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[Physical Examination][Doctor] you cleared out the lungs ? all right , let me take a look at your feet . [Patient] okay .[SEP][Physical Examination][Doctor] okay . extremities are without edema . pulses are palpable on the dorsalis pedis posterial tibial . she has thickened nails . [Patient] yeah .[SEP][Physical Examination][Doctor] yeah . mildly dry skin , no skin breakdown . l- let me know if you can feel this . [Patient] okay . i closed my eyes . yeah , yeah , okay .[SEP][Physical Examination][Doctor] mildly decreased sensation in the tips of the first and second toes . okay , we're done with your exam . [Patient] okay .[SEP][Discussion][Doctor] okay . so again , try to keep the feet moisturized . [Patient] yeah .[SEP]
|
[
"Discussion",
"Medication",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 0 |
[Personal History][Doctor] right . what do you do when it's really bad ? [Patient] um , i try to just get as much rest as i can .[SEP][Personal History][Other Socials][Doctor] okay . and you had talked about doing yoga . are you doing yoga anymore ? [Patient] i wish i said yes , but i have n't really made it a habit .[SEP][Acute Symptoms][Doctor] okay . okay . well , um , you know , said ... you said you were coming in with shortness of breath , so we sent you to get some pulmonary function tests . [Patient] mm-hmm .[SEP][Physical Examination][Doctor] so let's just look at those . hey , dragon , show me the pulmonary function tests . okay , so it looks like ... , it's interesting . it says that you might be having a little bit of asthma or , uh , copd . and if you are , we'll talk about that . [Patient] mm-hmm .[SEP]
|
[
"Physical Examination",
"Radiology Examination"
] |
[
"Objective"
] | 1 |
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hey dylan what's going on [Patient] so i lift quite a bit of weights i try to stay in shape as much as i can i'm not like normal people i lift heavy weights and my elbow is extremely sore[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 2 |
[Acute Symptoms][Doctor] alright were you able to continue playing [Patient] no i had to stop i actually it was like i had to be held from the field because i could n't put weight on my foot[SEP][Therapeutic History][Doctor] i'm sorry okay so what have you been doing for the pain since then [Patient] i wrapped it after a the game they had some ace wraps in their clubhouse and so i wrapped it up and then i iced it last night and i just kept it up on a pillow and then i took some ibuprofen[SEP][Acute Symptoms][Doctor] okay could you one more time when did this injury happen [Patient] this happened about couple days ago[SEP][Therapeutic History][Doctor] okay so did you say whether does the ibuprofen help at all [Patient] yeah it helps a little bit but then you know it it you know after a while it wears out[SEP][Acute Symptoms][Doctor] okay and then have you experienced any numb numbness or tingling [Patient] no no numbness[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 3 |
[Chitchat][Doctor] okay alright well i have a peloton who is your favorite instructor [Patient] i i actually do n't have a favorite instructor i have more favorite rides[SEP][Chitchat][Doctor] okay what kind of rides do you like [Patient] i like rock music and regain music rides so whoever is doing those in a began or a medium content i'm cool with[SEP][Acute Symptoms][Doctor] i ca n't picture you as a regade person so that's interesting to know okay alright and any numbing or tingling in your foot at all [Patient] yes but not from the knee injury i broke my foot my second toe on my right foot and i have numbness depending upon the shoe i wear[SEP][Personal History][Doctor] okay when did you break your toe [Patient] i've broken it three times over the last ten years so it's just something that's a an annoyance but it was n't caused by this injury[SEP][Personal History][Doctor] okay so you do have some numbing and tingling but it's not new [Patient] right correct[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 4 |
[Personal History][Doctor] all right . um , and how about from a diabetes standpoint ? how ... how's your blood sugar been running ? especially now that you kind of have this , like , acute thing going on ? have your blood sugars been okay ? [Patient] they've been okay . i've noticed that they sometimes get a little high and a little low . um , but nothing too far out of range .[SEP][Therapeutic History][Doctor] okay . all right . um , and you're still taking the metformin ? [Patient] yes .[SEP][Therapeutic History][Personal History][Doctor] okay . all right . good . and then in terms of your high blood pressure , are you monitoring the blood pressures at home ? [Patient] yeah , i , i have a ... i bought a cuff last year , and i've been , um , taking it myself at home . those have looked good . i've been staying away from the salty foods .[SEP][Personal History][Doctor] mm-hmm . [Patient] um , so that's been good .[SEP][Therapeutic History][Doctor] okay . and , um , so you're still taking the lisinopril ? [Patient] yes .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 5 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] patient mrn : abc123 . date of birth : january 1st , 1960 . patient is a 60 year old , right-handed male , referred today for evaluation of numbness and tingling . hello , mr. cook . how are you doing this morning ? [Patient] hi , dr. martinez . this weekend was a bit rough . i've had this numbness and tingling for a few weeks now .[SEP][Acute Symptoms][Doctor] so it's in both of your hands ? [Patient] yes , ever since my car wreck last december when i broke them ... well , once they healed , i mean , i noticed it more , the tingling and the numbness .[SEP][Acute Symptoms][Personal History][Doctor] and you still wear the splint only on the right wrist ? [Patient] no , i also wear the left sometimes . the right is just worse , but the splint helps . both have really gotten worse over the last month . when i broke them , my right wrist was definitely in worse shape . i've also been having some s- mild stiffness in my neck too . i hit my head during the accident , and they told me it was a contusion .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 6 |
[Acute Symptoms][Vegetative History][Doctor] and does he act like he has a sore throat or is he pulling on his ears ? [Patient Guest] well , i know he's been pulling on his ears , yeah .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . [Patient Guest] you know , he also , he's also been going crazy rubbing at his nose too .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . and , any fever you've noticed ? [Patient Guest] i checked his rectal temperature and it was 100.3 .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . so , a little bit of a low-grade fever there , definitely . and , how was his appetite ? did he eat last night ? [Patient Guest] yes , he did . yeah .[SEP][Acute Symptoms][Vegetative History][Doctor] and how about this morning ? did he eat his breakfast ? [Patient Guest] uh , this morning he ate about seven ounces from the bottle .[SEP]
|
[
"Acute Symptoms",
"Vegetative History"
] |
[
"Subjective"
] | 7 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] hey philip good to see you today so take a look here at my notes i see you're coming in for some right knee pain and you have a past medical history of hypertension and we will take a look at that so can you tell me what happened to your knee [Patient] yeah i was you know i was just doing some work on my property and i i accidentally slipped and fell down and i just still having some knee issues[SEP][Chitchat][Doctor] okay well that that's not good do you [Patient] no[SEP][Acute Symptoms][Doctor] what part of your knee would you say hurts [Patient] i would just say you know the it it you know it basically when i when i'm flexing my knee when i'm moving it up and down and i put pressure on it[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 8 |
[Personal History][Doctor] okay and ever have you ever had any issues where you had what we call urinary retention where you could n't pee and you needed to have like a catheter inserted [Patient] my gosh no[SEP][Personal History][Doctor] alright and have you ever seen a urologist i do n't think so you've been my patient for a while i do n't remember ever sending you but have you ever seen one [Patient] i do n't think so[SEP][Personal History][Doctor] okay now tell me how are you doing with your with your heart when was the last time you saw doctor moore the cardiologist i know that you had the the stent placed in your right coronary artery about what was that twenty eighteen [Patient] yeah sounds about right i think i just saw him in november he said everything was okay[SEP][Acute Symptoms][Doctor] he said everything was okay alright and so you have n't had any chest pain or shortness of breath you're still walking around doing your activities of daily living are you exercising [Patient] kind of[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 9 |
[Chitchat][Doctor] yes sir work harder [Patient] okay[SEP][Personal History][Doctor] do you do you play sports in in college or high school [Patient] i did in high school[SEP][Personal History][Doctor] yeah so and you and you still doing anything athletic now other than just rocking kids [Patient] no[SEP][Personal History][Doctor] just kinda you're thinking walking the dog [Patient] yeah rocking kids and walking dogs and going on the occasional swim[SEP][Personal History][Doctor] on the occasional swim alright how have you been swimming since you hurt your knee [Patient] no no i have n't would you recommend that[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 10 |
[Conversation Start][SEP]
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[
"Greetings"
] |
[
"Subjective"
] | 11 |
[Personal History][Doctor] great . and any urgent care or er visits at all for breathing over the past year ? [Patient] nope .[SEP][Therapeutic History][Doctor] okay , so i'm going to assume no one has put you on prednisone for breathing issues then . [Patient] nope .[SEP][Other Socials][Doctor] okay . and now , military wise , what's the time frame of when you'll be completing some of these exertional tests ? like , what are your next steps ? [Patient] so , hopefully i'm going to be enlisted early spring of 2022 . so that gives me about six to seven months to get to a point where i'm able to exert my body where i do n't really need the inhaler . or at least show them that i have it under control .[SEP][Physical Examination][Doctor] now when you were in the other room you completed a breathing test , correct ? [Patient] correct .[SEP][Personal History][Therapeutic History][Doctor] okay , great . so now let me ask you about the allergies , 'cause i know typically you'll use the zyrtec in the spring , summer and fall , correct ? [Patient] yeah , i do n't really ... um , or i'm sorry , i use it more during the spring and fall . i do n't really have to use it too much in the summer .[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 12 |
[Conversation Start][SEP]
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[
"Acute Symptoms",
"Greetings"
] |
[
"Subjective"
] | 13 |
[Acute Symptoms][Personal History][Greetings][Doctor] carolyn is a 34 -year-old female with a history of diabetes mellitus type two who is here today with a headache so hi there carolyn it's nice to see you again listen i'm sorry you're having headaches well let's talk about it but i would like to record this conversation with this app that's gon na help me focus on you more would that be okay with you [Patient] yes that's okay[SEP][Acute Symptoms][Doctor] okay great thanks so carolyn tell me about your headache and headache or headaches when did when did they start and and what symptoms are you having [Patient] my headache started about a week ago it's feeling like a dull pain in the back of my head i have flushing in my ears they get really red and hot and sometimes i just feel a little bit dizzy when i get these headaches but i've taken tylenol and advil and it's not really going away it just keeps coming back[SEP][Acute Symptoms][Doctor] okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what [Patient] it comes and goes i it it's relieved when i take my tylenol or advil but then it comes right back[SEP][Acute Symptoms][Doctor] hmmm okay and do you notice any any timing difference you know is it is it worse in the morning worse in the evening is there anything else that makes it better or worse [Patient] it's definitely worse in the evening[SEP][Acute Symptoms][Doctor] okay and do you feel any sort of tightness in the back of your neck or in your shoulders or you know you said it's in the back of your head primarily any discomfort anywhere else [Patient] yes no just in the back of my head[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 14 |
[Personal History][Doctor] okay so have you ever hurt your left foot before [Patient] no i've had a lot of injuries in soccer but never injured this foot[SEP][Acute Symptoms][Doctor] okay and then so after the fall and the entanglement with the other player were you able to continue playing [Patient] no i had to stop playing right away and actually being helped off the field[SEP][Therapeutic History][Doctor] wow okay and what have you been doing for the the pain since then [Patient] so i've been keeping it elevated icing it the trainer wrapped it yesterday and taking ibuprofen as well[SEP][Acute Symptoms][Doctor] okay alright so without any ibuprofen can you tell me what your pain level is [Patient] without ibuprofen i would say my pain is a three[SEP][Acute Symptoms][Doctor] okay and then with your ibuprofen can you tell me what your pain level is [Patient] like a seven eight[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 15 |
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hey anna good to see you today so i'm looking here in my notes says you have you're coming in today for some right ankle pain after a fall so can you tell me what happened how did you fall [Patient] yeah so i was taking out the trash last night and i ended up slipping on a patch of ice like and then when i fell i heard this pop and it just hurts[SEP][Acute Symptoms][Doctor] okay so have you been able to walk on it at all or is it you know [Patient] at first no like my friend who was visiting thankfully had to help me get into the house and i you know and now i'm able to put like a little bit of weight on it but i'm i i'm still limping[SEP][Acute Symptoms][Doctor] okay well you know that's not good we'll we'll hopefully we can get you fixed up here so how much how much pain have you been in on a scale of one to ten with ten being the worst pain you ever felt [Patient] it's it's more like so when i first fell it was pretty bad but now it's it's at like a six you know like it's uncomfortable[SEP][Acute Symptoms][Doctor] okay and how would you describe that pain is it a constant pain or is it only when you move the ankle [Patient] it's it's constant it's like a throbbing pain you know and like when i touch it it feels kinda warm[SEP]
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 16 |
[Acute Symptoms][Doctor] okay . all right . and have you had any , any body aches ? [Patient] yeah , i have .[SEP][Acute Symptoms][Personal History][Vegetative History][Doctor] okay . all right . um , and i know that you were out hiking in the woods and , and that type of thing a couple of weeks ago , and we thought that that's where you got the bite . so , um , how's your , how's your appetite ? have you been okay ? a little nauseous ? [Patient] yeah , i've been a little nauseous . i have n't been able to eat much . i've been trying just to keep , you know , toast and crackers and that's all about i've been able to stomach , really .[SEP][Acute Symptoms][Doctor] okay , and , and i know that you had had that , that , uh , bite there . have you noticed any other rash anywhere else ? [Patient] yeah , i have .[SEP][Acute Symptoms][Doctor] okay . all right . sometimes they kind of describe it as looking as like a bull's-eye . [Patient] yes .[SEP][Acute Symptoms][Doctor] is that what it looked like ? [Patient] mm-hmm .[SEP]
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[
"Acute Symptoms"
] |
[
"Subjective"
] | 17 |
[Therapeutic History][Doctor] okay , yeah . i see here you're on the protonix , 40 milligrams , once a day . [Patient] yes .[SEP][Therapeutic History][Doctor] so that's , you're doing well with that ? [Patient] yep .[SEP][Physical Examination][Doctor] okay . all right . so let's go ahead and do a quick physical exam . so , listening to you , um , look , or looking at you , you appear in no distress . your thyroid is a little enlarged , but non-tender . there's no carotid bruits , your heart is in irregular rate and rhythm , and your lungs are clear . your abdomen is nice and soft , and you have no edema in your lower extremities . let's go ahead and look at some of your test results . [Patient] okay .[SEP][Reassessment][Diagnostic Testing][Medication][Doctor] hey , dragon ? show me the blood sugar . hey , dragon ? show me the blood glucose . hey , dragon ? show me the hemoglobin a1c . okay , so i see here that both your blood sugar and your hemoglobin a1c are elevated . so your blood sugars have probably been running high for probably a few months . okay ? um , let's go ahead and look at some of your other results . hey , dragon ? show me the diabetes labs . yeah . okay . yeah , so , um , my impression of you at this time , um , for your high blood sugars , that you do have this diagnosis of diabetes . now , we're not sure if it's type i or type ii . even patients in , you know , in their mid-twenties can develop type i diabetes , so we're gon na go off and , we're gon na go ahead and , and send some labs to work that up . hey , dragon ? order a complete metabolic panel . and i'd like to start you on metformin , 500 milligrams , twice a day . that will help keep your blood sugars down . [Patient] okay .[SEP][Discussion][Diagnostic Testing][Medication][Doctor] hey , dragon ? order metformin , 500 milligrams , twice a day . and then if some of the autoimmune labs that come back show that you have an autoimmune disorder , meaning that you would have type i diabetes , then we would have to go ahead and put you on insulin . but i'm gon na hold off until we have those results , okay ? [Patient] okay .[SEP]
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[
"Other Treatments"
] |
[
"Plan"
] | 18 |
[Discussion][Personal History][Therapeutic History][Reassessment][Doctor] okay good so i think we should probably repeat your hemoglobin a1c it sounds like you've you know you've improved your diet and it sounds like you've you're following the regimen so maybe the numbers will be better this time and we do n't have to change your medication so that will be awesome how are you doing with your blood pressure i know we have you on norvasc we asked that you check it like you know once a week or more than that if you have time blood pressure looks good today in the office it's about one fifty i'm sorry one twenty over fifty right now so no nothing here in the office how are things at home [Patient] i get there now every once in a while you know the lower numbers a little bit you know higher but it's not you know usually it's either close or or on on range[SEP][Physical Examination][Discussion][Referral][Medication][Acute Assessment][Doctor] okay alright good so let me examine you now so tyler i'm examining you now i'm gon na just verbalize some of my findings your neck is fine i do n't see any swelling in your neck your thyroid feels normal i do n't feel any masses in your neck there's no lymph nodes i'm looking at your throat and that looks okay there is no masses or any swelling that i can see there is no redness yeah there is no carotid bruit your lung exam is clear your heart exam is normal no murmurs on your belly exam you have some epigastric tenderness right here in the right here where i'm pressing but i do n't feel any masses or any significant swelling back there no normal back exam your extremity exam looks normal your neurological exam's fine so for this difficulty swallowing i'm concerned that you may have a narrowing in your throat that's causing this and sometimes it can be from a stricture where some narrowing of the esophagus and sometimes i need to go in and dilate that so i'm gon na go ahead and send you give you a referral for gastroenterology and have them do a scope and take a look down there i'm gon na recommend we put you on some prilosec sometimes also reflux medicine can if you have reflux sometimes that can also exacerbate this sometimes so i'm gon na put you on some prilosec twenty milligrams once a day again i'm gon na recommend that you chew your foods frequently and make sure you have a you know especially if you're eating something hard like steak or meat chew them really well so they do n't get tend to get stuck some people have sometimes things get stuck and they do n't go down and if that happens as an emergency you do have to go to the emergency department but seems like you know things are going down they just seem to sometimes slow down or get stuck temporarily so why do n't i get you a referral for gi we will start you on the prilosec and then we will have you you know if you you know if you have any other symptoms or worsenings give my office a call we will get you in or get you referred to the er if needed any questions about that [Patient] no that sounds great[SEP][Discussion][Follow-up][Referral][Diagnostic Testing][Reassessment][Doctor] okay and for the diabetes i'm gon na order another hemoglobin a1c i'm gon na order some more blood work today we'll check a kidney function and i notice that you have not had an eye referral so i'm gon na also give you an eye referral to ophthalmology to check your eyes for your diabetic for your for any retinopathy continue the metformin i'll have you come back in about a month and that way we'll have the results back for the blood test if we need to make any adjustments we can but i i wan na see you back in about a month and i think that's it for that any questions about that [Patient] no[SEP][Discussion][Medication][Reassessment][Doctor] okay and the high blood pressure i think you're doing great continue with the norvasc if you have any issues certainly call me but otherwise there is really nothing else to add for that did we forget anything or do you need refills for anything [Patient] you know i think i'm low on the norvasc so if you could send something to my pharmacy that would be great[SEP][Discussion][Medication][Doctor] okay sure i'll get you a refill for norvasc we'll get that sent over to the pharmacy okay [Patient] thank you[SEP]
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[
"Chitchat"
] |
[
"Null"
] | 19 |
[Physical Examination][Drug History][Doctor] okay okay i just have to ask alright so i do wan na do a quick physical exam i did review your vitals and like part of why i wan na know about your smoking history is that you are stating kind of low like it looks like you are might be in the ninety five percentile range and so we might need to explore some things [Patient] sent them off yeah[SEP][Physical Examination][Doctor] pardon [Patient] because i'm fat my cousin was fat too and and he gained a bunch of weight he he had to have oxygen[SEP][Physical Examination][Drug History][Doctor] you know honestly there are a few other factors weight gain does n't necessarily help you're right but like smoking has like a stronger impact so but it's okay we can explore like you know other options here i as i listen to your heart you have a regular rate and rhythm i do n't appreciate any murmur on so i'm gon na go ahead and do a back exam i do n't notice any overlying erythema or ecchymosis on your skin so no redness or bruising when i push here on your spine does that hurt okay okay so there is midline tenderness on the l4 l5 disk space with right sided lumbar paravertebral tenderness when you bend forward does it hurt [Patient] yeah it hurts[SEP][Physical Examination][Doctor] okay and when you bend backward does it hurt [Patient] a little bit[SEP][Physical Examination][Doctor] okay so pain with lumbar flexion and extension alright and as i raise your leg does this hurt when i raise your leg up [Patient] stop[SEP]
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[
"Physical Examination"
] |
[
"Objective"
] | 20 |
[Other Socials][Doctor] okay where did you go [Patient] i was in zambia[SEP][Chitchat][Doctor] hmmm i heard that's beautiful [Patient] it's so beautiful it's so beautiful i had a great time[SEP][Physical Examination][Vegetative History][Doctor] okay well let me let me go ahead and do a physical examination here i reviewed your vitals you know that the the assistants collected when you first came in including your weight and everything looks good there there is no fever there there is nothing that i'm concerned about there now on your heart exam you have a nice regular rate and rhythm and i do n't appreciate any murmurs that's kind of those extra sounds that i would hear and that that all sounds good on lungs lung exam your lungs are clear there's no wheezes rales or rhonchi now on your neck exam i do n't appreciate any lymph lymphadenopathy swollen lymph glands and then let me just go ahead and i wan na press on your belly a little bit is that tender anywhere that i press it does n't seem like you making any facial [Patient] no[SEP][Physical Examination][Discussion][Acute Assessment][Lab Examination][Doctor] no okay so your you know your abdominal exam is your belly is soft there is no tenderness as i i push around there now i did review the results of your recent lab work and it is consistent as as your pcp noted with an iga deficiency that's that immunoglobulin a that we talked about so let me tell you a little bit about the assessment and plan so for your first problem the that a iga deficiency is it very common immunodeficiency your your body makes many different types of antibodies in one of your z iga is just a little bit lower than normal now most of the time people live their entire life without even knowing they have that deficiency and function perfectly normal now some people may find that they get tend to get frequent respiratory tract or sinus or abdominal infections but this does n't necessarily seem to be the case for you now it can go along with other immunodeficiencies but i think there is a low likelihood hood in your case but we're gon na order some additional blood work that includes checking those other antibodies now do you have any questions on what i just told you [Patient] yeah so is there anything i need to do or should be watching for or should i be worried[SEP][Discussion][Diagnostic Testing][Doctor] no i i really do n't think you need to be worried now we're gon na check these additional studies and that will give us some more guidance but really i think this is just a finding that's common to you and you know it it's many people have have have these type of you know immunodeficiency what i want you to watch for is those infections that do n't stop you have trouble getting it under control or you know any changes to your abdominal tract you know severe diarrhea anything like that then you know we may want to look at it a little bit further but for now i do n't think there is anything significant we want to do now go ahead and get your lab work and bring you in for that now the only other thing that i would say is if you eat end up needing any blood products between now and when i see you next make sure you tell them that you have that iga deficiency [Patient] why is that[SEP]
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[
"Discussion"
] |
[
"Plan"
] | 21 |
[Acute Symptoms][Vegetative History][Doctor] have you lost weight ? [Patient] no , but i stopped taking the camila birth control . my hunger level was at a new high . i mean , i was eating constantly . i felt like , " what is going on ? "[SEP][Acute Symptoms][Doctor] all right . [Patient] and now i am feeling better .[SEP][Acute Symptoms][Doctor] okay , that's good . and your masked face , though , it does look thinner . [Patient] well , the past six months i have lost some weight .[SEP][Acute Symptoms][Doctor] okay , good . um , anything else going on ? [Patient] no .[SEP][Personal History][Doctor] all right . so your pap was in 2019 . i do n't think that we need to repeat that because it was negative/negative . um , have you ever had an abnormal pap ? [Patient] not with you , but i did around 2009 , and then i had to be seen every six months for a while . and then i had a normal pap .[SEP]
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[
"Diagnostic Testing"
] |
[
"Plan"
] | 22 |
[Discussion][Medication][Doctor] correct , it's not a steroid . [Patient] okay , good .[SEP][Discussion][Medication][Doctor] it's called a calcineurin inhibitor . it's kinda like a steroid in that it calms inflammation . [Patient] okay .[SEP][Discussion][Medication][Doctor] but it's not a steroid , so do n't use steroids on your face , for sure , as they'll make this kind of rash worse . but also , steroids carry the risk of causing thinning of the skin . [Patient] all right .[SEP][Discussion][Medication][Doctor] these medications do n't cause thinning of the skin and they're not going to cause some other kind of rash . um , the thing to know is that sometimes five to 10 minutes after you put it on , it can cause this weird kind of tingly or needle-like sensation or make it redder or flush . but it should only last a few seconds and then go away . it's not an allergy or anything bad . [Patient] okay . got it .[SEP][Discussion][Medication][Doctor] so it only lasts a couple seconds . it does n't mean it's going to happen again . it's nothing bad . it will still work , so keep using it as long as you know you can stand it , okay ? [Patient] okay , thank you for explaining .[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 23 |
[Physical Examination][Doctor] and what about the outside does that hurt as well [Patient] yeah it does[SEP][Physical Examination][Doctor] are you able to move your wrist towards your arm like [Patient] not without extreme pain[SEP][Physical Examination][Doctor] okay so pain on flexion what about extension when you pick your wrist up [Patient] yeah i have a hard time doing that actually[SEP][Physical Examination][Doctor] alright what about we're gon na go ahead and hold your arm like straight like flat and then try and move it sideways does radial deviation hurt [Patient] yeah[SEP][Physical Examination][Doctor] alright and then lateral as well [Patient] yeah it's really hard to move any direction of this hand for some reason[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 24 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] hey philip good to see you today so take a look here at my notes i see you're coming in for some right knee pain and you have a past medical history of hypertension and we will take a look at that so can you tell me what happened to your knee [Patient] yeah i was you know i was just doing some work on my property and i i accidentally slipped and fell down and i just still having some knee issues[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 25 |
[Acute Symptoms][Doctor] okay alright and then so how's the pain with your knee on a scale of one to ten one being the least pain ten being the worst pain how's how's it been ranging [Patient] it's somewhere between six and seven right now it's about four or five with some of the swelling going down[SEP][Acute Symptoms][Therapeutic History][Doctor] okay alright and did you take anything at all to relieve the pain [Patient] anti-inflammatories[SEP][Acute Symptoms][Therapeutic History][Doctor] okay alrighty and did that help [Patient] yeah the ibuprofen helped a little bit but i'm on it pretty on a pretty regular basis right now[SEP][Acute Symptoms][Doctor] gotcha okay now tell me are you able to bend or straighten your leg ever since then [Patient] i can bend it but it hurts towards the end of the motion and i can straighten it but it does n't it feels like i have to help get it straightened[SEP]
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[
"Acute Symptoms"
] |
[
"Subjective"
] | 26 |
[Physical Examination][Doctor] okay okay and i wan na turn your wrist over here and turn your hand over and i'm gon na go ahead and tap on the right wrist on the back here does that do anything when i do that [Patient] i still i feel a little jolt or a zing in my finger tips[SEP][Physical Examination][Doctor] okay and then when i do that on the left side [Patient] yeah same thing[SEP][Physical Examination][Discussion][Diagnostic Testing][Acute Assessment][Other Treatments][Doctor] same thing okay so you do have a bilateral positive tinel's sign so so here's here's where i'm at i think your your diagnosis is beginning to have some bilateral carpal tunnel syndrome usually we see that with repetitive actions such as the landscaping the heavy labor and you you know your your clinical exam and and history sound like it's a carpal tunnel syndrome i do want to order so where are we gon na go from here i would like to order a a study it's called an emg where it it measures some of that electrical impulses down into your fingers we will follow up with that but as far as your treatment so the treatment for carpal tunnel syndrome is really some activity modification now i know you are a landscaper is there any way that you could be work to have some lighter work during the time [Patient] i suppose i could try to pass it off to some of my other employes and delegate[SEP][Discussion][Diagnostic Testing][Follow-up][Other Treatments][Medication][Doctor] okay that would be good so that's i i just want you to kinda eliminate that the active repetitive motions that you're doing all the time just for a couple weeks i'm also gon na give you a wrist splint to wear and that should help and i'd like you to take ibuprofen six hundred milligrams every six hours and then i wan na see you back here in the office in two weeks and in that two week period i think we're gon na see if there's need for any other intervention if i need to do more diagnostic testing or if there is a possibly looking at a surgical intervention to release that pressure that's on the nerves in that hand does that sound like a a good plan for you [Patient] yeah it sounds like a good first start[SEP][Chitchat][Doctor] okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do [Patient] mostly like yard work and maintenance flower beds not really designing just up keep[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 27 |
[Discussion][Medication][Doctor] . 'cause that might help relieve your pain . [Patient] okay .[SEP][Discussion][Doctor] mm-hmm . [Patient] . so , um , i hope that should n't matter , right ?[SEP][Discussion][Doctor] um , that does n't seem related to your pain . [Patient] okay .[SEP][Discussion][Doctor] so ... but i would try to rest my , your left arm- [Patient] okay .[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 28 |
[Conversation Start][SEP][Greetings][Doctor] hi miss russell . [Patient] hi-[SEP][Greetings][Doctor] nice to meet you- [Patient] doctor gutierrez . how are you ?[SEP]
|
[
"Greetings"
] |
[
"Subjective"
] | 29 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Therapeutic History][Lab Examination][Doctor] next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 . hey , how are you today ? [Patient] all right , how have you been ?[SEP][Chitchat][Doctor] i'm good . [Patient] good , good .[SEP][Personal History][Vegetative History][Doctor] have you lost some weight or are you at least putting on some muscle ? you look trim . [Patient] no , i think i'm pretty much the same as i've always been .[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 30 |
[Vegetative History][Doctor] okay alright any loss of sensation [Patient] no[SEP][Vegetative History][Doctor] okay how yes sir okay how about any weakness [Patient] no i do n't feel any weakness[SEP][Vegetative History][Doctor] okay and i know this sounds like a weird question but i do need to know do you experience any loss of control of your bladder or bowels [Patient] no[SEP][Acute Symptoms][Therapeutic History][Doctor] alright this this is a no judgment zone i there i'm working through some things in my head to make sure that i give you the best care that we need right i'm making a plan as we move along you mentioned that the pain has been getting worse have you done anything or tried anything that's worked in the past [Patient] i tried to take some ibuprofen and tylenol[SEP][Acute Symptoms][Therapeutic History][Doctor] mm-hmm [Patient] that that sometimes helps[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 31 |
[Physical Examination][Doctor] no okay on your lumbar spine exam i do appreciate do you have pain when i touch here [Patient] no[SEP][Physical Examination][Acute Assessment][Doctor] okay so there is no pain to palpation of the lumbar spine there is decreased flexion and extension of the lower back the patient does have a positive straight leg raise and there is some spasm of the paraspinal muscles of the lumbar spine on musculoskeletal exam the lower extremities strength is equal bilaterally so what does that mean jeremy that means that you have some you know maybe a some arthritis in your neck here and or maybe just a a little bit of some injury from from that from that back that back thing that you told me about [Patient] mm-hmm[SEP][Acute Assessment][Radiology Examination][Doctor] okay but i think overall things look really good so you know i had them do an lumbar spine x-ray on you before i saw you and i looked at the results of your lumbar spine x-ray which showed no acute bony abnormality you know there was no fracture of your back or anything which is not surprising based on your history so let's just talk a little bit about my assessment and plan so i do believe it sounds like you have an acute disk herniation now this did happen a few months ago but it sounds like that's what you had based on the fact that you're still having symptoms [Patient] mm-hmm[SEP][Diagnostic Testing][Referral][Doctor] i do wan na go ahead and order a a lumbar spine mri to get a a a better look at what's going on you know x-rays really just look at the bones they do n't show us any of the soft tissue so let's go ahead and order the lumbar spine mri i wan na continue with physical therapy so i'm going to refer you to a a physical therapist through our health system [Patient] mm-hmm[SEP][Medication][Doctor] and then i also wan na go ahead and prescribe meloxicam fifteen milligrams once a day [Patient] mm-hmm[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 32 |
[Conversation Start][SEP][Greetings][Doctor] hi , martha . how are you ? [Patient] i'm doing okay . how are you ?[SEP][Chitchat][Doctor] i'm doing okay . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you , okay ? [Patient] okay .[SEP][Personal History][Doctor] martha is a 50-year-old female with a past medical history significant for congestive heart failure , depression and hypertension who presents for her annual exam . so , martha , it's been a year since i've seen you . how are you doing ? [Patient] i'm doing well . i've been traveling a lot recently since things have , have gotten a bit lighter . and i got my , my vaccine , so i feel safer about traveling . i've been doing a lot of hiking . uh , went to washington last weekend to hike in northern cascades, like around the mount baker area .[SEP][Chitchat][Doctor] nice . that's great . i'm glad to hear that you're staying active , you know . i , i just love this weather . i'm so happy the summer is over . i'm definitely more of a fall person . [Patient] yes , fall foliage is the best .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 33 |
[Discussion][Medication][Acute Assessment][Doctor] so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ? [Patient] yes , i do .[SEP][Discussion][Referral][Reassessment][Doctor] okay . hey dragon , order methotrexate , 2.5 mg once weekly . for your second problem , the atrial fibrillation . so , you're going in and out of a-fib and i'd like to just keep you in normal sinus rhythm . so , i wan na go ahead and refer you to cardiology for a cardiac ablation which just maps out where that rhythm is coming from and burns it so it does n't come back . okay ? you're young , we wan na keep you in a normal rhythm and , being that you're going in and out of a-fib , i think that's what we should do . okay ? [Patient] okay .[SEP][Discussion][Referral][Medication][Other Treatments][Doctor] hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ? [Patient] will do .[SEP][Discussion][Doctor] any questions ? [Patient] no , i do n't .[SEP][Chitchat][Doctor] okay . all right . it was good to see you . [Patient] good seeing you .[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 34 |
[Acute Symptoms][Doctor] yeah that sounds painful and so when did this occur [Patient] it it occurred over the weekend on saturday[SEP][Acute Symptoms][Doctor] and have you been able to to walk at all at all or no [Patient] a a little bit but it's definitely swollen and it's definitely painful[SEP][Acute Symptoms][Therapeutic History][Doctor] okay so what all have you been doing for the pain [Patient] just like taking some you know advil and then just icing you know icing on and off you know a little heat here and there just you know trying to comfort but that's about it[SEP][Personal History][Doctor] have you ever had any type of injury to your knee before and it is this the left or right knee [Patient] it's the right knee no it's the first time i've had any knee injuries[SEP][Physical Examination][Doctor] okay alright let's see take anything for it okay well let's see let's just do a quick physical exam here so so your now your vitals those look alright your no fever you're at ninety seven . nine your heart rate is sixty four sounds healthy respirations are sixteen blood pressure is one ten over seventy four your o2 sat looks good at you know ninety eight percent so look real healthy there and so i'm just gon na do a quick physical exam so i do appreciate some edema and some ecchymosis around surrounding your knee your right you said right knee right [Patient] yeah[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 35 |
[Medication][Doctor] actually , i will . i'll go ahead and just give you some as well . [Patient Guest] okay . okay .[SEP][Discussion][Medication][Doctor] but , if he does n't become barky , you do n't have to use it . it only works for the barky cough . [Patient Guest] mm-hmm , got it .[SEP][Follow-up][Medication][Doctor] okay . we'll do the same thing with him , as long as nothing gets worse , and we'll see him back in one week . so , it wo n't get rid of a regular cough . he can use zarbee's , but use the dose for kids under a year of age . so , if you wan na get some of that , you can definitely try that for him , it can help out a little bit with the regular cough . [Patient Guest] i do have a question . do you or do you not give honey to babies ?[SEP][Discussion][Other Treatments][Doctor] yes , that's a great question . you do n't give honey to kids under a year , instead , you can give them agave , which is a different type of nectar . um , now you can give honey to his older sister , that is okay , but for him , it would not be very good because his stomach acid's not good enough to break down the botulism spores . so , it'd cause him harm . um , you should look at the package of say , honey nut cheerios . it says right on there to not give it to a baby . [Patient Guest] okay .[SEP][Discussion][Other Treatments][Doctor] now , whether that would really hurt a baby , i am unsure , but it has real honey in it . so , no honey for him , but agave is definitely fine . [Patient Guest] okay . so , zarbee's for the stuffy nose .[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 36 |
[Acute Symptoms][Therapeutic History][Doctor] okay and so does that help at all [Patient] it's it it makes it feel better in the morning when i first go to my desk and at the end of the day before bed you know i take ibuprofen so i do n't have swelling overnight but honestly i have a pretty decent threshold for pain so it's not good it's not changing it by much[SEP][Acute Symptoms][Doctor] okay do you feel like your symptoms are getting worse or better [Patient] i think i think pretty much for the last two weeks they've remained about the same the the only time i feel like they get worse is when i exert myself doing up and down like gardening in the yard or moving pots and stuff outside that's the only time i felt like it got any worse but nothing to the point where it stayed worse[SEP][Discussion][Diagnostic Testing][Referral][Doctor] okay alright well let's go ahead and refer you to physical therapy if you're still having pain then we might have to consider an mri [Patient] okay[SEP][Discussion][Doctor] any questions about that [Patient] no[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 37 |
[Personal History][Doctor] alright and okay not a problem so what is your do you are you measuring your calories at all looking at your macros are you just eating what you feel like [Patient] yeah just trying to watch what i eat more than anything but nothing specific[SEP][Personal History][Doctor] okay and are you do you know if you're particularly focused on your salt like is it like a low salt diet [Patient] no just trying to watch my carbs a little bit more but not counting or anything[SEP][Personal History][Doctor] alright so like is it a specific diet i just wan na make sure like are you on like the keto diet [Patient] no[SEP][Physical Examination][Doctor] okay alright not a problem so if you do n't mind i'm gon na go ahead and do a quick physical exam as i mentioned before your blood pressure is a little high as i listen to your heart i do like it's got a nice regular rate and rhythm i do n't appreciate any murmur when i listen to your lungs they sound clear bilaterally i would like to look at your knee though so when i press here on the outside does it hurt [Patient] little bit[SEP][Physical Examination][Doctor] okay and then when i press on the inside does it hurt [Patient] no[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 38 |
[Therapeutic History][Doctor] okay , and that's the , the ferrous sulfate ? [Patient] yeah , that's it . i take one in the morning and one in the evening .[SEP][Therapeutic History][Doctor] okay . anything else ? [Patient] yeah , i take vitamin b12 , just the over the counter stuff .[SEP][Chitchat][Doctor] okay , very good . all right , well let's go ahead and take a look and see what's going on . [Patient] sounds good . thank you .[SEP][Chitchat][Doctor] of course . you'll hear me , uh , talk through your exam so that i get all the information documented . [Patient] okay .[SEP][Physical Examination][Doctor] all right . so use my general physical exam template . i will start by listening to your heart and lungs . [Patient] okay .[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 39 |
[Other Socials][Doctor] okay so how long have you been playing soccer [Patient] really since i was like four five i've been playing a long time[SEP][Chitchat][Doctor] well that's cool yeah we our our youngest daughter she is almost sixteen and she plays the inner marrial soccer league they are down at the rex center did is that where you started playing or did you guys did you start playing somewhere else [Patient] yeah just like this local town leak i started playing that way and then played all throughout school[SEP][Chitchat][Doctor] that's [Patient] high school teams[SEP][Acute Symptoms][Doctor] that's awesome so just out of curiosity with the left foot have you experienced anything like numbness or tingling or or any strange sensation [Patient] no i have not[SEP][Physical Examination][Radiology Examination][Acute Assessment][Other Treatments][Doctor] okay now if it's okay with you i would like to do a quick physical exam i reviewed your vitals and everything looks good blood pressure was one eighteen over seventy two heart rate was fifty eight respiratory rate was fourteen you are afebrile and you had an o2 saturation of ninety nine percent on room air on your heart exam your regular of rate and rhythm do n't appreciate any clicks rubs or murmurs no ectopic beats noted there on auscultation listening to your lungs lungs are clear and equal bilaterally so you're moving good air i'd like to do a focused foot exam on your left foot so i do see some bruising on the bottom of your foot and on the top of your foot as well now there is associated swelling and i do appreciate tenderness to palpation of your midfoot and you are positive for the piano key test on a neurovascular exam of your left foot you have a brisk capillary refill of less than three seconds dorsalis pedis pulse is intact and strong and you do have motor and sensation that it's intact to light touch now i would like to do a review of the diagnostic imaging that you had before you came in so i do notice a subtle dorsal displacement of the base of the second metatarsal with a three millimeter separation of the first and second metatarsal bases and the presence of a bony fragment in the lisfranc joint space so lem me talk to you a little bit about my assessment and plan now for for the first concern of right foot pain your right foot pain is due to a lisfranc fracture which is a fracture to one of your second metatarsal bones at the top of your foot where the metatarsals meet your cuboids now there are ligaments at the top of your foot so i'm gon na be ordering an mri to assess for injury to any of these ligaments now based on your exam and from what i'm seeing on your x-ray you're most likely going to need surgery of that foot now the surgery will place the bones back in their proper position and using plates and screws will hold them there while they heal and this is gon na allow those bones and ligaments to heal properly it is a day surgery and you will be able to go home the same day and then i'm going to have you follow up with me here in the clinic you'll be in a cast and you will need to use crutches and you will not be able to use that left foot for about six to eight weeks now after that six to eight weeks you will gradually start walking on your foot based on how you tolerate it and we'll see how you do at that point so i do believe you're gon na need surgery i i'm recommending this because there are significant complications to your foot if we do not do this poor bone and ligament healing can lead to losing the arch of your foot and you're becoming flat-footed you also have a high likelihood of developing arthritis in that foot so what i'm gon na do unfortunately you'll be out the rest of the season but we are gon na get you fixed up and ready for next season if you're okay with all of this i'm gon na have the nurse come in and get you started on your paperwork and then i will see you on monday morning and we will get your foot taken care of [Patient] alright thank you[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 40 |
[Personal History][Doctor] yeah and have you ever had headaches like this before [Patient] not like this you know you know as you know sometimes i get migraine but i know i never really take anything for it that's like once a year or once or every two years but not like not like this one headaches like this one[SEP][Vegetative History][Doctor] okay and have you had any congestion anything like that cough runny nose [Patient] yeah i thought maybe because you know now it's springtime and i tend to get my allergies but it it's it's very different and i've not actually had any like runny nose or cough or congestion along with the headache[SEP][Physical Examination][Doctor] okay if you tap on your forehead do you have any tenderness [Patient] right here[SEP][Physical Examination][Doctor] okay if you tap down here on these bones your cheek bones any tenderness there [Patient] a little bit not as much as i guess if i tap up here[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 41 |
[Physical Examination][Personal History][Greetings][Lab Examination][Doctor] kelly wood . date of birth , february 15th , 1979 . established patient here for renal ultrasound because of hematuria . urine dipstick today . negative for leukocytes , nitrates , protein , ketone , bilirubin and glucose . color yellow and clear , urobilinogen 0.2 , ph 5.5 and specific gravity 1.020 . there is a trace amount of blood in the urine and intact . renal ultrasound impression . right kidney is 10 cm in length by five centimeter wide . there are no stones , masses or hydronephrosis . the left kidney is 10.8 centimeters in length and five centimeters wide . there is a six millimeter left renal stone non-obstructing . 533 milliliters pre-void and 0 milliliters post-void . hi , mrs. wood . i see you're just finished your ultrasound . [Patient] yes , ma'am .[SEP][Acute Assessment][Doctor] well , it looks like you have one stone in the left kidney but it's not obstructing anything . [Patient] i knew it had to be a kidney stone . i passed what looked like two small stones last week after i scheduled this appointment . and then for the past six weeks , i've had a few episodes of bright red urine the color of , like , cherry kool-aid . and last week , i was constantly having to pee and it hurt something terrible .[SEP][Personal History][Doctor] how bad was your pain on a scale of zero to 10 ? zero being no pain and 10 being worse , as you can imagine . [Patient] um , at the time , i'd say an eight .[SEP][Acute Symptoms][Doctor] are you having any flank pain now or tenderness in your lower back ? [Patient] no , after passing those stones , things have felt a lot better .[SEP][Therapeutic History][Vegetative History][Doctor] that's good to hear . now , it looks like you're only taking alavert 10 milligrams a day and have no drug allergies . is that correct ? [Patient] that's right .[SEP]
|
[
"Discussion",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 42 |
[Personal History][Greetings][Doctor] patient , bruce ward . date of birth 5/21/1969 . please use my neuro consult template . this is a 52-year-old male with dia- newly diagnosed pituitary lesion . the patient is seen in consultation at the request of dr. henry howard for possible surgical intervention . mr . ward presented to his primary care provider , dr. howard , on 3/1/21 complaining of worsening headaches over the past few months . he denied any trouble with headaches in the past . his past clinical history is unremarkable . worked out for worsening headaches was initiated with brain mri and serology where pituitary lesion was incidentally discovered . i personally reviewed the labs dated 3/3/21 including cbc , unes , uh , coagulation , and crp . all were normal . pituitary hormone profile demonstrates a low tsh , all other results were normal . um , i personally reviewed pertinent radiology studies including mri for the brain with contrast from 3/4/21 . the mri reveals a pituitary lesion with elevation and compression of the optic chiasm . the ventricles are normal in size and no other abnormalities are lo- are noted . hello , mr . ward . nice to meet you . i'm dr. flores . [Patient] hi , doc . nice to meet you .[SEP][Acute Symptoms][Personal History][Doctor] i was just reviewing your records from dr. howard and he's referred you because the workup for headaches revealed a mass on your pituitary gland . i did review your mri images and you have a significant mass there . can you tell me about the issues you've been experiencing ? [Patient] yeah sure . so i'm really getting fed up with these headaches . i've been trying my best to deal with them but they've been going on for months now and i'm really struggling .[SEP][Acute Symptoms][Doctor] where are the headaches located and how would you describe that pain ? [Patient] located behind my eyes . it's like a dull nagging ache .[SEP][Personal History][Doctor] okay . was the onset gradual or sudden ? [Patient] well it started about three months ago . and they've been getting worse over time . at first it was like three out of 10 severity , and it just gradually worsened . and now it's about six out of 10 severity . the headaches do tend to be worse in the morning and it feels like a dull ache behind the eyes . they last a few hours at a time , nothing makes them better or worse .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . can you tell me if the pain radiates , or if you have any other symptoms ? specifically feeling sick , fever , rashes , neck stiffness , numbness , weakness , passing out ? [Patient] no . i have n't been sick or felt sick . ca n't recall a fever or any kind of rash . no- no neck issues , no numbness , no tingling . and i've never passed out in my life . but , um , for some reason recently i seem to be bumping into door frames .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 43 |
[Physical Examination][Doctor] pain with supination no pain with pronation [Patient] correct[SEP][Acute Assessment][Radiology Examination][Doctor] alright so dylan it took some x-rays coming in looks like you do n't have any any fractures or any bony misalignment which i expect with this kind of injury i do think that what you have is medial epicondylitis which is [Patient] is that golfer's elbow[SEP][Other Socials][Doctor] yes same thing have you been golfing a lot [Patient] well not in the past year and a half i've had this for a long time[SEP][Chitchat][Doctor] okay also known as pictures elbow [Patient] well i have n't been pitching either[SEP][Diagnostic Testing][Doctor] hmmm well in any case what i'm gon na have to do is i'm gon na send you up for mri to take another look at this [Patient] mm-hmm[SEP]
|
[
"Diagnostic Testing"
] |
[
"Plan"
] | 44 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] michelle king , date of birth 01/05/1986 , mrnq27631 . new patient visit for acid reflux . past medical history of anxiety and seasonal allergies . hello , are you mrs. king ? [Patient] i am .[SEP][Chitchat][Doctor] i'm dr. phillips . very nice to meet you . [Patient] you as well .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 45 |
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] alright david so you were just in the emergency department hopefully you can hear me okay through the zoom meeting what happened [Patient] well it seems that i was outside and i fell down i was walking a bit and i did have a pain in my chest but i did n't think anything of it and i just kept on going and then all of a sudden i'm here[SEP][Acute Symptoms][Doctor] hmmm my gosh so it looks like you you went into the er and looks like they said that your ankles were swelling a little bit too and did you have some shortness of breath [Patient] i did but i did n't think anything of it[SEP][Personal History][Therapeutic History][Doctor] sure yeah okay yeah i know we've been talking through your hypertension looks like your blood pressure was two hundred over ninety have you been taking those meds that we have you on [Patient] i have but i miss them every year and then so i think today i took one[SEP][Therapeutic History][Doctor] okay alright yeah i have you on bumex cozaar and norvasc does that sound right [Patient] i guess so that sounds about right[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 46 |
[Discussion][Referral][Reassessment][Doctor] yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance . [Patient] okay , will do .[SEP][Discussion][Doctor] you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well . [Patient] okay . that's really good to know . thank you .[SEP][Follow-up][Doctor] yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay . [Patient] sure , okay . and can i ask you about work before i go ?[SEP][Discussion][Doctor] okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job . [Patient] all right . so would you write a note to excuse me for another six weeks ?[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 47 |
[Chitchat][Doctor] okay alright great alright now are you are you a meds fan or a yankie's fan or god for a bit of filly's fan [Patient] nope[SEP][Chitchat][Doctor] do n't like sports just the wine [Patient] no[SEP][Physical Examination][Doctor] okay alright well let's go ahead i wan na just do a quick physical exam now i'm gon na be calling out some of my findings and i'm gon na let you know what that means when i'm done okay so looking here first at your vital signs your vital signs look pretty good you do have a low-grade fever of about a hundred . four right now but otherwise your blood pressure is pretty good it's about one thirty two over eighty and your heart rate is eighty four now that looks pretty good so i'm just gon na go ahead and examine you so on your facial exam i'm gon na just press on your face here does this hurt [Patient] no not no it does n't bother me[SEP][Physical Examination][Doctor] okay on facial examination the patient has no pain to palpation of the frontal or maxillary sinuses on nasal examination there is edema and erythema of the nasal turbinates bilaterally with associated clear discharge open up your mouth and say [Patient] ah[SEP]
|
[
"Physical Examination",
"Medication",
"Other Treatments",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Assessment",
"Plan",
"Objective"
] | 48 |
[Acute Symptoms][Personal History][Doctor] roger is a 62 year old male here for emergency room follow-up for some chest pain . so , roger , i heard you went to the er for some chest discomfort . [Patient] yeah . we were doing a bunch of yard work and it was really hot over the weekend and i was short of breath and i felt a little chest pain for probably about an hour or so . so , i got a little nervous about that .[SEP][Personal History][Doctor] okay . and had you ever had that before ? [Patient] no , i never have , actually .[SEP][Chitchat][Doctor] okay . and- [Patient] whose mic is on ? i'm in .[SEP][Acute Symptoms][Doctor] okay . and , um , how are you feeling since then ? [Patient] um , after , uh , we were done , i felt fine ever since , but i thought it was worth looking into .[SEP][Acute Symptoms][Doctor] okay . and no other symptoms since then ? [Patient] no .[SEP]
|
[
"Family History"
] |
[
"Subjective"
] | 49 |
[Personal History][Doctor] okay how often are you checking it [Patient] i would say four five times a week[SEP][Therapeutic History][Personal History][Doctor] okay you might wan na switch to maybe two or three times a day but you know that's something i'm glad that you are measuring are you taking your metformin [Patient] yes[SEP][Therapeutic History][Doctor] okay and then i think we have you on five hundred milligrams correct [Patient] yes[SEP][Personal History][Doctor] alright how is your diet [Patient] kinda the same as my exercise decent could be better[SEP][Personal History][Doctor] alright and okay not a problem so what is your do you are you measuring your calories at all looking at your macros are you just eating what you feel like [Patient] yeah just trying to watch what i eat more than anything but nothing specific[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 50 |
[Discussion][Other Treatments][Doctor] i really think your liver enzymes are going to get better once you lose the weight , though . [Patient] okay , that would be great .[SEP][Discussion][Medication][Doctor] since we stopped your birth control , we can try once called phexxi , which is kind of like a spermicide , basically . [Patient] okay .[SEP][Discussion][Medication][Doctor] and you just apply it before intercourse . [Patient] okay .[SEP][Chitchat][Doctor] if you need some , uh , just let me know . [Patient] okay , i will . i'll let you know .[SEP][Discussion][Diagnostic Testing][Doctor] okay , perfect . so , stay put for me now . i'm going to go see if they have discount samples , and bring you that prescription . and then , i'm going to order the labs for next time . [Patient] okay , great , thank you so much .[SEP]
|
[
"Follow-up",
"Medication",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 51 |
[Vegetative History][Doctor] okay alright now do you have any numbing or tingling in your toes [Patient] no[SEP][Acute Symptoms][Doctor] okay and can you feel your toes okay [Patient] i think so[SEP][Other Socials][Doctor] okay alright now are you a pretty active person you said you were skiing do you do what kind of other activities do you do [Patient] i chase my two four -year-old[SEP][Other Socials][Doctor] okay do you have twins [Patient] i do[SEP][Chitchat][Doctor] nice that's great [Patient] yeah[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 52 |
[Vegetative History][Doctor] how is that going for you is it still happening [Patient] i mean sometimes i stay awake just kinda worrying about things but but i've tried some meditation apps and that helps[SEP][Vegetative History][Doctor] okay alright and i know we talked a little bit before about practicing proper sleep hygiene you know just making sure that all of your electronics are off you know dark room [Patient] yeah[SEP][Vegetative History][Doctor] cool room have you been doing that [Patient] well i do like to sleep with the tv on and my phone is right by my bed because i never know if someone's gon na call me you know[SEP][Referral][Doctor] yeah i i know i'm like apple i do n't know if you have an iphone or not but i know apple has this the the sleep mode now do that disturbance so you put that on [Patient] it's a good idea[SEP][Chitchat][Doctor] interrupt you [Patient] yeah[SEP]
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] | 53 |
[Conversation Start][SEP]
|
[
"Greetings"
] |
[
"Subjective"
] | 54 |
[Personal History][Doctor] okay so in the past have any doctors ever told you that you had hep c [Patient] no never that's why i'm i'm so surprised[SEP][Other Socials][Drug History][Drug History][Doctor] okay so just you know i need to ask do you have a history of iv drug use or you know have known any hep c partners [Patient] i mean i used to party a lot and even did use iv drugs but i have been clean for over fifteen years now[SEP][Chitchat][Doctor] okay that that's good i mean i'm i'm happy that you were able to to kick that habit i know a lot of my patients that i see you know they're still dealing with with those dements so i'm i'm i'm happy that you're able to do that so hopefully we can get you better okay [Patient] thank you[SEP][Drug History][Drug History][Doctor] so what about alcohol use is that something that you used to do a lot [Patient] i did i did i mean i i still have a beer here and there everyday but not as much as i used to[SEP][Drug History][Doctor] okay and have you ever smoked before [Patient] i do smoke i smoke about one to two cigarettes per day i've cut down a lot but i'm just having a hard time kicking those less too[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 55 |
[Chitchat][Doctor] okay well first of all i'm i'm sorry that you're nervous and what we're gon na do is we're gon na partner together okay and i'm gon na be right by your side the whole time to hopefully make you a little less nervous and and recognize the fact that we're you're gon na have a big support team around you okay [Patient] okay[SEP][Personal History][Doctor] so let's talk a little bit about how long you've had that cough before you went to see your doctor [Patient] i you know off and on i've had it for about three months i first noticed it when i was loading some pay i have horses and i i bought you know four hundred bills a day and when i spent a day loading it and then it's i just started coughing a lot more i think around that time and after that i i i just got a cold so that's what sent me to my pcp now i i i do exercise i i do a lot of biking and i typically do n't get sick and my cough has gone away[SEP][Other Socials][Doctor] okay that's good to hear you mentioned exercise and biking i love to bike myself i've got a track seventy one hundred hybrid have you been on the the new trails they opened it was the old the old rail the old rail road right away they've opened that up it's like sixty miles of trails [Patient] i love that that road i just i i do n't like riding on the road so i prefer to do those rails the trails type[SEP][Chitchat][Doctor] yeah i love riding over there way we will we will get you all fixed up we will have to go for a bike ride [Patient] absolutely i'd love it[SEP]
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] | 56 |
[Personal History][Doctor] pretty bad lately ? [Patient] yeah .[SEP][Personal History][Doctor] okay . and , that's really the only thing that's different is your diet , pretty much ? [Patient] yeah .[SEP][Other Socials][Doctor] and , that's because of the new job and all that ? [Patient] yeah. it has been really challenging to resist the temptation.[SEP][Chitchat][Doctor] it's hard to ignore those desserts , are n't they ? [Patient] yeah .[SEP][Chitchat][Doctor] no willpower like me ? [Patient] no , no willpower .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 57 |
[Vegetative History][Doctor] good very good how about have you been having any shortness of breath or problems sleeping since you've been home [Patient] nope no shortness of breath i can get up and move around i do n't have any trouble and no problem sleeping i do have a good afternoon nap[SEP][Vegetative History][Doctor] good that's good you need to rest every now and then as well and now tell me have you had any chest pain [Patient] no chest pain at all since i've been home[SEP][Physical Examination][Doctor] okay alright very good alright well i'm gon na go ahead and do a quick physical exam on you here kevin and so i'm looking at your vital signs here and your blood pressure today is actually pretty good at one twenty eight over seventy two your vital signs also look good in general your heart rate's been nice at like seventy nine so that's very nice and normal your respiratory rate is twenty six that's probably because you're talking to me here but that's that's alright and then your o2 sat is ninety nine percent so that's good and now on your neck exam there is no jugular venous distention so that's good on your heart exam i appreciate a two out of six systolic ejection murmur which i have heard this before and it's stable so we will just keep on monitoring that okay now your lungs here lem me listen okay they're clear bilaterally and let me take a look at your legs real quick here kevin okay so your lower extremities they do show a trace of edema so that that's gon na be that we're gon na be able to help that with the water pills that you're taking okay [Patient] okay[SEP][Medication][Other Treatments][Radiology Examination][Reassessment][Doctor] now i did review the results of your echocardiogram which shows a preserved ef of fifty five percent abnormal diastolic filling and also mild to moderate mitral regurgitation so what all that means let me go ahead and tell you about my assessment and plan so for your first problem of your you know congestive heart failure it sounds like this was caused by you know dietary indiscretion in an uncontrolled hypertension so what i wan na do is i want you to continue on bumex two milligrams one daily that's that water pill that you're talking about and then i want you to continue to watch your diet and also avoid salty foods i know you love your pizza and chicken wings but we are gon na have to cut back on those okay kevin [Patient] alright[SEP][Discussion][Follow-up][Doctor] alright now i want you to weigh yourself though everyday and then call me if you gain like three pounds in two days okay [Patient] okay[SEP]
|
[
"Referral"
] |
[
"Plan"
] | 58 |
[Conversation Start][SEP]
|
[
"Acute Symptoms",
"Personal History",
"Greetings"
] |
[
"Subjective"
] | 59 |
[Medication][Acute Assessment][Doctor] so for your knee pain , i think that this is an acute exacerbation of your arthritis , okay ? so i wan na go ahead and if ... and prescribe some ultram 50 milligrams every six hours as needed . [Patient] okay .[SEP][Discussion][Diagnostic Testing][Doctor] okay ? i also wan na go ahead and just order an autoimmune panel , okay ? hey , dragon , order an autoimmune panel . and you know , i , i want , i want you to just take it easy for right now , and if your symptoms continue , we'll talk about further imaging and possibly referral to physical therapy , okay ? [Patient] you got it .[SEP][Follow-up][Medication][Reassessment][Doctor] for your second problem , your hypothyroidism , i wan na go ahead and continue you on this ... on the synthroid , and i wan na go ahead and order some thyroid labs , okay ? [Patient] sure .[SEP][Discussion][Medication][Diagnostic Testing][Reassessment][Doctor] hey , dragon , order a thyroid panel . and then for your last problem , the arthritis , you know , we just kinda talked about that . you know , it's gon na be a struggle for you because again , you ca n't take some of those anti-inflammatory medications because of your kidney transplant , so ... [Patient] mm-hmm .[SEP][Follow-up][Doctor] you know , let's see how we do over the next couple weeks , and again , we'll refer you to physical therapy if we need to , okay ? [Patient] you got it .[SEP]
|
[
"Discussion",
"Chitchat"
] |
[
"Plan",
"Null"
] | 60 |
[Acute Symptoms][Doctor] what is a while ? [Patient] it goes away for a couple weeks . um , so when it happens , i just take the day nice and slow , i do n't push myself .[SEP][Acute Symptoms][Doctor] okay . so , maybe it's a couple times a month you feel this way ? [Patient] yeah , just often enough for me to notice .[SEP][Therapeutic History][Doctor] understood . okay . are you taking your medications regularly ? [Patient] uh- . i've been trying to keep up with that . there's a lot of extra pills now , but i have a reminder app , so i do pretty well .[SEP][Therapeutic History][Doctor] okay . that's great . and so , you're taking coumadin , right ? [Patient] yeah , also lasix and the atenolol .[SEP][Therapeutic History][Doctor] are you having any side effects from the medications at all ? [Patient] not really . uh , i notice that the atenolol is making me irritable in the beginning , but i guess i've gotten used to it , does n't seem to bother me as much now .[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 61 |
[Chitchat][Doctor] yeah okay well you know we can get you there too you know we can work on that so we we'll take we'll talk more about some tips to help achieve those goals okay [Patient] okay[SEP][Vegetative History][Doctor] okay and tell me does anyone at home smoke [Patient] well when i used to live with my parents they did but i live on my own now[SEP][Vegetative History][Doctor] okay you know if your friends come over if they smoke too or what okay [Patient] nope[SEP]
|
[
"Family History"
] |
[
"Subjective"
] | 62 |
[Discussion][Doctor] any questions [Patient] yeah you know i've been kinda down ever since i had my heart attack is there any medication that i could take to make me feel a little bit less sad[SEP][Vegetative History][Doctor] yeah i mean are you having any thoughts of of harming yourself or harming others [Patient] no no i just feel kinda down[SEP][Personal History][Doctor] you feel kinda down what's your [Patient] life sucks[SEP][Other Socials][Doctor] what well i do n't think so what what's your support system like [Patient] you know i i live with my dog and that's it so it's kind of you know lonely[SEP][Discussion][Referral][Doctor] okay alright well would you be interested in in like a referral to psychiatry or something like that so that you have someone to talk to about some of of issues because medication can help but i do i think it's important to have you know talk some of these things out [Patient] okay yeah you know i'll give that a try i mean i'm retiring i got plenty of time[SEP]
|
[
"Discussion",
"Referral",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 63 |
[Discussion][Medication][Doctor] yeah if you if you stop walking the chest pain goes away you do n't have to take the pill but if you are walking or you stop and the chest pain does not go away i would take the pill and see if it goes away if it does not [Patient] how long like how long do i wait to see if it goes away[SEP][Discussion][Medication][Doctor] about five minutes so you can take it up to three pills every five minutes and if it does n't go away then i would you know go to the hospital and get this checked out because i worry about with this chest pain that you're having making sure it does n't lead to a heart attack those chest pain could be a you know a a a sign that you may be having some less blood flow to your heart and we need to get that checked out pretty quickly [Patient] okay[SEP][Chitchat][Doctor] alright [Patient] mm-hmm[SEP][Discussion][Follow-up][Medication][Other Treatments][Reassessment][Doctor] and for the second problem the diabetes you know i think you're doing fairly well continue with your eye ophthalmology appointment you have for your eye exam for the diabetic retinopathy continue the metformin five hundred milligrams twice a day i'm gon na order another hemoglobin a1c today and i'm gon na have you come back in about two weeks and we can see if we need to make any adjustments continue to try to stay away from you know the the pop and the sweet things and once we have your heart taken care of or make sure your heart is okay you can and we can hopefully resolve this chest pain that you're having get back to your exercise regimen okay any questions about that [Patient] no[SEP][Medication][Reassessment][Doctor] okay and for the third diagnosis the high blood pressure you you do have a trend i've noticed in your chart that your blood pressure's been running a little bit high several other people have documented as well i'm gon na go ahead and start you on some hydrochlorothiazide it's a pretty low dose medication to help you with your blood pressure plus it'll also help with you some of the swelling you have in your in your feet i'm gon na have you use a blood pressure cuff at home and enter your findings at epic mychart and i'll get a reading of those as well and then what when you come back in two weeks we'll keep a log of your blood pressure daily in the morning when you wake up and see how things are going and then if we need to make any adjustments to the medications we can but especially considering your history and the chest pain and the diabetes and the swelling i think starting this hydrochlorothiazide is a probably a good idea [Patient] okay are there any side effects with this medication[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 64 |
[Therapeutic History][Chitchat][Doctor] yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ? [Patient Guest] only pepcid .[SEP][Therapeutic History][Doctor] okay . [Patient Guest] yeah . so she takes 40 milligrams of pepcid a day and then also takes claritin for allergies .[SEP][Family History][Doctor] all right-y . and any difficulties with your pregnancy with her or during delivery ? [Patient Guest] no . um , renal disease does run in my family , though . my dad , aunt , and my cousins all have issues with their kidneys . i have their paperwork right here for you with their diagnoses .[SEP][Family History][Doctor] great . i will definitely review that over . any other , uh , family history to be aware of ? [Patient Guest] yes . my mom had breast cancer too .[SEP][Family History][Doctor] okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ? [Patient Guest] yes , that is correct . he did .[SEP]
|
[
"Family History"
] |
[
"Subjective"
] | 65 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Therapeutic History][Lab Examination][Doctor] next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 . hey , how are you today ? [Patient] all right , how have you been ?[SEP][Chitchat][Doctor] i'm good . [Patient] good , good .[SEP]
|
[
"Personal History",
"Vegetative History"
] |
[
"Subjective"
] | 66 |
[Medication][Doctor] and then hold off until i see you again before you start back any of your old products . um , if it's starting to flair again , um , if it's just a little bit , you can try just doing the tacrolimus for a couple days , to see if that's enough . if it's not , then restart the dy- doxycycline as well . [Patient] all right .[SEP][Discussion][Follow-up][Doctor] i do n't expect that to happen , but , you know , if it does , you have the tools . um , then you'll be seeing me for a followup . we can figure out what to do next . i would say if it's getting worse rather than better , just give me a call or send me a mychart message , okay ? [Patient] yeah , sounds good .[SEP][Discussion][Medication][Doctor] do you have enough refills ? [Patient] yeah , i think so .[SEP][Discussion][Medication][Doctor] okay . so it looks like you have another refill of the doxycycline , so you're good there . metro cream , you probably still have enough of that one . [Patient] yes , i do .[SEP][Discussion][Medication][Doctor] all right . and i'll cancel the elidel cream , just so we do n't complicate your list . uh , you have plenty of the face wash still . [Patient] yes .[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 67 |
[Personal History][Doctor] yeah . i can imagine that is . um , let's see if we can help though . since you had your hysterectomy your periods , of course , are no longer the issue . um , when was your last colonoscopy ? [Patient] about five to six years ago .[SEP][Personal History][Doctor] and was it relatively a normal exam ? did you have any polyps ? [Patient] no . they said they'd see me in 10 years .[SEP][Chitchat][Doctor] well that's good news . [Patient] yeah , i agree .[SEP][Vegetative History][Doctor] um , do you have a pacemaker or defibrillator , or have sleep apnea , or use oxygen at night ? [Patient] no .[SEP][Drug History][Doctor] all right . do you ever drink alcohol ? [Patient] yeah , but only once or twice a year .[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 68 |
[Personal History][Doctor] okay and i know that they went through your wrist for the cardiac catheterization how is your wrist doing [Patient] it's good i you know it was red for a while but it seems to be healing and i think there is no infection[SEP][Other Socials][Doctor] okay and you're right handed correct [Patient] correct yes right handed[SEP][Vegetative History][Doctor] okay alright and any shortness of breath when you walk around or move anything like that [Patient] yeah i i would say you know i've been trying to keep my my i i'm not doing a lot of exercise but i will say that when i go up and downstairs you know i do feel like i have shortness of breath[SEP][Therapeutic History][Doctor] okay now i know they put you on that medication the brilinta are you you're taking it correct [Patient] yes i take it twice a day every twelve hours[SEP][Therapeutic History][Doctor] okay great and you're still taking your aspirin correct [Patient] i take the baby aspirin at night is that okay[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 69 |
[Personal History][Doctor] so what have your blood sugars been running daily [Patient] well i do n't check it very often[SEP][Physical Examination][Doctor] okay so i'm looking here i think last after your last visit you got a1c now was six . seven so it's a little bit high it's gone down a little bit since you were first diagnosed with the type two diabetes a year ago so i'm glad we're making progress with that as well alright so i'm just gon na do a quick physical exam on you before i do just wan na make sure are you having any chest pain today [Patient] no[SEP][Physical Examination][Doctor] alright any any belly pain [Patient] no[SEP][Physical Examination][Doctor] alright so i'm gon na listen to your lungs your lungs are clear bilaterally i do n't hear any crackles listen to your heart so on your heart exam i do hear that grade two out of six systolic ejection murmur and we already knew about that previously so it has n't gotten any worse so that's good so i'm gon na just press here in your abdomen because that you did have those kidney stones does that hurt [Patient] no[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 70 |
[Conversation Start][SEP][Greetings][Doctor] morning christine , nice to see you . [Patient] nice to see you too .[SEP][Chitchat][Doctor] so i know my nurse told you a little bit of- ... um , about dax and i'm gon na tell dax a little bit about you , if that's okay ? [Patient] go for it .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 71 |
[Therapeutic History][Doctor] are , are you taking that ? [Patient] i am taking it . i think it's just a lot has been weighing on me lately .[SEP][Acute Symptoms][Therapeutic History][Doctor] okay . um , and do you feel like you need an increase in your dose , or do you ... what are you thinking ? do you think that you just need to deal with some stress or you wan na try a , a different , uh , medication or ... [Patient] i think the , the medication has helped me in the past , and maybe just increasing the dose might help me through this patch .[SEP][Personal History][Doctor] okay . all right . and , and what else has been going on with you ? i know that you've had this chronic back pain that we've been dealing with . how's that , how's that going ? [Patient] uh , i've been managing it . it's still , um , here nor there . just , just keeps , um , it really bothers me when i sit for long periods of time at , at my desk at work . so i have ... it helps when i get up and move , but it gets really stiff and it hurts when i sit down for long periods of time .[SEP][Acute Symptoms][Doctor] okay , and do you get any numbing or tingling down your legs or any pain down leg versus the other ? [Patient] a little bit of numbing , but nothing tingling or hurting down my legs .[SEP][Acute Symptoms][Doctor] okay , and does the , um , do those symptoms improve when you stand up or change position ? [Patient] yeah , it does .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 72 |
[Vegetative History][Doctor] okay and then any kind of hearing any kind of hearing problems visual disturbances [Patient] no[SEP][Personal History][Doctor] okay have you do have you ever like played sports before or had like a sports accident before [Patient] yeah i played football[SEP][Personal History][Doctor] okay and then when you got in the car accident did you end up going to the emergency room [Patient] no i mean i i know that going to the emergency room that like the english rides like five hundred bucks so i did n't want to do that[SEP][Personal History][Doctor] i understand i understand okay was there any like swelling or bruising on your neck [Patient] not that i know about no other mag of my neck i really ca n't see that[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 73 |
[Conversation Start][SEP]
|
[
"Greetings"
] |
[
"Subjective"
] | 74 |
[Vegetative History][Doctor] okay how long has that been going on for [Patient] probably three weeks or so[SEP][Vegetative History][Doctor] okay and are you coughing a lot of blood or just a little bit of blood [Patient] i shave three to four cups a day[SEP][Vegetative History][Doctor] wow that's a lot of blood okay are you throwing up any blood are you having bleeding in any place else or just when you cough [Patient] only when i cough[SEP][Vegetative History][Doctor] okay have you noticed any bruising or bleeding from your teeth or anything like that or from your gums or anything like that [Patient] no[SEP][Other Socials][Doctor] okay any leg swelling or calf swelling or any any anything like that any recent travel history you've been on a plane or trip recently [Patient] i had some knee problem but there is no swelling but it hurts that's been going on for quite some time[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 75 |
[Discussion][Other Treatments][Doctor] mm-hmm and help with some of the healing of your elbow [Patient] so it's kinda like dry needling then[SEP][Discussion][Doctor] what is it [Patient] is it is that that thing where like you take the blood out of like say my my thigh[SEP][Discussion][Doctor] mm-hmm [Patient] and then you literally inject it into my tendon[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 76 |
[Vegetative History][Doctor] okay . and so how about any passing out at all ? [Patient] no .[SEP][Acute Symptoms][Doctor] okay , good . and how about irregular heartbeats ? do you ever feel like your heart is going too fast or like it skips a beat ? [Patient] i do n't notice it at all .[SEP][Acute Symptoms][Doctor] okay , great . and how about any swelling in the legs at all ? [Patient] yeah , my ankles swell .[SEP][Personal History][Doctor] okay . and how long has this been going on ? [Patient] um , i would say for probably six months . but it goes up and down , and sometimes it's worse than other times .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 77 |
[Chitchat][Doctor] i'm doing well . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you when we get started , okay ? [Patient] okay .[SEP][Acute Symptoms][Personal History][Doctor] all right . so , joyce is a 50 year old female with a past medical history significant for copd , congestive heart failure who presents for follow-up to an abnormal lab finding . so , joyce , i , i got the results of your lab , uh , your labs . your hemoglobin was low . uh , so , i asked them to schedule a follow-up appointment with me . so , how are you feeling ? [Patient] i've been feeling really tired lately . over the past couple of months , i've noticed that my energy has really gone down . i used to be really active , um , just trying to be as healthy as i can be , running, climbing . um , i at least try to do an hour or two a day . and over the past month , it's gone slowly downhill . i've just been so tired and exhausted and i have n't been able to really keep up with the way i , i was g- was going with my exercise .[SEP][Vegetative History][Doctor] okay . all right . um , now , have you had ... have you noticed any blood in your stools at all ? [Patient] uh , no , not really . not , not at this time .[SEP][Vegetative History][Doctor] okay . and are your stools , like , dark or charry or black looking ? [Patient] no . not that i've noticed .[SEP][Vegetative History][Doctor] okay . and are you spotting a lot with your periods ? [Patient] no , i'm not .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 78 |
[Acute Symptoms][Therapeutic History][Doctor] okay did that help at all [Patient] no[SEP][Acute Symptoms][Doctor] no it did n't help alright did you hear anything pop or anything like that when [Patient] i heard like an like a crack crackle so[SEP][Acute Symptoms][Doctor] you heard a crack [Patient] yeah[SEP][Other Socials][Doctor] okay alright how long have you been mountain biking [Patient] for like three years[SEP][Other Socials][Doctor] three years wow [Patient] or so[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 79 |
[Acute Symptoms][Doctor] okay okay just mainly up underneath your on your scalp there uh and i can i can see that man that looks really itchy and scaly have you died your hair recently or used any other chemicals you you know like a new hair spray or gel [Patient] nothing new i mean i do dye my hair but i've been doing that for years now but otherwise i do n't really use a lot of products in my hair[SEP][Therapeutic History][Doctor] yeah i you know it's funny you say that because i keep saying i earned this gray hair and i'm gon na keep it so yeah have you tried any over the counter treatments i know there is a lot out of there something you know like a t gel or any of those other have those helped [Patient] yeah i did that i did head and shoulders i even tried some castor oil and but none of them really seemed to be helping[SEP][Acute Symptoms][Doctor] okay okay let's talk about some other symptoms any joint pain fever weight loss [Patient] not that i can recall i've been pretty good otherwise[SEP][Family History][Doctor] okay good and going back you know to your grandparents has anybody else in the family had similar symptoms that you're aware of [Patient] no well maybe my sister[SEP][Family History][Doctor] maybe your sister okay [Patient] yeah maybe my sister i mean i know she'll is no one has as bad as i do but she does report like just having a dry scalp[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 80 |
[Acute Symptoms][Doctor] okay . is it one knee versus the other , or both ? [Patient] both equally .[SEP][Acute Symptoms][Doctor] okay . and , um , does it hurt more in the morning when you wake up , or does it hurt more when you're walking around and that type of thing ? [Patient] usually when i get up in the morning , they're pretty stiff and sore , and then by the end of the day , i start to feel that same sensation . kind of pretty much , like , uh , probably around dinner time or so .[SEP][Acute Symptoms][Doctor] okay . and any other , any other joints bothering you , your elbows , wrists , shoulders , anything like that ? [Patient] no , it's just the knees .[SEP][Vegetative History][Doctor] just the knees . and have you noticed any swelling of your knees , or any redness of your knees ? [Patient] uh , they look a little inflamed in the morning , and then in the afternoon , same but not as bad , not as noticeable .[SEP][Vegetative History][Doctor] okay . and do you have any other symptoms with this ? do you have any other associated fatigue or fever or anything like that ? [Patient] no , no .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 81 |
[Acute Symptoms][Greetings][Doctor] hey george how are you today i understand you're here for some numbness and tingling in your fingers and some pain in your wrist [Patient] right my right wrist and hand has been bothering me probably for a few months now with pain and numbness[SEP][Acute Symptoms][Doctor] okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or [Patient] it just kinda started on it's own it i notice it mostly at night[SEP][Other Socials][Doctor] what kind of work do you do [Patient] i do yard work[SEP][Chitchat][Doctor] yard work [Patient] landscaping landscaping[SEP]
|
[
"Personal History",
"Other Socials"
] |
[
"Subjective"
] | 82 |
[Personal History][Doctor] a seven out of 10 pain . um , and no other injuries while you went down this double black diamond ? [Patient] no , interestingly enough , this is the only one .[SEP][Chitchat][Doctor] okay . well , i guess you escaped ... i mean ... [Patient] could have been much worse .[SEP][Personal History][Doctor] could have been much worse , yes . so , um , do you have any medical problems ? [Patient] um ... yeah , i'm ... i have chronic constipation .[SEP][Personal History][Therapeutic History][Doctor] do you take any medicine for it ? [Patient] miralax .[SEP][Personal History][Therapeutic History][Doctor] and does that help ? [Patient] seems to flow nicely .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 83 |
[Conversation Start][SEP][Personal History][Greetings][Doctor] hey bruce so see here my my notes here is you here he had positive lab work for hep c so how're you doing today [Patient] i'm doing okay but i'm a little bit anxious about having hep c i've really surprised because i've been feeling fine they had done it as you know a screen as just part of my physical so i'm really surprised that that came back positive[SEP][Personal History][Doctor] okay so in the past have any doctors ever told you that you had hep c [Patient] no never that's why i'm i'm so surprised[SEP][Other Socials][Drug History][Drug History][Doctor] okay so just you know i need to ask do you have a history of iv drug use or you know have known any hep c partners [Patient] i mean i used to party a lot and even did use iv drugs but i have been clean for over fifteen years now[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 84 |
[Conversation Start][SEP][Greetings][Doctor] hi diane , how are you ? [Patient] i'm doing okay , how are you ?[SEP][Chitchat][Doctor] i'm doin' okay . so i know the nurse told you about dax and i'd like to tell dax a little bit about you okay ? [Patient] okay .[SEP][Personal History][Doctor] diane is a 28 year old female with a past medical history , significant for , depression and hypertension who presents for emergency room follow-up . so diane what's going on ? i heard that your- your blood pressure was really high in the emergency room . what happened ? [Patient] yeah , so i ended up going for a walk , um , yesterday 'cause it was sunny and it was really great . and i just felt really light-headed , um , and i started to fall a bit , and , um , luckily i was with my boyfriend and he caught me , um , and then we went right to the e , to the er .[SEP][Personal History][Doctor] yeah , okay . yeah , i saw that the blood pressure was pretty high , like in , like , the , almost 200 . [Patient] yeah .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 85 |
[Chitchat][Doctor] okay great [Patient] good to go[SEP][Physical Examination][Doctor] sensation is normal to the touch [Patient] yes[SEP][Physical Examination][Doctor] pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt [Patient] not as much[SEP][Physical Examination][Doctor] how about this way [Patient] not as much[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 86 |
[Vegetative History][Doctor] okay okay and how about any fevers [Patient] i have n't had a fever yet[SEP][Vegetative History][Doctor] no fever okay and then any shortness of breath [Patient] no shortness of breath[SEP][Acute Symptoms][Therapeutic History][Doctor] no shortness of breath okay and what have you been doing for your cough [Patient] i've just been kinda drinking lots of water taking some cough medication over the counter and it seems like it's not really working[SEP][Personal History][Doctor] it's not helping okay and tell me do you have any history of any seasonal allergies [Patient] right around spring time i get a little bit of sneezing and the runny runny nose[SEP][Vegetative History][Doctor] okay okay and then any how about any body aches for you [Patient] no body aches[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 87 |
[Discussion][Medication][Other Treatments][Doctor] sorry no problem sorry yeah not a thumb spica we're gon na brace your arm and you're gon na have that we we have a couple of options but i think the best course of action is gon na be for surgery we will in the meantime give you pain medication i wan na put you on fifty milligrams of ultram every six hours and then i also wan na get you on get you into physical therapy a few weeks after surgery this is gon na be just a normal procedure you will be in for an overnight stay but after that once we assess and make sure that everything is good you'll be able to go home okay [Patient] when do i have to have the surgery[SEP][Discussion][Other Treatments][Doctor] we would like it to happen as quickly as possible you know your body is a wonderful miracle and it's going to start trying to heal on it's own what we need to do is get your wrist straight and then like put screws in to make sure that we hold it in place or else it could like heal and malform [Patient] okay[SEP][Discussion][Other Treatments][Doctor] alright so what [Patient] how how long do i have to wear that brace[SEP][Discussion][Other Treatments][Doctor] you're gon na be wearing the brace for about six weeks [Patient] six weeks[SEP][Referral][Other Treatments][Doctor] yeah so you're gon na you're gon na come in for your surgery we're gon na perform it you're gon na stay overnight and then you'll be bracing it for six weeks in the meantime you'll also then go to physical therapy i want you there like we're gon na they're gon na do an assessment and determine how much but i'm thinking probably three times a week just to make sure that you can get your wrist as strong as possible to prevent like future injury now the cool thing about getting any kind of a bone break is that your your body comes out even stronger so this should n't happen again but unfortunately like it's these situations that oof that just kind of [Patient] oof[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 88 |
[Therapeutic History][Doctor] miralax ? [Patient] miralax . that's it .[SEP][Therapeutic History][Doctor] okay . miralax is sufficient . [Patient] miralax . yes .[SEP][Personal History][Doctor] and any surgeries in the past ? [Patient] i did have my appendix taken out when i was 18 .[SEP][Physical Examination][Doctor] okay . let's do your exam . uh , so , it's this finger right here . and does it hurt here on your , on this joint up here ? [Patient] no .[SEP][Physical Examination][Doctor] okay . and how'bout right there ? no ? [Patient] no .[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 89 |
[Conversation Start][SEP][Greetings][Doctor] good alright hello hannah how are you today [Patient] i'm doing well[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 90 |
[Discussion][Doctor] mm-hmm [Patient] and right after that i have to go to work[SEP][Discussion][Doctor] mm-hmm [Patient] you know if i told you i'm about changing jobs did i[SEP][Discussion][Doctor] no you did n't mention that but one of the cool things about being a doctor is i can write you a note so you're gon na do it and then you can go to the class and we could figure it but like it's really cool that you're changing jobs i'm happy for you i hope you know that like it's always great to be able to make some income and make some decisions that means that you'll be able to start paying for your test soon uh [Patient] well yeah this new job there is no insurance and my old boss sucks so i'm hoping i'll get a new boss and you know hopefully some free food with with this ut because it's had a restaurant so we'll we'll see how that goes[SEP][Discussion][Other Treatments][Doctor] we might have to have a conversation about the free food at the restaurant if we do n't get some of these infections under control because your salt intake is about to be very important okay [Patient] got it[SEP][Discussion][Doctor] alright okay so do you have any more questions before i send my nurse in [Patient] do i need to get a shot today[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 91 |
[Chitchat][Doctor] okay , very good . all right , well let's go ahead and take a look and see what's going on . [Patient] sounds good . thank you .[SEP][Chitchat][Doctor] of course . you'll hear me , uh , talk through your exam so that i get all the information documented . [Patient] okay .[SEP][Physical Examination][Doctor] all right . so use my general physical exam template . i will start by listening to your heart and lungs . [Patient] okay .[SEP][Physical Examination][Doctor] all right . next , i'd like you to lay back so i can examine your abdomen . [Patient] okay .[SEP][Physical Examination][Doctor] is there any tenderness where i'm pressing ? [Patient] no .[SEP]
|
[
"Physical Examination",
"Acute Assessment"
] |
[
"Assessment",
"Objective"
] | 92 |
[Therapeutic History][Doctor] okay . are you taking your blood pressure medications ? [Patient] yeah , but i'm only taking half of the lisinopril .[SEP][Therapeutic History][Vegetative History][Doctor] and are you also taking the full dose of the hydrochlorothiazide ? do you have any , um , chest tightness or pressure or any shortness of breath ? [Patient] yeah i'm taking the full dose of that medicine too , and no none of those symptoms .[SEP][Acute Symptoms][Doctor] okay . anything else i should be aware of or that we should be checking ? [Patient] mm , no .[SEP][Personal History][Doctor] okay , good . are you doing the blood pressure checks at home ? [Patient] yes . yes i am .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 93 |
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] patient shirley taylor . date of birth 5/4/1961 . mrn 0000123 . patient is a 60 year old right-handed female new patient referred by dr. jacob ward for evaluation of bilateral hand numbness and tingling . please note that i personally reviewed the ct brain with and without contrasting did 2/5/21 . uh , no metastatic disease . no acute intercranial abnormalities . hello ms. taylor . how are you doing this morning ? [Patient] hi dr . lopez . this weekend was a bit rough . i've had this numbness and tingling for a few weeks now .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 94 |
[Personal History][Doctor] i do n't think so . [Patient] okay .[SEP][Lab Examination][Radiology Examination][Doctor] let's took at some of your results . hey , dragon , show me the back x-ray . so this is an x-ray of your lumbar spine . you know , there's good bony , bony alignment . i do n't see any fracture or anything like that . so that's a good sign . um , hey , dragon . show me the labs . and your labs here all look good , so i'm , i'm happy to see that . uh , so let's talk a little bit about my assessment and my plan for you , okay ? [Patient] okay .[SEP][Diagnostic Testing][Acute Assessment][Doctor] so i ... my assessment for your first problem , your back pain . i think you have a lumbar strain . i do n't think that anything else is going on , but i wan na go ahead and order an mri- [Patient] okay .[SEP][Discussion][Doctor] just to be sure . [Patient] okay .[SEP][Medication][Doctor] okay ? and then i'm gon na prescribe you some meloxicam 15 milligrams once a day along with some ultram , 50 milligrams every four hours as needed , okay ? [Patient] okay .[SEP]
|
[
"Discussion",
"Medication",
"Referral"
] |
[
"Plan"
] | 95 |
[Referral][Vegetative History][Doctor] okay that's okay yeah i certainly can help you with that now managing your diabetes is also going to play an important role in your coronary artery disease which it sounds like you already know that which is really good so i will put in another referral for diabetic education for you how are you doing watching your sweets i know that you know you do have an afinity for those chocolate chip cookies [Patient] it's okay my a1c was n't where i wanted but my glucose is coming in in about one thirty[SEP][Lab Examination][Doctor] okay what was the what was the a1c the hemoglobin a1c if you do n't mind me asking [Patient] i thought it was close to sixty[SEP][Other Treatments][Lab Examination][Doctor] okay yeah that's really high so we want it to be about six so you you do have some work to do with your diet [Patient] yeah yeah so okay so i know you asked me to do a blood test so i did that i was wondering if you got the results[SEP][Personal History][Lab Examination][Doctor] i did you know i looked at the results of your kidney function that's what we call your creatinine just because you had some contrast dye and sometimes contrast dye can impact the kidneys and your kidney function is stable which is great when was the last time you saw your nephrologist [Patient] oh[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 96 |
[Medication][Diagnostic Testing][Vegetative History][Doctor] okay yeah that's that's really good yeah so i that's that's pretty good so what we're gon na do we're gon na get a a1c just to see you know that range and it's possibility we can we can you know lower that metformin dosage but we will do that after your visit then we will take a look at that so lem me go ahead and will do that quick exam of your elbow but first i want to make sure you're not having any chest pain or anything like that [Patient] no[SEP][Vegetative History][Doctor] no belly pain [Patient] no[SEP][Physical Examination][Doctor] alright so listen to your lungs so your lungs are clear bilaterally listen to your heart so your heart exam you do still have that grade two out of six systolic ejection murmur but we know it about that before so let me take a look at your elbow so when i press right here on the back of your elbow is that painful [Patient] yes[SEP][Physical Examination][Doctor] alright so when i have you you you flex and extend it it's painful does that does that hurt [Patient] yes it does[SEP][Discussion][Medication][Other Treatments][Radiology Examination][Diagnostic Testing][Reassessment][Acute Assessment][Doctor] alright so your right elbow exam shows you have pain to palpation of the olecranon area of the posterior elbow you do have mild pain with flexion and extension but you do have also normal range of motion at that elbow so we we did do an x-ray before you came in and luckily nothing's broken no fracture no bony abnormality so it's a normal x-ray which is really good so let me just talk to you a little bit about my assessment and plan for you so you have a elbow contusion i believe your son did hit you with the lacrosse stick and it caused that that pain i see some swelling little inflammation there as well you have a little bit of a bruise i think that's that's what happened so for that i know you're having some pain i'm gon na prescribe you eight hundred milligrams of ibuprofen you can take that twice a day and that should help with some of that swelling and pain i also want you to ice it three times a day for twenty minutes at a time that should also help with the swelling and pain and just for the time being for the next couple of weeks just you know maybe you know not play lacrosse with your son just to help that heal then you can get back on on the field so for your your high blood pressure we're just gon na keep you on the hypertension we'll just keep you on that twenty milligrams of lisinopril looks like you're doing great with that and your diet and then for your diabetes we will keep you on the five hundred milligrams of metformin and we will also get a a1c just to check your levels and see if we do need to adjust the medication in the future alright so do you have any questions for me [Patient] no sounds good[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 97 |
[Discussion][Medication][Doctor] yes , and keep using the face wash. [Patient] okay .[SEP][Discussion][Medication][Doctor] i think you could just do it once a day . i do n't think you need to do it twice a day , just because i do n't wan na dry your sky out too much , okay ? [Patient] i never noticed that my face is dry or got thin . i feel so good after using it .[SEP][Discussion][Medication][Doctor] i understand , but it could get dry and i do n't wan na create other problems for you . [Patient] all right . i'll just wash once a day with it . but it was feeling very good , like there's this little bit of moisture getting back in . with the other wash , when i would use it twice a day , i was drying out . but not with this one .[SEP][Discussion][Medication][Doctor] i see . okay . well then do what feels good . if you do notice that you're starting to get dry , then reduce to once per day . [Patient] that sounds good .[SEP][Medication][Doctor] so to review , um , continue using the same face wash , continue with metro cream , and increase the use of doxycycline to twice a day . [Patient] okay .[SEP]
|
[
"Medication"
] |
[
"Plan"
] | 98 |
[Chitchat][Doctor] no there's no judgment here whatsoever i want to make sure that i'm giving you the best advise possible and in order to do that i need the most information that you can provide me makes sense [Patient] yes[SEP][Acute Symptoms][Doctor] alright so we're gon na say hope maybe that you had a car crash and we can verify this in february of this year and you've been experiencing some neck pain since then right [Patient] yes[SEP][Acute Symptoms][Doctor] okay alright on a scale of one to ten what ten is your arm is being cut off by a chainsaw severe how bad is your pain [Patient] twelve[SEP][Personal History][Therapeutic History][Doctor] okay terrible pain now i know you mentioned you had previous car crashes and you've been to therapy has anyone prescribed you any medication it's you said you went to a pain clinic yes [Patient] well they had prescribed it recently i was i was on fentanyl[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 99 |
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