patient: Nope. +Doctor: Good, I know you have had some anemia in the past, any new problems with that? Any blackouts, convulsions, seizures, paralysis, strokes, or headaches? +Patient: No, I have not had anemic labs in a while. And, no to any of those things you just listed as well. +Doctor: Alright, good. That is it for all of my symtom questions. Thank you for bearing with me for that. +Patient: No problem, I am just glad to not be experiencing a lot of those." +67,"Doctor: How old are you? +Patient: Fifty six. +Doctor: Are you right handed or left handed? +Patient: I'm right handed. +Doctor: So, you have this long standing on and off lower back pain on your right side. And it all happened after your motor vehicle accident in September of two thousand and five. +Patient: That's right. Right after accident. At that time, I did not feel anything, but five days later I started getting this abnormal like pain in the lower side of my back, especially on the right side. It kind of like moved from there to my buttocks on the posterior side on my thigh and on outside of my calf. +Doctor: Does anything elevate your pain or decreases it? +Patient: It gets worse when I'm sitting for a longer period, such as like driving or if I'm walking for a long period of time. It is a little less bad when walking, but still, it is there. Lying down relieves the pain for a bit and also standing helps. +Doctor: Is there any symptom like weakness or pain in your left leg or your right leg? +Patient: Nope. +Doctor: Any change in your bowel movement or your urine function? +Patient: Nope. +Doctor: Were your symptoms sudden or were they increasing gradually? +Patient: They increased slowly. I had the pain killers, Medrol but, it has not been very effective. I also had that big injection in my back. It helped me for a few hours but then next day it was all same for me. +Doctor: When did this happen? When did you get the injection? +Patient: This was done four and a half weeks ago. +Doctor: Okay, let me just quickly check your legs. They look full in strength, and they also seem symmetric to me. Can you raise your leg? Like straight up? +Patient: Yeah sure. +Doctor: Yeah, yes. Straight leg raising is also normal." +68,"Doctor: Are you married? +Patient: Yes. +Doctor: Are you working? +Patient: I'm doing farming as a part time thing. +Doctor: Do you drink or smoke or have taken any kind of drugs? +Patient: Nope." +69,"Doctor: Have you ever had surgery, ma'am? +Patient: What, like a joint replacement? +Doctor: Well, it could be anything from a joint replacement to a C section. +Doctor: Oh, no. I've never had surgery. I had all of my children naturally." +70,"Doctor: Are you taking any medication? +Patient: Yes, they have it in the chart. +Doctor: Okay, let me take a look. +Patient: Nurse just updated them. +Doctor: Yes I see Morphine, Darvocet, Flomax, Avodart and Ibuprofen. +Patient: That's right." +71,"Guest_clinician: Did you see that patient today? His general appearance looked good. +Doctor: Yeah, the patient was well developed and well nourished. +Guest_clinician: Was he in any acute distress? +Doctor: No." +72,"Doctor: Do you have any family medical history? +Patient: No. I don't know of any family health problems." +73,"Doctor: Hi, how are you? +Patient: I am okay, but I have this pain on my right side of the chest which is troubling me. +Doctor: Where exactly do you have pain? +Patient: Ah, um it's kind of on the upper right side of my chest. +Doctor: Hm, do you have any nausea vomiting? +Patient: Yeah, I have nausea sometimes but no vomiting. +Doctor: How is your appetite are you having a proper diet? +Patient: No not really. I don't feel hungry that much, my appetite has reduced a lot. +Doctor: Okay. +Doctor: Any fever, diarrhea headache or joint pain? +Patient: No sir. +Doctor: Did you ever have any seizure or have loss consciousness or any stroke like symptoms? +Patient: Nothing of that sort. +Doctor: So, I just reviewed your past medical and surgical history. Tell me something, does anyone else in your family have this kind of chest pain? +Patient: No, it's just me! +Doctor: Hm, okay." +74,"Doctor: Good morning, ma'am. +Patient: Good morning, doctor. +Doctor: What's a young lady like you doing in my office today? +Patient: Well, I'm not as young as I used to be, I'm sixty eight years old now. +Doctor: So, what seems to be the problem today? +Patient: Well, I've had knee pain for about thirteen years now. +Doctor: I see, how have you been treated for this in the past? +Patient: I actually had a knee replacement at another facility, but I'd like to have another surgery. +Doctor: What kind of symptoms are you having? +Patient: I have so much pain, and I feel snapping, I'm also having trouble walking. It feels like my knee is giving away. +Doctor: Okay, did they do any x rays today? +Patient: Yeah, the tech just brought me back. +Doctor: Good, well, these show some malalignment of the hardware from your previous surgery." +75,"Doctor: Good afternoon, sir, and who is this with you today? +Patient: How are you doing, doctor? This is my daughter. +Doctor: I'm doing well, but how are you? How have you been doing since I last saw you? +Patient: I've been doing quite well, doctor. +Doctor: So, no symptoms of heart disease, or failure? +Patient: Nope, absolutely not. +Doctor: Did you follow up with Doctor X? +Patient: Yes, she said I was doing well, too. +Doctor: Great! How has your blood sugar been? +Patient: It's been in a normal range, which I'm thankful for. +Doctor: Have you had any falls since your last visit? +Patient: Nope, I've been doing really well. +Doctor: How is your knee doing? +Patient: Well, my right knee is having some pain at times. +Doctor: How are you managing this pain? +Patient: Um, I just take Tylenol occasionally as needed for the pain. Do you think a knee brace would be good for this? +Doctor: We could look into it. I'm glad to see your spirits are high. +Patient: They really are, sir. +Doctor: Are you going to the bathroom regularly, no incontinence? +Patient: Correct. +Doctor: Any memory issues? +Patient: No sir, my memory is really clear." +76,"Doctor: That is just normal male breast tissue, nothing to worry about. +Patient: Oh okay." +77,"Doctor: You look good? What are you eating these days? +Patient: I've just started a protein rich diet. I am taking whey protein and have added a lot of greens as well. +Doctor: You look great! Keep doing whatever you're doing. It's working for you." +78,"Doctor: I see here that you have a history of frequent U T I's. Are you currently experiencing any urinary symptoms? +Patient: Nope. I've been drinking a lot more water and taking preventative measures to reduce my chances of getting another one anytime soon. I'm being even more conscious of it since I'm now bed bound. +Doctor: That's good news. Are you having other symptoms, such as fever or chills? +Patient: Nope. +Doctor: How has your weight been? Has it been pretty stable since you have been bed bound? +Patient: Weight is stable. +Doctor: Okay, now for the routine stuff. Any coughing, chest congestion or chest pain? +Patient: No. +Doctor: What abut shortness of breath? Any type of bleeding in your feces or rectum? +Patient: Nothing. +Doctor: Great to hear. Any constipation, stomach pain, nausea, or vomiting? +Patient: Nothing as of late." +79,"Doctor: Did you have any medical issues in the past? +Patient: I was found positive for prostate cancer. +Doctor: Anything else? +Patient: I also had on and off trouble holding my urine. +Doctor: Any surgery in the past? +Patient: I had my hip replaced on the left side." +80,"Guest_clinician: Is the patient restrained? +Doctor: No, but she does have a palm protector in her right hand." +81,"Doctor: Welcome to the clinic, sir! +Patient: Thank you. +Doctor: Do you use tobacco product, alcohol, or recreational drugs? +Patient: I don't drink or do drugs. I do smoke cigarettes. +Doctor: How much do you smoke per day? +Patient: I probably smoke less then a pack a day. +Doctor: Do you live at home with anyone? +Patient: I live at home with my wife. +Doctor: What do you do for work? +Patient: I am currently unemployed. I have been out of work for several months now. I was working as an I T software developer. +Doctor: I am sorry to hear that." +82,"Doctor: Does anyone else in your family suffer from high blood pressure? +Patient: Oh yeah, quite a few relatives actually. +Doctor: How about diabetes? +Patient: Yeah, sadly." +83,"Guest_clinician: I took her R O S, and everything looks normal except for mild soreness in her arm due to the vaccine. +Patient: In my left arm. +Doctor: Okay, thank you for updating the notes. +Guest_clinician: Sure, no problem." +84,"Doctor: How're you feeling after the Prednisone? +Patient: Much better than before. It looks like the redness and swelling has calmed down a bit. +Doctor: This was your first wasp sting, correct? +Patient: Yeah, and I really hope it's my last. It definitely did a number on me." +85,"Doctor: Did you ever have had any surgery? +Patient: Not that I remember." +86,"Doctor: Do you have any history of psychiatric disorders, sir? +Patient: What, like depression? +Doctor: Well, it could be anything like depression, or mood disorders. Does anything like that ring any bells? +Patient: Oh, no, I don't have anything like that." +87,"Doctor: Hi, how are you all? +Guest_family: We're good. Thank you. +Doctor: How are you related to the patient? +Guest_family: We are family. I am her mother and this is her sister. +Doctor: Do you suspect any abuse of drugs? +Guest_family: we are not sure, but I guess she used to smoke or consume weed. +Doctor: I suspect there was some use of drugs as well. We can't tell which drug she was taking, but It looks like she was taking something. +Doctor: I hope you have understood her case very well and if there are any questions, please reach out to me." +88,"Doctor: Have you had any G I issues? +Patient: Nope. +Doctor: So no symptoms other than what we discussed earlier? +Patient: You got it. +Doctor: Looks like you're in good shape. We're almost done. I just need to confirm a few more things. Seems like they all will be negative. +Patient: No worries. +Doctor: Any heart issues or genital or urinary tract issues? +Patient: None that I have discovered. +Doctor: Great. And lastly, how is your range of motion? +Patient: Normal I think. I want to be more flexible, but nothing seems out of the ordinary. Like, I don't have any muscle or movement issues." +89,"Doctor: I just need a few pieces of background information, before we get started. +Patient: Absolutely, doctor. +Doctor: What do you do for a living, sir? +Patient: Actually, right now I'm on disability. +Doctor: Okay, and do you drink or smoke? +Patient: No, doctor. I don't do either of those. +Doctor: Good, are you married? +Patient: Not married yet, but I've been dating my girlfriend for a while now. +Doctor: Do you two live together? +Patient: Yes, doctor, we do. +Doctor: How would you describe your activity level day to day? +Patient: Do you mean like exercise? +Doctor: Well, anything from bathing, dressing, feeding, etc. We call these activities of daily living, how would you rate that? +Patient: To be honest with you doctor, I'd have to say it's minimal. My girlfriend has to help me with most of it right now. +Doctor: Okay, and do you remember when you had your last drug test? +Patient: No, doctor. I really can't remember." +90,"Doctor: Have you ever been hospitalized for anything? +Patient: No, thankfully. I was close to being hospitalized once, but it never actually happened. +Doctor: And when was this? +Patient: About two years ago. I got into a pretty brutal skateboarding accident. +Doctor: Oh gosh. How long have you been skateboarding? +Patient: Since I was a kid. Bout eight or nine years old. +Doctor: Do you skate in your neighborhood or at a skatepark? +Patient: Skatepark. I'll go with my friends every now and again. +Doctor: Nice. I've never been skateboarding, but I've always been in awe of kids like you who know how to do cool skateboard tricks." +91,"Doctor: How old are you madam? +Patient: I am seventy-five. I have been feeling very weak and shaky. +Doctor: Can you tell me how this all started? +Patient: I cannot catch a breath when I walk. It is getting harder to move around. +Doctor: Hm, how about chest pain or palpitations? +Patient: No, I am not having any. +Doctor: Do you have any cough, bloody sputum or any wheezing sensation? +Patient: No, I do not haveany of that. +Doctor: How about any fainting spells, feeling like you are going to pass out? +Patient: Nope. +Doctor: How long have you been feeling like this? +Patient: Oh, it's been a while now but it is getting worse lately." +92,"Doctor: How're you feeling? +Patient: My head still hurts. +Doctor: How often do you get migraine headaches? +Patient: Once in a while. I think it's worse when the weather changes. +Doctor: I understand. Do you see a neurologist? +Patient: Not at this moment, but I should find one. +Doctor: I can write you a referral because it's always best to get a second opinion or a brain scan. +Patient: Gotcha. I'll plan to make an appointment in the near future." +93,"Doctor: So, tell me any chest pain or shortness of breath? +Patient: No, none of those. +Doctor: Any bleeding disorder, prolonged bleeding or anything? +Patient: No. +Doctor: And I already have G I and urinary tract reports. Anything else? +Patient: No, I don't think so." +94,"Doctor: Any past surgeries I should know of? +Patient: Uh yes. I had a femur fracture repaired. +Doctor: Do you remember which side? +Patient: It was on the right. +Doctor: Let me pull up your records. +Doctor: Okay, I see. It looks like you had a repair of the right intertrochanteric femur." +95,"Doctor: Hello there! +Patient: Hi, how are you? +Doctor: I am good. Do ypu mind stating your age and waht brings you in today? +Patient: Oh, yes, I am 85 years old and I am having this weird muscle pain in my rightbuttocks region that I think it's radiating from my lower back or spine area I am not sure. +Doctor: Hm, what kind of pain is it? Like sharp pain or dull? +Patient: It's kind of difficult to explain, but it's very irritating. +Doctor: Okay! So, it's on the right side? +Patient: Yes. +Doctor: And when was your last visit to renal clinic? +Patient: About four months back. +Doctor: Hm and you mentioned you are doing much better than before in terms of managing your high blood pressure with the current medication? +Patient: Oh yes, absolutely I am doing so much better. I think earlier the nurse mentioned she has never seen my blood pressure this good. +Doctor: Yes, it is much better than any of your previous visits. And no side effects, right? +Patient: No. +Doctor: Hm, and any other problem or any uneasiness? +Patient: Not really. +Doctor: Any nausea, vomiting or diarrhea? +Patient: No. +Doctor: Any weakness, dizziness or lightheadedness? +Patient: Nope. +Doctor: Any constipation or stomach pain? +Patient: No, I think just the hip pain. +Doctor: Any shortness of breath, chest pain or difficulty breathing? +Patient: I am fine no issues there. +Doctor: How bout any breathing issues while you sleep or when you lay down? +Patient: No. +Doctor: And do you exercise? +Patient: It is same as before not much difference. +Doctor: Okay. +Patient: Right now, it is just this hip pain which is bothering me. +Doctor: And you mention it is kind of radiating from your lower back. +Patient: Yeah, kind of like from my spine maybe, I am not sure. +Doctor: And no pain in your toes or lower legs? +Patient: No. +Doctor: Okay, did you try any medicines? +Patient: Yes, I did try some Tylenol but that's it. It does help a bit. +Doctor: Okay, let's try something stronger, I will write you a prescription for it. You can take it for a week and if your pain does not improve, we will take some x rays. +Doctor: How old are you again eighty-five? +Patient: Yes. +Doctor: Okay. Overall, you do look better today and these medicines should take care of the pain. +Patient: Thank you! +Doctor: Take care." +96,"Doctor: Do you have any known drug allergies? +Patient: No. None that I know of." +97,"Doctor: Hello, miss. How was your weekend? +Patient: It was fun. I went to a party, but now my back hurts. +Doctor: I see. Did you drink alcohol at the party? +Patient: Just a little. I only drink when I go to special occasions. +Doctor: Would you say you drink occasionally then? +Patient: I do." +98,"Doctor: Do you have any personal history of heart disease or diabetes? +Patient: No, but I do have high blood pressure. +Doctor: Any family history of heart disease, diabetes or hypertension? +Patient: No, none that I know of. +Doctor: Your bloodwork came back with borderline elevated cholesterol levels. I would like to just keep any eye on this for now. Let's have you come back in one month. We will check your cholesterol levels again." +99,"Doctor: Are you experiencing any symptoms? +Patient: Nope." +100,"Doctor: I'm sorry to see that she's not doing well. +Guest_family: I can't even begin to tell you how hard this past week has been for us. She has had so much congestion. She's also coughed more than she ever has before. She is only two months old and it breaks my heart to see her like this. +Doctor: Oh wow. We'll see what we can do for her. How's her breathing been? +Guest_family: She's had some irregular breathing where she would breathe very quickly and retract. +Doctor: Has she been running a fever? +Guest_family: She's been running in the hundreds between one O two and one O four. +Doctor: Has she been feeding well? +Guest_family: No, not at all. She's been feeding less and I notice she hasn't had as many wet diapers as a result. +Doctor: Is anyone else in the family sick? +Guest_family: My son has an upper respiratory infection. +Doctor: How long has he been sick? +Guest_family: A day or two before our two month old. +Doctor: You mentioned that she's been coughing a lot. Is she bringing anything up with her coughs? +Guest_family: Yeah, I think her coughs trigger some sort of reflex response, causing her to spit up or throw up a few times. It comes on so suddenly, it takes me by surprise. +Doctor: Does she happen to experience similar symptoms after her feedings? +Guest_family: Yeah, that's new too. +Doctor: Any diarrhea? +Guest_family: None." +101,"Doctor: Are you taking any medication? +Patient: Just multivitamins and calcium." +102,"Doctor: Hey what you got there? +Patient: I got this boil type of situation going on on my butt. +Doctor: Oops! +Patient: I know. +." +103,"Doctor: How's everything going on? +Patient: I'm having this weird feeling where I feel that my face is going to twitch and I start doing these grimacing actions on my face, mouth, and then it kind of suppresses it, but I'm not sure what's happening. I'm still having a fear of feeling of pressure in the backside of my head and it comes approximately like once each week. +Doctor: What exactly does this pressure feels like? +Patient: It feels like pins and needles in my head and a lot of pressure and often it feels like water is running down my hair. +Doctor: How frequent are these feelings? Is anything helping you? Are you taking any medications or anything else for it? +Patient: It is like I said before, like once a week maybe. It has decreased from before. I am taking Aleve and it is kind of helping me. +Doctor: Is anything else going on? +Patient: Oh yeah, I'm still suffering from that problem of daydreaming at work and have noticed that I fall asleep when I'm sitting in front of my desk or in front of my television. I just fall asleep in non stimulating environments. It seems like I'm always tired and I cannot get enough amount of sleep no matter what I do. +Doctor: It feels like insomnia to me, but what are your working hours? +Patient: I work from four to midnight, and then after getting home I just, I cannot sleep. It takes me around two hours and then I wake up at nine each morning. So, it's just like I'm not getting to sleep more than five to six hours ever. Usually, it is like five hours of sleep for me. +Doctor: How is the quality of your sleep? Do you wake up many times or have sound sleep for those five hours? +Patient: It is good, I just need to get up and go to the bathroom. I think I snore, but I do not know exactly. +Doctor: Have you ever lost your sleep to catch your breath? +Patient: Not that I remember." +104,"Doctor: Have you ever had surgery on any of your extremities, like your arms or legs? +Patient: Yes actually, I've had surgery on my foot, as well as my knee. +Doctor: Good, have you had any other surgeries on anywhere else? +Patient: Now that I remember, yes, I had a tummy surgery." +105,"Doctor: Hello. It has been a long time. Nice to see you again. How can I help? +Patient: I am here for a physical. Nothing new and nothing has changed, but I think it's good to be seen once a year. +Doctor: Great! You are absolutely right. Prevention is key. Are your social history and medical conditions the same as last visit? Here, you can look at the chart. +Patient: Yeah, that looks right. It's all the same." +106,"Doctor: Do you have any known drug allergies? +Patient: No." +107,"Doctor: Hi, I'm the doctor that'll be treating you today. +Patient: Hiya. Sounds good. +Doctor: What's bringing you in? +Patient: A big ol lump in my chest. +Doctor: How long since you first noticed it? +Patient: It's been there for at least a year. +Doctor: Where on your chest? +Patient: On the left side. +Doctor: Is it causing you pain? +Patient: Um kind of it. It's gotten a lot more tender, and it hurts when I take deep breaths. +Doctor: Has it grown in size? +Patient: It has. +Doctor: And just to confirm what is in your chart, can you confirm your age, race, and gender. +Patient: Sure, I am a 56-year-old white man." +108,"Doctor: How's she doing today? +Guest_family: She's been blowing up green snot and complaing of ear pain. +Doctor: Both ears? +Guest_family: Both the right and left. +Doctor: How long has she been bringing up green snot? +Guest_family: Maybe six or so days? +Doctor: Let's see. It looks like she may have sinusitis. After checking both ears, I noticed fluid buildup in the right middle ear. I'll go ahead and prescribe her some antibiotics and hopefully she'll be as good as new in a few days. I'd like her to come back for a follow up to make sure all the fluid in her ear is gone." +109,"Doctor: Do you have any allergies? +Patient: I am not allergic to anything as far as I know." +110,"Doctor: How old is the baby girl? +Guest_family: She is two and a half years old. +Doctor: And you both are her parents? +Guest_family: Yes. +Doctor: Tell me what happened in detail. +Guest_family: She has a history of seizures. She used to have shakes and lose consciousness. +Doctor: Was she taking any medications for that? +Guest_family: Yeah, she was placed on Keppra solution one hundred and fifty M G for two times a day. It helped a lot and she was doing fine. Her seizures were improving a lot but recently we have noticed something similar again. +Doctor: What kind of symptoms are showing now? +Guest_family: She will just stop doing everything and stare blankly. We tried to shake her but during that period she just does not respond. +Doctor: Does she becomes floppy like can't control her body during that phase? +Guest_family: No, we didn't notice that. +Doctor: How long is that period? +Guest_family2: I think it lasts somewhere around ten to fifteen seconds. +Doctor: What are your thoughts on this? As a mother you might be spending more time with her. +Guest_family: Yeah, I have noticed this too, but I think it stays for like three to four minutes. +Doctor: So, it is somewhere around thirty to forty seconds. +Guest_family: One day I was outside the store and then I noticed that she had a similar event. Her skin around her mouth turned blue. +Doctor: Was she having any kind of jerky motions? +Guest_family: No. +Doctor: Have you changed her medications like the amount you are giving or anything like that? +Guest_family: No, we haven't changed anything. She's still on the same dose. +Doctor: I'm looking at the record and it says that she is supposed to take twenty M G per kilogram every day. It looks like a very low dose for her." +111,"Doctor: Do you have any major medical conditions that run in your family that I should know about? +Patient: What do you mean by that, doctor? +Doctor: Well, it could be anything from A D H D to substance abuse to epilepsy. +Patient: Oh, yeah my grandfather was an alcoholic." +112,"Doctor: Is she taking any medications? +Guest_family: Um uh I wrote them down. Let me find the Post-it note. I had it right here. +Doctor: Take your time. +Guest_family: Ok uh found it. +Guest_family: It looks like she's taking some type of anxiety medication and estrogen." +113,"Doctor: And you're allergic to Sulfa drugs, correct? +Patient: Yes, ma'am. +Doctor: What happens when you take Sulfa drugs? +Patient: I get incredibly dizzy and I can't stop vomiting." +114,"Doctor: And we did review your family history last time. No one else suffers from heart problems in your family, right? +Patient: Yeah, it's just me." +115,"Doctor: So what brings you in today? +Patient: Um I think I'm due for a checkup. While I'm here, I also wanted to figure out why I'm having so much joint pain all over. +Doctor: When did you first notice the pain? +Patient: It's been a couple weeks now. I thought it'd go away on its own. I've taken Advil for it, which helps a tiny bit." +116,"Doctor: Have you ever taken any prescribed drug for your headaches. +Patient: No. +Doctor: What do you take when you get headaches. +Patient: I try not to take to much medication but when they get really bad, I take Excedrin or ibuprofen. +Doctor: So only over the counter medications? Do they work in providing you relief? +Patient: Yes, I have been using over the counter medications and they have been no help with my headaches . +Doctor: Okay." +117,"Doctor: Is this your first pregnancy? +Patient: Yes. I'm so excited for the baby to arrive!" +118,"Doctor: Do you smoke, sir? +Patient: No, that never appealed to me. +Doctor: How about alcohol, do you drink? +Patient: Nope, I don't do that either." +119,"Doctor: How many kids do you have? +Patient: I have three kids, and I'm blessed to say that they're all healthy and well. +Doctor: That's great to hear. Do they live with you or your ex husband? +Patient: They live with my boyfriend and me. +Doctor: Wonderful. +Patient: It's a full house for sure. +Doctor: Do you drink or smoke? +Patient: I don't touch tobacco or any other drugs. I sometimes drink, but only on rare occasions. +Doctor: Gotcha." +120,"Doctor: So, what's going on with your hand, miss? Is it right or left? +Patient: It's the right one. It's been on and off and it's been happening for the last several weeks. +Doctor: Can you elaborate what's happening? +Patient: Sometimes I feel like a lot of pins and needles are hurting my hand while other times it is totally numb. +Doctor: Did anything change in your daily routine? +Patient: I don't think there have been any big changes. But after I started having these episodes of numbness and tingling, I moved my keyboard down at work. I just hope that it will help. I was just worried if I had carpal tunnel. +Doctor: What does a normal day look like? What is it like at work? +Patient: I have a typical office job. I sit in front of the computer for eight hours and mostly work on a keyboard. I hardly take two coffee breaks in between and a lunch break. It is the same kind of thing I'm doing again and again every day. +Doctor: Is it the same day or night? +Patient: Oh, it is bad at night, how I'm sleeping. If I sleep in a certain way, then I will wake up with a lot of tingling. Then I must literally shake my hands out to get rid of this tingling. It's just-- it's all so much an it irritates me that it's affecting my mental health. +Doctor: Is it in your whole hand or some specific fingers? +Patient: It is mostly in my middle finger, but sometimes I also get this on the first or the second finger of my right hand. Sometimes I have pain in my thumb as well. Do you think it is arthritis? +Doctor: I don't think so. But we can get a test done to confirm it if you want." +121,"Doctor: Are you still take Prevacid? +Patient: No. I had to stop taking it. It gave me diarrhea." +122,"Guest_family: They just changed his P bag, that's why there is no pee in it. +Doctor: Okay. Yes, it looks empty. I think they did a straight cath. +Guest_family: Yeah, and they took out the urine to send it to the lab. +Doctor: Okay. Yes, there were no leukocyte seen. That means no infection. +Guest_family: But they said there was blood? +Doctor: Yes, during catheterization but the urine is normal. +Guest_family: Okay. +Doctor: In your x ray there was stool seen in the colon. +Guest_family: Okay. +Guest_family_2: He is fine? +Doctor: Yeah, he is fine. I can see that he is very active. Jumping up and down. +Doctor: Hi champ! +Patient: Hi." +123,"Doctor: Is there any relevant medical history or medical issues going on in your family in present or in past? +Patient: No, nothing that I could remember. +Doctor: Do you drink or smoke? +Patient: Nope." +124,"Guest_clinician: How's the patient doing? +Doctor: In stable condition, but I'm not yet able to obtain a history from them. +Guest_clinician: Please page me when they're awake and able to answer questions. I'll be on the eighth floor if you need me. +Doctor: Will do." +125,"Patient: I just had few questions. Can you tell me about my diagnosis? +Doctor: Sure. It's called Serotonin syndrome, ma'am. After careful evaluation of your labs, we found out that your white count and C P K was high, and those abnormalities lined up with serotonin syndrome. What are you experiencing right now? +Patient: I have been very restless and easily agitated, I have diarrhea. But no fever or shakiness. +Doctor: These can match serotonin syndrome as well. You deny any fever, tremor or hypperflexia so we will give you some IV fluids and I will check on you in an hour or so. +Patient: Okay. +Doctor: Looks like your C P K counts improved with I V fluids and after discontinuing Prozac. +Patient: How are the counts now? Are they normal? Because I feel normal. +Doctor: Yes, your C P K and white blood cell counts have come back down. Almost normal now. +Patient: My husband left me two weeks ago. My panic attacks are increasing day by day. +Doctor: Okay, I see that you have a history of panic attacks and you do have depression and anxiety, is that correct? Last Friday, I talked to psychiatrist about your issues, and he recommended Cymbalta as an alternative to Prozac. +Patient: Yes, I stopped taking Prozac, and I am going to see him on Monday or Tuesday. I have a counselor too. +Patient: I do think it will be difficult to go home alone but my daughter is coming to visit me in two weeks. +Doctor: Oh wow. +Patient: Yeah. +Doctor: That's nice. Do you have someone who can drop you home and help you? +Patient: Yes, I have a friend who does that, I am staying with her for next three days. +Doctor: Okay that sounds good. Just continue with your medications for high blood pressure and diabetes as well. So, we treated your imbalance issues and gave you IV fluids, you do not have any more diarrhea, right? +Patient: Yes, that's right." +126,"Doctor: Welcome to the clinic, miss. +Patient: Thank you. +Doctor: What brings you to the clinic today? +Patient: I am concerned that I have been having small seizures again. +Doctor: Do you have a history of epilepsy? +Patient: Yes, I do. I also have had non epileptic issues in the past. +Doctor: Okay. What makes you feel like you are having seizures again? +Patient: In the mornings I have been waking up with strange body aches and feeling confused. I have felt these feelings before after having seizures in the past. I live alone now so I don't know if I had a seizure or not. +Doctor: Okay. Do you have weakness when you wake up? +Patient: Yes. It also happens while I am at work at my desk. I work alone in my office most of the day so no one is around to notice what might be happening. +Doctor: Okay. That is good to know. How old are you? +Patient: I am forty six. +Doctor: Okay. I would like to perform a video E E G today. By doing the video E E G we will have more information on whether you are having epileptic seizures or non-epileptic events. +Patient: Yes. Let's do that. +Doctor: Do you have time for us to do it today? +Patient: Yes. I took the whole day off work so we can do it now. + Doctor: Excellent! I will have the nurse come in a get you set up. +Patient: Okay." +127,"Doctor: We have placed this nasogastric tube for decompression. +Guest_family: Okay. +Doctor: How are you feeling now? +Patient: Um. +Guest_family: She said that she feels better now." +128,"Doctor: We are following up with you for your prostate cancer which has metastasized to your bladder and in several locations throughout your body including the spine and shoulder. +Patient: Yes, you remember I had blood in my urine in the past, but I think it is coming back. I started noticing that from yesterday, and today I saw a lot of blood with very little urine. +Doctor: Oh okay, we will have to evaluate that then. Let me ask you few other questions to get this out of the way. How about your back pain, how's it? Also any incontinence? +Patient: Okay sure. No, there is no change in my chronic lower back pain, and no, no incontinence, urinary or stool. +Doctor: All right. How about fever, belly pain, nausea or vomiting? +Patient: No to everything. +Doctor: Are you able to pee noramally and pass urine, you aren't retaining? How about blood in stools? +Patient: Yes, I am passing everything well. No blood in stools. +Doctor: Okay. Can you tell me if you have finished your chemo? +Patient: Yes, I have already completed chemo. Now they started me with radiation therapy, but it is only targeted to the bones. They told me I will feel well as in there won't be any pain. It's not supposed to treat or cure the cancer, but just to make me comfortable. +Doctor: Yes, we are looking at that at this point. +Patient: Okay. +Doctor: Do you have any hospice care facility listed? +Patient: No, I haven't looked at it yet, but I would love to look at hospice facilities. +Doctor: That treatment management we are focusing on- +Patient: I know only comfort ha!" +129,"Doctor: Hello. I see you're here for a follow up. +Patient: Yeah, I am. I've been having some problems on my right side under my ribs. +Doctor: I see. Is it fine if I go over your medical history? +Patient: Yeah, that's fine. +Doctor: Great. I see you had a history of hives before, right? +Patient: Yeah, that's correct. +Doctor: I see you had dialysis as well. How many times have you had that? +Patient: I think I had that for two years. +Doctor: I see. You also have high blood pressure, right? +Patient: Yeah, I do. +Doctor: Hm. They might associate your kidney problems with high blood pressure. Let's take a closer look." +130,"Doctor: Looks like he has a foreign body in his left eye. +Guest_family: Does he need to see an eye doctor after this?" +131,"Doctor: His fever is running very high, I think he is having a febrile seizure. +Guest_clinician: Yeah, I think so too. +Guest_family: Is he going to be okay? +Doctor: Ma'am, let us have a look." +132,"Doctor: Do you have any history of tobacco, alcohol, or drug use? +Patient: I have a glass of wine with dinner every once in a while, but no other than that." +133,"Doctor: Do you have a history of alcohol or drug abuse? +Patient: I have had a drink on special occasions, but I don't drink. And I have never ever done drugs. +Doctor: Okay. Do you smoke or have you ever in the past? +Patient: No! +Doctor: Excellent!" +134,"Doctor: What are you taking? +Patient: You mean meds? +Doctor: Yes, sir. +Patient: Actually, that nurse asked me already and reviewed it with me. Do you want me to tell you again? +Doctor: No let me check the chart then. +Patient: Okay. +Doctor: You are not on any blood thinners right? +Patient: No I am not. +Doctor: Okay great. +Patient: Yeah." +135,"Doctor: Good afternoon, sir, before we begin, how old are you? +Patient: I'm twenty-six years old, sir. +Doctor: Good, and what race do you identify with? +Patient: I'm an African American, sir. +Doctor: Great, so how did you get hurt? +Patient: I stepped off a hilo at work, and I felt this pop in my left leg. +Doctor: Where did you feel the pop? +Patient: It was in the back of the leg. +Doctor: What treatments have you had for this knee so far? +Patient: I got put in a splint, and they recommended I follow up with you at ABC orthopedics. +Doctor: Good, thank you, and welcome." +136,"Doctor: Can you tell me more about your son, ma'am? +Guest_family: Well, I have his reports from his school right here. +Doctor: What do they say? +Guest_family: Well, in summary, he's having a lot of problems at school. +Doctor: What kind of problems is he having? +Guest_family: Well, he has been asking an unusual number of questions, and he's been obsessed with cleaning and cleanness. +Doctor: What about his interactions with his classmates? +Guest_family: According to the reports from his school, he doesn't relate well in the classroom. +Doctor: How is his mood? +Guest_family: Well, he seems to be confused and depressed sometimes. +Doctor: Is he still asking a lot of questions in class? +Guest_family: It's come down a little bit recently. +Doctor: Are there any other unusual behaviors you've seen? +Guest_family: Um, he used to collect old little toys when he was younger, and he's started doing that again. +Doctor: I see, what are his plans for the summer, will he be in classes? +Guest_family: He'll be in a social skills program this summer, doctor. +Doctor: I see here as well that A B C D has referred him to two psychologists for functional behavioral analysis, is that correct? +Guest_family: Yes, doctor, that's correct. +Doctor: Good, be sure to follow up with them please. +Guest_family: Yes, we will, doctor. +Doctor: Has he been taking his Zoloft? +Guest_family: No, he's taking, um, seven point five M G of Abilify. +Doctor: I see, how has he responded to stopping taking the Zoloft? +Guest_family: Actually, the tremors in his hands have been a little better." +137,"Doctor: Hm so it looks like you saw your cardiologist last week, correct? +Patient: Yeah. +Doctor: How did your visit go? +Patient: It went well. I was in for a follow up. I underwent bypass surgery a few months ago so she wanted to see how I was doing. +Doctor: I'm glad to hear that it went well. Does heart disease run in your family? +Patient: I'm the only one in my family that I know of who suffers from heart disease. +Doctor: I see. I asked the tech to do a quick E K G on you and it looks normal so that's good news." +138,"Doctor: Are you on any meds? +Patient: No why? +Doctor: I am asking for the EHR. +Patient: Oh ok. Nurse already asked me that. +Doctor: Ok, let me update it here. +Patient: Sure. Take your time. +Doctor: Thanks. +Patient: Anytime." +139,"Doctor: Hello, ma'am. I see you brought your baby daughter in today. Is she a new patient? +Guest_family: Hello, I am her mother. She is a new patient. +Doctor: Before we begin, could you verify her age and ethnicity, please? +Guest_family: She is a little over one years old, and we identify as black. +Doctor: Thank you. How did you hear about our dermatology office? +Guest_family: Well, we just came from Tanzania, my birthplace. I have been seeing this odd skin issue with my baby, so I took her to the A B C Practice. After, they sent me here so that you can check her skin problem. +Doctor: I see. Do you have a report from the A B C Practice? +Guest_family: I do. Here you go. +Doctor: Thank you. It looks like she has a history of this atopic eczema, correct? +Guest_family: Yes, she has. +Doctor: Did they provide you with any medication? +Guest_family: I have the bottle with me. Here you go. +Doctor: It looks like they gave you an Elidel cream. How often do you apply it to her rashes? +Guest_family: I've been putting it on my daughter twice a day for six months now. +Doctor: Is it effective? +Guest_family: It was, but now it doesn't work. Her skin is just dry now. I've been putting this oil on her now. +Doctor: Do you know the name of the oil? +Guest_family: No, I don't. It starts with a J. I can find a picture. +Guest_family: Here it is. It's this oil. +Doctor: Oh, I see. The Johnson's Baby oil. That's a good brand. Well, your daughter seems to be well-developed and has good health. She looks her age. We can see what else can help with her rashes." +140,"Doctor: Did you have any known allergies? +Patient: Not that I know." +141,"Patient: So, as you remember I was working with a patient and I accidently jammed that needle inside me. +Patient: I am coming for regular screening. +Doctor: Yes, thank you for that, sir. Did they screen patient? +Patient: Yes, he got negative H I V but positive hep C, they said he is a carrier only, never will show disease symptoms. +Doctor: Okay. +Patient: I am scared. +Doctor: Don't worry, we will do what we can okay. Firstly, let me check if they did some hepatitis B shots on you. Okay looks like you had three shots of hep B and Tetanus is up to date with all others. Antibodies are showing, which is good. +Patient: They did the tests on February seven two thousand and five. Have you seen my liver test results? And maybe some other? +Doctor: Yes, I can see that your liver function test were normal at eighteen and hepatitis C and H I V, both were negative. We took these labs on February seventh. You do not have any local signs of infection, right? Except acute intestinal problem? +Patient: Nothing local, but I do have intestinal squeakiness and vomiting. +Doctor: Let me look at your exam. +Patient: Okay. +Doctor: Abdomen is fine, no fever and no swellings. That's great. +Patient: Okay." +142,"Doctor: How are you feeling? +Patient: I am feeling very weak and shaky. +Doctor: Oh I am so sorry. +Patient: It's okay." +143,"Doctor: Hello. How are you doing today? +Patient: Not fine. I want to see if I can get my cancer treated. +Doctor: I see. Does cancer run in your family? +Patient: My two brothers and dad have some type of cancer." +144,"Doctor: Do you have anyone that lives at home with you? +Patient: My husband lives at home with me. My daughter and her husband live next door to us. They come and check on us every day. +Doctor: Do you use ethanol, tobacco or illicits? +Patient: No." +145,"Doctor: Lets talk about your family history, does anyone else in your family have cancer? +Patient: Yes, my mother had metastatic breast cancer and my mother's sister was dealing with bone cancer. +Doctor: Oh, I am sorry to hear that! +Doctor: Anything else? +Patient: Yeah, both sides of my family has diabetes. +Doctor: Were your family members young when they were diagnosed, or did they develop it later in life? +Patient: I believe they all were adults when they were diagnosed with diabetes. +Doctor: Ah, yes. They had adult onset diabetes mellitus. +Patient: Yeah." +146,"Doctor: Good morning, young man. Is this your mother? +Patient: Yes, doctor. +Doctor: Good, nice to mee you. Can you tell me more about your son, please? +Guest_family: Good morning to you too, doctor. Well, he's about five and a half now, and he broke both the bones in his forearm in September of two thousand seven. +Doctor: How did the fracture heal? Generally, children heal very well. +Guest_family: Well, yes, until he also rebroke it about a month ago. +Doctor: Yes, I see now, there's an ulnar nail pretty prominently visible under the skin, did he have surgery for this? +Guest_family: Yes, about a month ago now. Should we remove the nail? +Doctor: We'll have to, even though its early. +Guest_family: What will we do after the nail is removed? +Doctor: After that, we'll put him back in a cast for about another three weeks. We'll evaluate him and see how he's doing. +Guest_family: Okay. What are the risks of infection for this surgery? +Doctor: The risk of infection is overall very low, honestly its less than one percent. We use antibiotics to control for infection the entire time. Other risks include bleeding, changes in sensation in most of the extremity, or need for longer casting. I would not worry too much about these risks. I have not seen anything bad happen before. +Guest_family_1: Will he be asleep for the surgery? +Doctor: Yes, he won't feel a thing." +147,"Doctor: Does she take any medicine? +Guest_family: Um, let me check. She usually keeps them in her purse. Okay, so here we have three medicine bottles. The labels are all in Spanish, but I can translate for you. She takes one Aspirin a day along with her blood pressure and diabetes medicine. +Doctor: Do you mind if I take a look as well? +Guest_family: Sure, here you go." +148,"Doctor: How is your two week old newborn son doing today? +Guest_family: He's been doing very well. +Doctor: Great, what brings you in for a visit today? +Guest_family: We just have a question about his foreskin. It's not a severe issue, but we are still concerned. +Doctor: Other than the foreskin, which appears to not be out of the ordinary upon exam, does he have any other problems? +Guest_family: No, not really, he's been doing pretty well. " +149,"Doctor: Are you aware of any medical issues running in your family? +Patient: Well, my mom died of a stroke. She was in her late fifties. My dad had some heart issues. He also had high blood pressure. +Doctor: Do you smoke? +Patient: I was a heavy smoker before many years ago, but then I quit in nineteen ninety. +Doctor: How much would you use to smoke before? +Patient: Around two to three packs per day. +Doctor: What did you used to do for a living? +Patient: I've been a feed salesman almost throughout my adulthood." +150,"Guest_family: My baby is sick. +Doctor: Don't worry, I will help you. +Guest_family: He has had a fever for five days. +Doctor: How old is he? +Guest_family: Just eighteen months. He is a Swedish American. +Doctor: You gave him medication? +Guest_family: Yes, he finished Amoxil several days ago for sinus infection. +Doctor: He takes Zyrtec as well right? +Guest_family: Yes. For allergies. +Doctor: Okay. Is the fever constant throughout the day or it fluctuates? +Guest_family: It is higher at night. +Doctor: Have you checked it? +Guest_family: Yes, it was one o two point six for two days. I have not checked it since then. But isn't it strange just when I thought to bring him to the doctor, he is better. +Doctor: Ha, that tends to happen? +Guest_family: Yeah. +Doctor: His tooth is coming out. +Guest_family: No wonder! Maybe that's why he is fussy and drooling so much. +Doctor: Yeah. How about any diarrhea or vomiting? +Guest_family: No, he doesn't have that. +Doctor: Cough? +Guest_family: No coughing. +Doctor: Have you seen any change in the color of his mucous that is coming out of his nose? +Guest_family: Yes, his snots are discolored in the morning but not so much in the day. +Doctor: Is he eating well? He seems hungry? +Guest_family: Yeah, yeah." +151,"Doctor: Did you ever have any surgery? +Patient: Oh yes, around seven or eight years ago. +Doctor: What was it about? +Patient: It was about my disc in the back. +Doctor: Anything else? +Patient: Not that I remember." +152,"Doctor: Good morning, Miss XYZ. +Patient: Good morning, Doctor. +Doctor: So, I hear from my nurses you have F C R tendinitis. Have you seen another doctor for this? +Patient: Yes, I saw Doctor A B C, but what is F C R tendinitis? I don't have his notes with me today. +Doctor: That stands for flexor carpi radialis, it's a tendon in your forearm that has become inflamed. +Patient: Okay, thank you for explaining that for me. +Doctor: You're very welcome, my dear. So, you don't have his reports, but do you remember how this has been treated in the past? +Patient: So far, I've had two cortisone shots. +Doctor: I see. So, what do you do for fun? Do you have any hobbies? +Patient: Actually, I play a few instruments. +Doctor: Does this make the pain worse? +Patient: Yes, but only from time to time. +Doctor: I see. Do you take anti-inflammatories when the pain gets bad? +Patient: Yeah, I do. I was thinking about having surgery, but if it's managed with the anti-inflammatories would I even need it? I'd like your opinion on that." +153,"Doctor: And does diabetes run in your family? +Patient: Actually yes, my dad had it. He is no more. +Doctor: I am sorry." +154,"Patient: I am in pain! You have to help me. +Doctor: Where is the pain? +Patient: It is all over. My whole body hurts. I have been stabbed, shot, and injured multiple times that I have chronic pain and am in pain all the time. +Doctor: I have your chart notes from Doctor X Y Z from several years ago. I see that you have been treated for heroin use. Are you using heroin again, sir? +Patient: Yes! I have been trying to cope with the pain and I just keep going back. When the pain hits me hard the cravings start." +155,"Doctor: Hello, miss how can I help today? Do you mind stating your age and ethnicity for documentation purposes? +Patient: Okay. I am a white forty seven year old female. I am concerned about a spider bite on the back left side of my shoulder. I don't remember how it happened, I just noticed a bump near my shoulder two days ago. It is tender and red. I think it is getting bigger. Also, I want to know what the red streaks going up my neck are. +Doctor: Is it tender when I touch the area? Have you had any fever? +Patient: It is slightly painful, but nothing to cry about. No, I have not had a fever." +156,"Doctor: Have you ever had surgery in the past? +Patient: No, not that I know of. +Doctor: So, there's no history of gallbladder or appendix removal, or joint replacements? +Doctor: No, I've never had any of that done." +157,"Doctor: What is your living status? Do you live alone or with your family? +Patient: I live with my family. +Doctor: Who all is there in your family? +Patient: My mom, my dad and my two little sisters. We are a happy family. We love to spend time together. Every Friday it is a game night. Many times, we go on a hike on weekends. +Doctor: Have you been in contact with anyone who is sick? +Patient: Not that I am aware of." +158,"Doctor: So, I am looking at your x ray here. +Patient: Oh yes please tell me if everything is fine. +Doctor: Yes so, we have a two view of you shoulder. I am not seeing any bone abnormalities or any degenerative changes, so no wear and tear. +Patient: Is that normal? +Doctor: Yes, it is normal. +Patient: That's good." +159,"Doctor: How old are you, sir? +Patient: I'm fifty one years old, doctor. +Doctor: Welcome to A B C D General Hospital, what seems to be the problem today, sir? +Patient: I have been diagnosed with, um, let me look at my notes, um, degenerative joint disease of the big toe. +Doctor: Yes, looking at these x rays, the arthritis is in your M P J of the big toe. +Patient: Yep, that's right where it hurts. +Doctor: Has this pain been getting worse? +Patient: Yes, it just keeps getting worse and worse. Is there anything we can do about this? +Doctor: Actually, there's surgical options available. +Patient: Yes, I can't take it anymore, I want that surgery done." +160,"Doctor: Welcome to the clinic. Let start with your medical history. +Patient: I was diagnosed with Parkinson disease by Doctor Johnson five years ago." +161,"Doctor: Can you tell me if you ever had chronic issues? Like any illnesses? +Patient: Let me think, um, yeah they took my tonsils out for recurrent infections." +162,"Doctor: Hello, miss. How are you doing today? +Patient: I have so many wrinkles on my face. I'm fifty seven right now, but I want to look younger. Can you help me? +Doctor: Of course! Before I talk about any procedures with you, I have to ask a few questions. Do you currently smoke? +Patient: Nope. I never have. +Doctor: Great. Have you ever had a skin disease? +Patient: Not that I know of. +Doctor: Perfect. I'm just going to examine your face really quick. +Patient: Thank you doctor. +Doctor: After examining your face, it looks like your submandibular region and mid-face region are predominantly full. Your nasolabial folds are prominent." +163,"Doctor: Good afternoon, ma'am, I see you're a new patient with us. +Patient: Yep, this is my first time in. +Doctor: Well, welcome. Before we get started, how old are you? +Patient: I'm only thirty eight. +Doctor: Thank you, what seems to be the problem today. +Patient: I have pain in my hips, but my right hurts more than my left. +Doctor: How long have you been dealing with this pain? +Patient: It's been about two years now on the right, and it just started in the left recently. +Doctor: Is the pain getting worse? +Patient: Yeah, it's been getting worse since it started. +Doctor: Can you show me where the pain is? +Patient: It's here in the front, like in the groin, and then on the side. +Doctor: Do any activities bother your hip? +Patient: Oh yes, walking is so painful for me now. I hear this popping and clicking now too. +Doctor: Have you seen another doctor for this pain? +Patient: No, you're the first." +164,"Doctor: How old are you, ma'am, twenty? +Patient: You flatter me doctor, I'm fifty three. +Doctor: I see here that you have a herniated disc at T eight T nine, does that sound familiar? +Patient: Yes, that's it. It's the cause of my rib pain! +Doctor: How have you managed this? +Patient: So far, I've taken antiinflammatories, and rested. +Doctor: Has this helped at all? +Patient: No, not at all. Is there any surgery we can do for this? I want this pain gone." +165,"Doctor: Do you have any chronic diseases that you think I should know about? +Patient: What do you mean by chronic disease? +Doctor: Anything like high blood pressure, diabetes, depression, or arthritis. Do any of those ring any bells? +Patient: Um, actually yes, I have high blood pressure." +166,"Doctor: We have a fifty eight year old female who was allegedly in her typical healthy state until four o'clock P M on January eighth, nineteen ninety three when she suddenly became blind. +Guest_clinician: Did she experience any slurred speech or other neurological symptoms? +Doctor: She complained of tongue numbness and slurred speech in conjunction with vision loss. She explained that her vision improved slightly on her way to the local E R. She noticed severe blurring right before arrival, but the vision problems worsened shortly after. +Guest_clinician: Is this the first time she had experienced any of these symptoms? +Doctor: Yes. While being evaluated, she became unresponsive. She wasn't responding to deep noxious stimuli. +Guest_clinician: Did they transfer her? +Doctor: Yes. She was transferred to U I H C. Her symptoms improved markedly upon her arrival." +167,"Doctor: So tell me something, does depression or depression like symptoms run in your family? +Patient: Hm, not in my immediate family, but I have a second cousin who had depression. He later had a nervous breakdown. +Doctor: I see." +168,"Doctor: Has your E coli improved since your last visit, ma'am? +Patient: Yes, but I had some complications with the medicine. +Doctor: You were taking the Macrobid, correct? +Patient: Yes, I took it once a day at night for about seven days. +Doctor: What complications did you have? +Patient: Well, I had a skin rash and hives, so I discontinued the medicine. +Doctor: Since stopping the medicine, have these symptoms gone away? +Patient: Yes, since I stopped taking the medicine. +Doctor: Do you have any pain with urination or blood in your urine? +Patient: No, nothing to report there. +Doctor: What about fever or chills? +Patient: No, nothing there either. +Doctor: Good, how many times a day do you urinate? +Patient: Well, it's about every two or three hours, and then maybe once at night. +Doctor: Are you controlling your urine well? +Patient: Yes, I'm having no problems there. It's getting better under stress too, with the pelvic exercises and rehab. +Doctor: Are you familiar with the results of this renal ultrasound from August fifth two thousand eight? +Patient: It was normal, right? +Doctor: Basically, yes. There's nohydronephrosis, masses, or stones. +Patient: That's good to hear. +Doctor: I hear that you've had E coli few times, once in November of two thousand seven, and then in May and July of two thousand eight. +Patient: Yes, that sounds familiar." +169,"Doctor: Tylenol? +Patient: I take P M for sleeplessness. +Doctor: Okay. What other medications do you take? +Patient: Water pill and blood thinner. Then some multivitamins and folic. +Doctor: Okay I see Norvasc and Lanoxin too. +Patient: Yes, and my blood pressure medications should be there as well. +Doctor: Yes, I see, Diovan and Atenolol. +Patient: That sounds about right." +170,"Doctor: Hello nurse, who do we have here today? +Guest_clinician: This is a thirty-seven-year-old, left-handed male. He visited us one month ago for headaches, nausea, and vomiting. His exams from that time showed no evidence of bowel obstruction and he was released home. +Doctor: Was there any improvement after your discharge, sir? +Patient: No, I had the same symptoms on and off after that. +Doctor: What problems are you facing now? +Patient: I am seeing things blurred and having difficulty concentrating. My headaches are worse when sitting up. I notice them first thing in the morning. +Doctor: How would you describe your headaches? +Patient: They're dull, constant, and it feels like as if my head is wrapped in a tight band. +Doctor: Your headache starts from which part of your head? +Patient: It normally starts on the forehead and then it kind of goes to the back. It happens like six times a day. Lying down or putting my head down between my knees helps. +Doctor: What else do you feel along with your headaches? +Patient: Like I told the Nurse here before, I get blurry eyesight, nausea and there is vomiting. Any kind of bright light hurts. I'm just afraid of loud sounds. +Guest_clinician: I discussed with him about any blind spots, positive visual phenomena, weakness, numbness, tingling or double vision or any speech disorder, but he denies everything. +Doctor: How about your weight? +Patient: It has been going up and down like for over past three months. I was one hundred and sixty three and then I know it was one hundred and forty eight at a point. +Guest_clinician: Today his weight is one hundred and fifty four pounds. +Doctor: How are you eating habits in the last, let's say, one month? +Patient: It has been bad. I don't feel like eating anymore. Looks like I have lost my appetite." +171,"Doctor: Good morning, ma'am. Are you married? +Patient: Good morning, doctor. Yes, my husband and I have been married for a while now. +Doctor: That's great, do you have stairs in your home? +Patient: No, we don't. It's a single level home. +Doctor: Great, well, how are you feeling today? +Patient: I'm feeling well, doctor. I'm in good health. +Doctor: What about your husband? +Patient: He's doing well too, he helps me around the house and with things I need help with. +Doctor: That's great, do you smoke? +Patient: Absolutely not. +Doctor: What about alcohol, do you drink? +Patient: Yeah, I have the occasional glass of wine with dinner. +Doctor: Do you exercise? +Patient: I used to daily and for an hour or an hour and a half. +Doctor: Why aren't you still doing this? +Patient: Well, I haven't been able to do this since about June of two thousand eight, because of this back pain. +Doctor: I see. What do you do for a living? +Patient: Right now, I work full time as a project manager. +Doctor: What does this entail? +Patient: I have to walk a lot for long periods of time throughout the day." +172,"Doctor: Do you like to travel? +Patient: I do. In fact, I have been to more than six countries. +Doctor: Have you travelled outside the country recently? +Patient: No not recently, it's been couple years now, but I plan to. +Doctor: That's great. +Patient: Yeah." +173,"Doctor: Any chest pain or shortness of breath? +Patient: No chest pain, but I tend to have shortness of breath after any type of exertion. +Doctor: How about bladder and bowel issues? +Patient: No, that is fine. +Doctor: Any excessive or unstoppable bleeding issues? +Patient: No, I do not have any bleeding issues. +Doctor: Oh. +Patient: Yeah." +174,"Doctor: Tell me about your family medical history. +Patient: My mother died from cancer. +Doctor: Do you know what kind of cancer she passed from? +Patient: She had cancer in her stomach. My sister had Alzheimer and she passed away for complication after getting pneumonia. +Doctor: What about your fathers' medical history? +Patient: He died in a car accident when I was a teenager. +Doctor: Any other siblings or just your sister? +Patient: My brother died from mesothelioma. He had positive asbestos exposure from working in the shipyards." +175,"Doctor: Any allergies to any drugs? +Patient: Ah, yes, what is called, cepro- +Guest_family: Oh, you are allergic to Cephalexin mother! +Patient: Yep, thank you honey." +176,"Doctor: Do you smoke cigarettes? +Patient: I did way back in the past when I was young, but not now. +Doctor: How about alcohol? +Patient: No, I do not drink. +Doctor: Never? +Patient: Nope." +177,"Doctor: Good afternoon, and who is this with you today? +Patient: This is my power of attorney, doctor. +Doctor: Do you have any major medical conditions that I should know about, ma'am? +Patient: Well, I'm fifty five, and I've had a stroke. +Doctor: Okay, thank you. So, what brings you in for a visit today? +Patient: I have the urge to use the bathroom all the time. +Doctor: Do you ever pee on yourself because of this? +Patient: I have. +Doctor: Has this problem been getting worse? +Patient: Yes, it has been recently. +Doctor: What medications have you taken for this? +Patient: I've had VESIcare, but it hasn't improved yet. I'm taking Enablex right now. +Doctor: Have you had any improvement with that? +Patient: No, not yet. +Doctor: Has the nursing home done a voiding diary? +Patient: No, they haven't done that either. +Doctor: Are you having any blood in the urine, or pain with urination? +Patient: No, thankfully I'm not. +Doctor: How about fever or chills? +Patient: No, none of that either? +Doctor: What about bowel issues? +Patient: No, but I go through several pairs of Depends a day. +Doctor: Okay, and I'm looking at the results of your urodynamics from April of two thousand eight, which we did in the office. +Patient: What does that show, doctor? +Doctor: Well, it shows significant detrusor instability with involuntary urinary incontinence and low bladder volumes, and the cystoscopy was unremarkable, which is good." +178,"Doctor: Do you have any medical conditions or illnesses? +Patient: I have asthma." +179,"Doctor: Good afternoon, sir, did you just have your forty first birthday? +Patient: Yes, I just had it. +Doctor: Happy birthday! Just to confirm my charts, you identify as White, correct? +Patient: Yes, doctor. That's correct. +Doctor: Great, thank you. So, we've treated you for H I V in the past. I have your lab results from your last visit right here. +Patient: Can you tell me those numbers again, doctor? +Doctor: Absolutely, your C D 4 count was four hundred twenty five, your viral load was less than fifty, and that was in August of two thousand seven. +Patient: Are those normal? +Doctor: Both of those are low, actually, but the low viral load is good. +Patient: Oh, that's good, I guess. +Doctor: Have you had any medical complications recently? +Patient: Well, I was in the hospital recently. +Doctor: What was that for? +Patient: I had an abscess in my left glute, so I had a surgery to remove and clean it out. +Doctor: How is the abscess today? +Patient: It's getting better, I follow up with the surgeon today after this appointment. +Doctor: Good, what about your medical history? +Patient: I have high blood pressure and high triglyceride levels. +Doctor: Okay, thank you. What about newly diagnosed conditions? +Patient: Well, I got diagnosed with diabetes too. +Doctor: What symptoms have you been experiencing with your diabetes? +Patient: Well, I've been peeing a lot, and I've been really thirsty, too. +Doctor: How have you been treated for this to date? +Patient: Um, I saw the endocrinologists while I was in the hospital, and they gave me insulin. +Doctor: Are you still taking the insulin? +Patient: No, I can't afford to pay for it. So, they gave me Glucophage and, um, glyburide. +Doctor: Have you been taking these? +Patient: Yes, exactly as instructed. +Doctor: Good, and how do you feel today? +Patient: Overall, I'd say I'm feeling better." +180,"Doctor: Do you have any medical conditions in your past that I should know about? +Patient: No, not that I know of. +Doctor: So, there's no history of depression, high blood pressure, or anything like that? +Patient: Oh, no. I can't remember anything." +181,"Doctor: How are you doing today? +Patient: I am doing okay. +Doctor: I see in your note that you told the nurse that you have a strong family history of Huntington disease. +Patient: Yes, I do. +Doctor: Who in your family had Huntington disease? +Patient: My mother, grandmother, and my two younger brothers. +Doctor: How is everyone doing? +Patient: My grandmother and my mother both died of Huntington disease. +Doctor: I am so sorry to hear that. What about your brothers? +Patient: My brothers are doing okay. One of my brothers just started a neurological treatment. I am not sure what it is called. +Doctor: Okay." +182,"Guest_clinician: Does the patient have any drug allergies? +Doctor: None that I'm aware of. Let me check his chart again to confirm. +Guest_clinician: Thanks. +Doctor: Yeah, it looks like he's not allergic to anything." +183,"Doctor: So, let's see what we have here. I have down that you're not allergic to any medications. +Patient: Correct, no drug allergies. +Doctor: Good, great." +184,"Doctor: Are you married? +Patient: Yes, I have been married for ten years. +Doctor: Are you a smoker? Do you drink alcohol and if so, how many times a week do drink? +Patient: I do not smoke or drink. +Doctor: Any recreational drug use? +Patient: No." +185,"Doctor: Hello, sir. What are we doing today? +Patient: Hello. I am here for a regular physical. Both of my parents died from medical issues, and I want to make sure when I go that it is just from old age. +Doctor: What did your parents have? +Patient: My father died from lung cancer and ischemic cardiac disease. He was eighty four. +Doctor: What about your mother? +Patient: She died of congestive heart failure. Not sure the exact age she was, but it was in her eighties too. +Doctor: I am sorry to hear that. Do you have any siblings? +Patient: I have six sisters and two brothers. A few of my sisters live around here. They are all in good health that I know of." +186,"Doctor: Hello ma'am. How are you doing today? Can you state your age please? +Patient: I was born in nineteen forty three and am seventy eight years young. I am doing well other than the hypertension issue. +Doctor: Luckily, all of the intercranial lab work has come back negative. Are you still on the hydrochlorothiazide and the potassium chloride? +Patient: Yes, I take twenty five M G of the hydrochlorothiazide once a day. I also take the potassium once a day as well. Both control my blood pressure fine. +Doctor: Any chest pain, shortness of breath, dizzy spells, ankle swelling, or trouble breathing when sleeping? +Patient: I have none of that so far." +187,"Doctor: Ma'am, are you feeling okay? +Patient: No not really, I feel dizzy. +Doctor: Who brought you to emergency? +Patient: My husband, he is trying to find parking outside. +Doctor: Okay. +Doctor: Let me check your blood pressure and this will monitor your heartbeat. +Doctor: Well, your blood pressure looks quite high and so does your heartbeat. Do you have a history of hypertension or tachycardia, how old are you? +Patient: I am sixty six." +188,"Doctor: Remind me, please, when was your last appointment, miss? +Patient: Um, it was about three months ago. +Doctor: How have your diabetes and kidney disease progressed since? +Patient: Well, I've had a lot of variability in my glucose control too largely, and recent upper and lower respiratory illnesses. +Doctor: Who treated you for these? +Patient: I didn't see anyone, the symptoms just kind of improved on their own. +Doctor: I see, are you still having difficulties with blood sugar management? +Patient: Yes, my two week average is one hundred ninety one, and it was high this morning. +Doctor: What do you think caused this? +Patient: Um, I had problems with my infusion set. +Doctor: Let's try a correction bolus. Okay, now your blood sugar is quite low. Let's try to get some glucose and crackers into you. +Patient: Yes, I feel a little better now. +Doctor: Okay, your blood sugar is back up to over one hundred, which is good. +Patient: I should be able to manage this on my own. +Doctor: Good, Are you having any other medical problems that have interfered with glucose control? +Patient: No, not that I know of. +Doctor: Have you had any diet changes recently? +Patient: A little bit, I've been away traveling and visiting my family for some time." +189,"Doctor: What medications are you taking currently? +Patient: I take Synthroid for my low thyroid and I used to take Aspirin, but I stopped that about a week ago. +Doctor: I see. And you're no longer taking Terazosin, Lisinopril, or Atenolol? +Patient: Yeah. My cardiologist, Doctor X, told me to stop taking them weeks ago." +190,"Doctor: Let me quickly examine your eyes nose and ears. +Patient: Sure. +Doctor: Well, eyes look fine no lesion seen on lids, brows or corner of the eyes. Extra ocular movements are intact. Sclerae look great. Pupils look fine. Can you open your eyes wide for me I am going to check with this instrument. Everything looks fine here. +Patient: Okay. +Doctor: I don't see any swelling or glaucoma. No cataracts. Let me check your ears, Looks perfectly normal. Ears normal set and shape with normal hearing and tympanic membrane. No hearing problem or tinnitus or anything? +Patient: Nope. +Doctor: No cough or cold or sinus congestion, right? +Patient: No. +Doctor: Open your mouth for me, stick your tongue out, say ""ahhhhh"" for me. Everything looks normal here. +Doctor: Do you regularly visit your dentist? +Patient: Yes, I recently got some dental work done. +Doctor: Okay." +191,"Doctor: When did you stop using all the drugs, sir? +Patient: I think I was twenty five. +Doctor: So, everything is clean after that? No more accidents? +Patient: I think I had a relapse once. It has been like more than 10 years. I have been clear since then. +Doctor: Are you still smoking cigarettes at the same level? +Patient: Yes, sir, still a heavy smoker. +Doctor: But do you know this is a problem for your health, especially your since you have chronic bronchitis? +Patient: I know, but it is hard to quit smoking too." +192,"Doctor: How has she been since the last time we saw you both? +Guest_family: She has been in good spirits. She has so much energy. She has had some constipation issues lately. +Doctor: How has her breathing been? Any changes? +Guest_family: No. Everything is the same. +Doctor: According to her chart she has not gained any weight since her last visit. I am sure it is due to her high energy level, but it is something we need to keep a close eye on. +Guest_family: What can I do to help her gain weight? +Doctor: I would like you to focus on making sure she is getting enough protein in her daily diet. Here is a handout on meal suggestions and tips for keeping meal times on a consistent schedule. +Guest_family: Thank you." +193,"Doctor: Okay, let me ask you few questions. +Patient: Sure. +Doctor: Are you married? +Patient: Yes I am. +Doctor: So, you live with your wife, sir? +Patient: Yes, that's right. +Doctor: And do you smoke? +Patient: No I don't. +Doctor: I think the nurse had already asked you some of these questions, so I would just agree with them all. I don't need to ask again. +Patient: Sure, thanks." +194,"""Doctor: Are you married? +Patient: Yeah, I'm divorced. +Doctor: Where do you work? +Patient: I'm a homemaker. +Doctor: Do you smoke or drink? +Patient: No.""" +195,"Doctor: Hi there, I love that dress, very pretty! +Patient: Thank you for complementing a seventy-two-year-old patient. +Doctor: No, I mean it, seriously. Okay, so you were admitted here in May two thousand nine. You have a history of hypertension, and on June eighteenth two thousand nine you had bad abdominal pain diarrhea and cramps. +Patient: Yes, they told me I might have C Diff? They did a CT of my abdomen and that is when they thought I got the infection. +Doctor: Yes, it showed evidence of diffuse colitis, so I believe they gave you IV antibiotics? +Patient: Yes they did. +Doctor: Yeah I see here, Flagyl and Levaquin. They started IV Reglan as well for your vomiting. +Patient: Yes, I was very nauseous. Vomited as well. +Doctor: After all this I still see your white blood cells high. Are you still nauseous? +Patient: No, I do not have any nausea or vomiting, but still have diarrhea. Due to all that diarrhea I feel very weak. +Doctor: Okay. Anything else any other symptoms? +Patient: Actually no. Everything's well. +Doctor: Great. +Patient: Yeah." +196,"Doctor: Any uncomfortable feeling in the back of your throat, like excess mucous accumulation or something like that? +Patient: Uh, no. I don't think so. +Doctor: Um, any soreness in your throat? +Patient: No." +197,"Doctor: It's good to see you sitting up in the bed, ma'am. +Patient: I've been walking around without any difficulty too. +Doctor: Have you eaten anything yet? +Patient: No, I've remained, um, NPO, just like you told me. +Doctor: Good, do you have any new symptoms since June tenth two thousand nine? +Patient: No, but I do have tenderness where you made the cut for the surgery. +Doctor: That's pretty normal. I'm glad that you're doing well after the procedure. Do you have any questions? +Patient: How did my procedure go? +Doctor: It went well, we are all down and you should be back to eating shortly." +198,"Doctor: Are there any major medical conditions that you know of that I should be aware of? +Patient: What do you mean by that, doctor? +Doctor: Well, anything from depression, to cancer. +Patient: No, none of that rings any bells." +199,"Doctor: Have you had your flu or Pneumonia vaccination this year? +Patient: I got my flu shot this year, but I did not get the one for Pneumonia." \ No newline at end of file