X7-qP2-mN9-v4/MTS_Dialogue-Clinical_Note huggingface dataset:
Doctor: Good afternoon, young lady. 
Patient: Good afternoon, doctor. 
Doctor: Let's get the personal questions out of the way to begin, shall we? 
Patient: Sure. 
Doctor: Have you had any S T D s recently? 
Patient: No, not that I know of. 
Doctor: Are you sexually active? 
Patient: No, I'm not. 
Doctor: I'm looking here, and your last P P D was negative, but we'll do another one today. 
Patient: Okay, that's fine, doctor. 
Doctor: Have you been compliant with all of the medicine you've been prescribed? 
Patient: Yes, I've taken everything exactly as you told me to. 
Doctor: Good, do you remember when your last dentist appointment was? 
Patient: Yeah, it was in November of two thousand seven. 
Doctor: What did they do for you at your last visit? 
Patient: They pulled two teeth for me. 
Doctor: Good, and when was your last pap smear? 
Patient: It was about a year ago.
Doctor: I assume it was negative?
Patient: Yes, thankfully. 
Doctor: Have you had a mammogram yet?
Patient: No, not yet. I'm not old enough. 
Doctor: Do you have a family history of breast cancer? 
Patient: No, I don't, at least not that I know of.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: No recent STDs, not currently sexually active, last PPD was negative, will be placed again today, 100% compliant with medication adherence, last dental exam was in 11/07 where 2 teeth were extracted, last Pap smear was negative 1 year ago, has not had a mammogram yet as not of screening age, no family history of breast cancer.
Plan Of Action: Treatment adherence counseling performed, PPD to be placed again today.
Doctor: Hi, I would like to physically examine your rectal area, ok?
Patient: No, I am not comfortable with that. I don't want you to do that.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: N/A.
Plan Of Action: Rectal examination deferred upon patient's request.
Doctor: Hello, what brings you here today? 
Patient: I fell four times on third of this month because my leg suddenly gave out. 
Doctor: How old are you? 
Patient: You don't ask age of a lady. She will never tell you the truth. 
Doctor: I know I'm in the wrong profession. I have to do that every time I meet someone. So how old are you?
Patient: That's true. I'm just teasing you. I'm fifty one. 
Doctor: Are you right handed or left handed? 
Patient: I am right handed. 
Doctor: So, you said that your legs suddenly gave out. What happened exactly? Was it sudden? Or were you noticing some weakness before as well? 
Patient: Oh, I noticed weakness in my right leg before as well and sometimes, like, I have to give the support of my arm to actually move it. Sometimes during these episodes I just turn pale and it's like overall weakness. I feel so tired. My husband, he gives me some sugar, three teaspoons, and then it helps a little bit but not completely. 
Doctor: So, is your weakness like overall in your legs or it is at any single point? 
Patient: It's overall. I remember in one of these episodes I was, like, in an odd fisted posture. 
Doctor: Is there any change in your sensations? Like if I touch you, is it like same before or was there any change? 
Patient: No, nothing like that. 
Doctor: Is there change in vision? Are you seeing double? 
Patient: Nope. 
Doctor: Any difficulty in swallowing or eating? Any loss of consciousness?
Patient: Nope. 
Doctor: Any difficulty in speech? Slurring, or anything like that? 
Patient: No. 
Doctor: You said that these episodes have been happening for some time, so did you see anyone for those before? 
Patient: Nope. It's just that I fall and then fell again last night. I was feeling so weak. Nothing was helping me. That's when, in the morning, my husband brought me to the U I H C hospital for the evaluation on the fifth.

Clinical note:
Symptoms: Weakness in right leg, overall weakness, feeling tired, falls (4 times), improvement with sugar intake, odd fisted posture during episodes, mild pallor during episodes.
Diagnosis: N/A.
History of Patient: 51-year-old female experienced weakness in her right leg, requiring arm support for movement, falls occurred on 1/3/93 and again on 1/4/93, brought to UIHC hospital for evaluation on 1/5/93.
Plan Of Action: Patient presented to UIHC hospital for evaluation of weakness and falls.
Doctor: Any medical traits in the family?
Patient: Oh yeah. Diabetes and high blood pressure runs in my family.
Doctor: Anything else?
Patient: Yeah, my mom suffered with a stroke when she was in her seventies.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Mother suffered a stroke in her 70s, family history of diabetes and hypertension.
Plan Of Action: N/A.
Doctor: Are you married, ma'am? 
Patient: No, I'm divorced. 
Doctor: Do you live alone?
Patient: Yes, so I have no support at home, it's difficult. 
Doctor: Do you drink or smoke? 
Patient: No, I never have. 
Doctor: What about more illicit substances? 
Patient: No, absolutely not.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Divorced, lacks support at home, denies tobacco, alcohol, and illicit drug use.
Plan Of Action: N/A.
Doctor: What is your family medical history, sir?
Patient: We have some heart issues in my family. My sister died during heart surgery two years ago. 
Doctor: I am so sorry. 
Patient: Thank you. My mom died of a heart attack. 
Doctor: How old was she when she passed? 
Patient: She was in her seventies? My dad died from a brain hemorrhage. He was only forty nine. 
Doctor: Your family had been through a lot of loss. 
Patient: Yes, we have. 
Doctor: Do you have any siblings that are still living?
Patient: I have another sister. Oh yeah. She is a diabetic. 
Doctor: Do you have kids? 
Patient: Yes, I have daughter. The only health problem she has is high cholesterol. 
Doctor: Do you know of anyone else in the family with neurological disorders? 
Patient: No. I don't think so.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Family history includes sister's death during heart surgery, mother's death from a heart attack in her seventies, father's death from a brain hemorrhage at age forty-nine, another sister with diabetes, one daughter with high cholesterol. No known family members with neurological disorders.
Plan Of Action: N/A.
Doctor: Do you have any known allergies?
Patient: Not that I know.
Doctor: Any allergies to any drug? 
Patient: Nope.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No known drug allergies.
Plan of Action: N/A
Doctor: Are you married? 
Patient: Yes, I am. 
Doctor: Is the baby your first kid?
Patient: You see, I am a missionary. I have four kids. My eldest is seven years old. Then the other ones are five and three and this one is the youngest. She is just six weeks old.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Welcome to A B C D General Hospital. Before we get started, ma'am, how old are you? 
Patient: I'm thirty nine, doctor. 
Doctor: Great, and what seems to be the problem today?
Patient: I've had this bunion for a good few months now. 
Doctor: Is the pain getting worse?
Patient: Absolutely, I can't take it anymore. 
Doctor: How have you managed this bunion so far? 
Patient: I got some wider shoes, and it's done absolutely nothing.
Doctor: I see. 
Patient: Is there surgery or something we can do? I can't take the pain.

Clinical note:
Symptoms: bunion pain
Diagnosis: N/A
History of Patient: 39-year-old female presenting with bunion for several months, progressively worsening pain, attempted conservative treatment with wider shoe gear without long-term relief, desires surgical treatment
Plan of Action: N/A
Doctor: How old are you? 
Patient: I'm twenty eight. 
Doctor: So, you are here for the dietary consultation. Is this your first pregnancy? 
Patient: No, this is my second pregnancy. I had gestational diabetes with my first one as well. 
Doctor: Were you taking any insulin at that time? 
Patient: Yes, I used insulin last time as well. I'm just here to understand if diet can help me with my gestational diabetes. 
Doctor: Sure. 
Patient: My Gynecologist was saying something about ketones, I don't know what they are. She asked me to talk about them with you.  
Doctor: Sure, I will explain everything to you. We also have a pamphlet to explain it. Here have a look. You can take it with you. 
Patient: Thank you. 
Doctor: Are you exercising?
Patient: I walk everyday with my daughter. I go to drop her to school and then back home. 
Doctor: How long is the walk to school?
Patient: It takes around twenty minutes on one side. So, everyday it is like forty minutes in the morning and same in the evening around four. 
Doctor: Do you drink milk?
Patient: I try to, I know it is a good source of calcium and is very essential especially with my pregnancy, but I am not a big fan of drinking milk.

Clinical note:
Symptoms: N/A
Diagnosis: gestational diabetes during pregnancy
History of Patient: 28-year-old female with gestational diabetes during first pregnancy, previously used insulin, seeking dietary consultation for current pregnancy, lacks understanding of ketones, walks her daughter to school and back daily (20 minutes each way), not a big milk drinker
Plan of Action: N/A
Doctor: Do you know of any family history of kyphosis? 
Patient: I'm sorry, what's that?
Doctor: It has to do with rounding of the spine. Does anyone in your family have a rounded posture?
Patient: Actually, yeah, my great grandmother had that, and my mom would talk about my second cousin, he had it too.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Of kyphosis in great grandmother and second cousin.
Plan of Action: N/A
Doctor: When did you retire from your job? 
Patient: About eleven years ago. It's definitely been nice. I'm able to spend more time with my grandkids. 
Doctor: Aw, how many grandkids do you have? And do you live alone? 
Patient: I have four grandkids between the ages of two and eleven. I live in the county with my wife and dog. My wife and I've been together for thirty some years now. 
Doctor: That's so wonderful to hear.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Good afternoon, young lady. 
Patient: Good afternoon, doctor. 
Doctor: How has your weight been since your last visit, with the phentermine? 
Patient: Well, since the last visit I've gained about a pound. 
Doctor: Well, it could be worse, but we're at a plateau, I'd like to see you lose some more per month. 
Patient: Yeah, I've been working really hard, but I haven't been able to get the weight down any further so far. 
Doctor: What has been your lowest weight?
Patient: My lowest? That was one hundred thirty six. I'm just as frustrated as you are, doctor. 
Doctor: Well, if this plateau continues, we should discontinue the phentermine. 
Patient: Why is that? 
Doctor: It shouldn't be used to maintain your weight, but only to get the weight down. So, if it's not serving that purpose, we shouldn't use it. There's no real benefit there. 
Patient: Okay, yes, I agree.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Follow-up on weight loss with phentermine, gained one pound since last visit, plateau in weight loss despite efforts, lowest weight reached was 136 pounds, frustration with lack of progress, discussion about discontinuing phentermine if plateau continues
Plan of Action: N/A
Doctor: Anyone in the family had a stroke?
Patient: No, no one had a stroke in my family.
Doctor: How about someone in the family with heart disease?
Patient: No one that I can remember.
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Negative for cerebrovascular accident or cardiac disease.
Plan of Action: N/A
Patient: You know doctor, I was born in Munich, Germany. 
Doctor: Wow, I cannot tell, you speak English so well, no German accent. 
Patient: Yeah, I always knew how to speak English even before I was a teen. So, when I moved to America I did not have any language problem.
Doctor: Okay and did you move with your family?
Patient: No, my family moved to the eastern side of the Germany which was occupied by Russia at that time, but I decided to move to America in nineteen fifty seven.
Patient: I had a high school degree from Germany, and I could speak German and English fluently.
Patient: As soon as I landed here in America, I started working. I started as a secretary at a private firm and later did clerical work at I B M. Now I am retired for almost twenty years due to my cancer complications. 
Doctor: Your Mesothelioma?
Patient: Yeah.
Doctor: Okay, and who all are there in your family?
Patient: Well currently I am alone without any companion. I am divorced. I have a son who lives in Santa Cruz he has grand children, but I have not seen them, I am trying to get in touch with them. I want to see my grandkids. 
Patient: Other than him I have a brother and a sister both are healthy and living their life we don't talk much. 
Doctor: Okay. 
Doctor: And do you drink or smoke?
Patient: Hm, nothing significant.
Doctor: Any funny drugs like heroine or coke? 
Patient: No. 
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: mesothelioma
History of Patient: Born in Munich, Germany, immigrated to America in 1957, divorced, worked as a secretary and later as a clerical worker at IBM, retired for over 20 years due to mesothelioma complications, denies significant tobacco, alcohol, or illicit drug use, bilingual in German and English, high school education equivalent in Germany, has one son living in Santa Cruz with grandchildren whom she is trying to contact, has one brother and one sister who are healthy but with whom she doesn't communicate much
Plan of Action: N/A
Doctor: What brings you in today? Can you also please state your age?
Patient: Yeah. I am forty five. I've had really bad stomach pain on my right side since last week. 
Doctor: On a scale of one to ten, how bad is the pain at its worst? 
Patient: I'd have to say a seven. 
Doctor: How would you rate it now? 
Patient: Oh um it's at a five at the moment. 
Doctor: Have you been taking your diabetes medication? 
Patient: Micronase? 
Doctor: Yes. 
Patient: Yeah, I've been taking it every day. 
Doctor: Great. Okay, let's try to get to the bottom of this stomach pain.

Clinical note:
Symptoms: abdominal pain on the right side
Diagnosis: N/A
History of Patient: 45-year-old male with abdominal pain on the right side since last week, pain rated as a seven at its worst and currently a five, long-standing history of diabetes treated with Micronase daily
Plan of Action: N/A
Doctor: Your cholesterol appears to be elevated today. Is this the first time you've been told that your cholesterol levels are high? 
Patient: No, unfortunately. I suffer from a few medical problems so maybe that's to blame. 
Doctor: I see here that you have diabetes and high blood pressure. 
Patient: Right.  
Doctor: Does diabetes or high blood pressure run- 
Patient: In the family? No, but heart disease does.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: CORONARY RISK FACTORS: History of hypertension, history of diabetes mellitus, nonsmoker.  Cholesterol elevated.  History of established coronary artery disease in the family and family history positive.
Plan of Action: N/A
Doctor: How was the sleep study? 
Patient: Not bad. Although I hafta admit it was difficult staying up in preparation for it. 
Doctor: I can imagine. That's always tough. It looks like the eval of your daytime fatigue and insomnia was sent over. Let me print out a copy and we can go over it together. How old are you again?
Patient: I am forty eight.

Clinical note:
Symptoms: daytime fatigue, insomnia
Diagnosis: N/A
History of Patient: 48-year-old woman returning for follow-up after full-night sleep study performed to evaluate for daytime fatigue and insomnia
Plan of Action: N/A
Doctor: So what brings you in today? 
Patient: Ugh. 
Doctor: I'm guessing you're not feeling too great. 
Patient: You got that right. I've had a fever on and off for the past few days. 
Doctor: When was the last time you took your temperature? 
Patient: Right before I drove here.  
Doctor: I see. Did the nurse take your temperature when you came in? 
Patient: Yes, she did.  
Doctor: Have you been experiencing cold like symptoms, such as cough, nasal congestion, headache, or nausea? 
Patient: Um no not really. 
Doctor: Have you tried taking any medicine to help with the fever? 
Patient: Yeah. I've taken Tylenol and that's helped a bit. 
Doctor: Have you had recent sick contacts? 
Patient: I don't think so. I live with three other roommates and they seem fine.

Clinical note:
Symptoms: fever
Diagnosis: fever of unknown origin
History of Patient: Patient has had a fever on and off for the past few days, no other cold-like Symptoms reported, Tylenol has provided some relief, denies recent sick contacts
Plan of Action: N/A
Doctor: Anything that has been going on? 
Patient: No. What do you mean?
Doctor: I mean anything wrong from head to toe that you would like to add? 
Patient: No everything is well. No other problems.
Doctor: Okay. Good.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: How was the procedure? 
Patient: It was okay. I was nervous to go under the knife at first, but it turned out better than I expected. Do you know others who've gotten hysterectomies that are near my age? 
Doctor: I do, actually. It's a pretty common procedure. I'm glad to hear that you didn't experience any complications. 
Patient: Me too.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Status post hysterectomy
Plan of Action: N/A
Doctor: Hello and welcome to our dermatology office. What is the reason for your visit? 
Patient: I have these rashes on my arms. 
Doctor: Let me take a look. Do you have prior reports about your history? 
Patient: Yeah, I do. I gave it to the nurse. 
Doctor: Let me go get it really quick. I'm reading the report and it looks like your family is positive for atopy. 
Patient: Oh, yeah. We all usually get some type of rash. 
Doctor: I see. Do you know if you have psoriasis? 
Patient: Uh. What's that's? 
Doctor: It's a skin disease that usually has scaly patches. 
Patient: Uhm. I don't think so. 
Doctor: Great. Before I prescribe you medicine to treat your eczema, are you allergic to any drugs?
Patient: Not that I know of.

Clinical note:
Symptoms: rashes on the arms
Diagnosis: eczema
History of Patient: Patient presents with rashes on the arms, positive atopic family history, denies psoriasis, no known drug allergies
Plan of Action: N/A
Doctor: Do you drink?
Patient: Well, I will call myself a social drinker. I would admit that I am addicted to caffeine. 
Doctor: How much coffee do you consume each day? 
Patient: I would say three to five cups. 
Doctor: Any history of sexually transmitted disease? 
Patient: Nope. 
Doctor: How're your eating habits? 
Patient: I would say I am a good eater and follow a healthy diet plan. 
Doctor: Do you exercise? 
Patient: I walk every day around five miles. Also, I'm very regular in my sprint training.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient admits caffeine and alcohol use, consumes 3-5 servings of caffeine per day, describes drinking as social, admits good diet habits, exercises regularly with daily walks and sprint training, denies history of sexually transmitted disease
Plan of Action: N/A
Doctor: Good afternoon Sir. Do you know how you got here? 
Patient: Yes, I passed out and the paramedics brought me to the hospital.  
Doctor: Do you have any recollection of the incidences leading up to your loss of consciousness? 
Patient: I think I had a seizure and then I passed out. 
Doctor: Prior to the episode did you experience any chest pain or shortness of breath? 
Patient: No. 
Doctor: Any feelings of abnormal heart rhythm? 
Patient: No.  
Doctor: Do you have any history of any cardiac problems? 
Patient: No.  
Doctor: How are you feeling now? 
Patient: I feel fine.
Doctor: Do you know how old you are?
Patient: I am sixty nine.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: episode of syncope, seizure activity, no Symptoms of chest pain or shortness of breath, no palpitation, no prior cardiac history.
Plan of Action: N/A.
Doctor: Hello Miss Lee how are you? 
Patient: I am okay, my arms are troubling me so much. 
Doctor: Yeah, I know it's been a longstanding pain in both your arms. 
Patient: Yeah, and hands too
Doctor: Can you pinpoint where exactly is the pain? 
Patient: Yeah, it's right here in the middle part of arm and my palm. 
Doctor: Okay so mostly in the medial part. Tell me do you feel any weakness?
Patient: No, but I do feel this tingling sensation kind of like numbness in my left hand, and it gets worse at night after doing repetitive work.
Doctor: Are you left handed? 
Patient: No, I'm right handed
Doctor: Hm, any neck pain?
Patient: Not really, nothing substantial. 
Doctor: Can you please tell me your age again?
Patient: I am fifty two.
Doctor: Did you ever have these kind of signs and symptoms in the past?
Patient: Nope!
Doctor: Okay and are you taking anything for pain?
Patient: Ah yes, I am taking Lyrica.
Doctor: Lyrica okay and is it helping?
Patient: Yes, somewhat. 
Doctor: Any problem in walking or change in how you walk? 
Patient: No.
Doctor: And you are having regular bowel movements any changes?
Patient: Yes, no changes. 
Doctor: How about urine, any burning or difficulty peeing?
Patient: No, it's all fine. 
Doctor: Okay good. So, the neurological exam we did earlier, I have the results for it. 
Patient: And?
Doctor: Well, you were tested positive for Phalen's test on your left hand.
Patient: What does that means?
Doctor: It means that you have something called Carpal tunnel syndrome, which explains your numbness and tingling sensation in your left hand. It also explains your pain in the middle part of your hand as it's caused due to pinching or compression of a nerve called median nerve. 
Patient: Oh, how did that happen?
Doctor: Well, it's possible that your repetitive hand motion could have caused it or sometimes it's just the anatomy of your wrist. 
Patient: Oh, that explains my increased pain in the night after work. 
Doctor: Yeah. 
Patient: Anything else came in the neuro test? 
Doctor: No, rest of your neurological exam was normal. 
Patient: Okay. I am worried now. 
Doctor: Don't worry we are here. 
Patient: Thank you!

Clinical note:
Symptoms: bilateral arm pain, pain in the middle part of arm and palm, left hand numbness and tingling sensation worse at night and after repetitive work, positive Phalen's test on left hand.
Diagnosis: Carpal tunnel syndrome.
History of Patient: longstanding bilateral arm pain, predominantly in medial aspect of arms and hands, no weakness, no significant neck pain, no change in bowel or bladder Symptoms, no change in gait, no similar Symptoms in the past.
Plan of Action: N/A.
Doctor: Have we gone over your survey results from your last visit? 
Patient: No, do you have those results with you right now? 
Doctor: Yes, I do, they show that you have anxiety disorder. 
Patient: That makes sense, thank you for sharing that with me.

Clinical note:
Symptoms: N/A.
Diagnosis: anxiety disorder.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: I see here that you've been having some chest pain. Where along the chest? 
Patient: It's mostly on the left side.  
Doctor: When did it start? 
Patient: Um a few days ago. 
Doctor: How'd you describe the pain? 
Patient: Kinda dull. 
Doctor: Any other symptoms with the pain, such as shortness of breath? 
Patient: Not really, no. 
Doctor: How long does the pain usually last? 
Patient: For a few minutes. It comes and goes. 
Doctor: Have you taken anything for the pain? 
Patient: I've taken some Advil, but it doesn't seem to help. 
Doctor: Have you had similar pain in the past? 
Patient: No, I don't think so.  
Doctor: And you had surgery on your abdomen five days ago, correct? 
Patient: Yes. Do you think the pain is related? 
Doctor: I'd like to run some tests and get you in for a CAT scan to see what's going on.

Clinical note:
Symptoms: left-sided chest pain,
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: run tests, CAT scan for evaluation of left-sided chest pain post abdominal surgery.
Doctor: It looks like he has a history of high blood pressure, high cholesterol, and Afib. 
Guest_clinician: Does he see a cardiologist for his Afib? 
Doctor: Not according to his chart. I'll see if I can call his emergency contact to confirm.
Guest_clinician: Okay. Keep me posted.

Clinical note:
Symptoms: N/A.
Diagnosis: atrial fibrillation, hypertension, hyperlipidemia.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: Do you smoke or drink alcohol? 
Patient: No, I do not smoke or drink alcohol.
Doctor: How about drugs?
Patient: Nope, I have never.
Doctor: Who do you live with?
Patient: Just my family.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: How old are you now? 
Patient: I am sixty five. My kids just through me a surprise birthday party last week. 
Doctor: Oh wow! That is so nice. Happy belated birthday. 
Patient: It was nice. 
Doctor: It looks like you are here today for a recheck for the prostatitis. 
Patient: Yeah. 
Doctor: I see you have been followed by Doctor Mathis. 
Patient: Yes. 
Doctor: How often do you see him? 
Patient: He has me coming in about every three or four months. 
Doctor: Excellent. And the last time I saw you was in May two thousand and four. 
Patient: Has it been that long? 
Doctor: Yeah, it has. Okay. You are here to discuss some libido problems? 
Patient: Sadly, yes. 
Doctor: How long have you been having these difficulties? 
Patient: I noticed the change when I started taking the Proscar. 
Doctor: That is a common side effect that some men experience from Proscar. Have you tried any medication to help bring back your libido? 
Patient: I take Viagra sometimes. 
Doctor: Does it help at all? 
Patient: There is some improvement. 
Doctor: How many times a night do you get up to relive yourself now? 
Patient: I still get up about three to four times. 
Doctor: Okay, so still often. 
Patient: Yes, but I have not had any U T Is since I have been on the Proscar. 
Doctor: That is good news.

Clinical note:
Symptoms: N/A.
Diagnosis: chronic prostatitis, decreased libido.
History of Patient: follow-up with Dr. XYZ every three to four months, last appointment in May 2004, noticed libido change after starting Proscar, tried Viagra with some improvement, no urinary tract infections since starting Proscar, nocturia x 3 to 4.
Plan of Action: N/A.
Doctor: Are you married, sir? 
Patient: Yes, I am, Doctor: 
Doctor: Is this your only marriage? 
Patient: Well, no. I've been married three times now. 
Doctor: If you don't mind my asking, how long was your longest marriage?
Patient: I don't mind at all, my longest was two years. 
Doctor: Do you have any children, sir? 
Patient: Yes, I have two. 
Doctor: How old are they, sir? 
Patient: They're both fifteen, they're twins, obviously. They're my wife's dependents, though. 
Doctor: Okay, thank you. Did you go to college, sir? 
Patient: Yeah, I have my bachelor's. I got the military to pay for it. 
Doctor: How long were you in the military? 
Patient: I did six years, sir. I was honorably discharged.  
Doctor: Where are you working currently. 
Patient: I've worked at Purdy Correctional Institute, you know, the one in Gig Harbor? I've worked there for nineteen years.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: So, looks like you have stones in your C B D. I am not hundred percent sure but most likely its stones. 
Patient: C B D? 
Doctor: Yeah, short for common bile duct. It's a small tube like structure which connects your liver duct and gallbladder. 
Patient: Oh! 
Doctor: Yeah, and because of that you have inflammation in your gallbladder.
Patient: Oh, I see.

Clinical note:
Symptoms: N/A.
Diagnosis: choledocholithiasis, cholecystitis.
History of Patient: N/A.
Plan of Action: N/A.
Guest_clinician: Has he had a blood transfusion in the past? 
Doctor: No, this is his first one. 
Guest_clinician: Okay, got it.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: Can you tell me more about your son, please? 
Guest_family: Sure, he's ten years old now. 
Doctor: How long has he used his walker?
Guest_family: Well, he's been using that since he started walking. 
Doctor: How old was he when he started walking?
Guest_family: He was about a year old. 
Doctor: Good, what seems to be the problem today?
Guest_family: He keeps complaining about the back of his legs being tight.
Doctor: Can you sit on the table, young man? Yes, I'm bending his legs, we call this the popliteal angle, and both sides flex to only about twenty. 
Guest_family: Where should that be normally?
Doctor: He should be able to get to ninety. 
Guest_family: What can we do about this? 
Doctor: I think we should do surgery on this leg. How does he walk? Can I see?  
Guest_family: Well, just look at him. 
Doctor: Yes, he does not walk with a crouched pattern, but he is toe walking. 
Guest_family: Can we correct that instead of the hamstring tightness? 
Doctor: Well, I believe he should have surgery on the hamstring, as well. 
Guest_family: Okay, right now we want to do surgery to fix his walking. What are the risks of infection?
Doctor: They're low, historically, they're less than one percent. The risks include anesthesia, infection, bleeding, changes in sensation and the motion of walking, and it may also not always cure the toe walking. There is also possible stiffness after wearing the cast and other cast issues. 
Guest_family: Okay, and will be under anesthesia during this? Is this worth it?
Doctor: Absolutely, he won't feel a thing. It is worth it because the chances of the risks happening are low. 
Guest_family: Yes, we'd like to do the procedure. Let me text my husband really quick. Okay, yes, my husband agrees.

Clinical note:
Symptoms: tightness in the back of legs.
Diagnosis: N/A.
History of Patient: toe walking since age one, popliteal angle of approximately 20 degrees bilaterally, mild hamstring tightness.
Plan of Action: surgery recommended for hamstring tightness and toe walking correction, risks of surgery discussed and agreed upon by parents.
Doctor: Did you ever have any reaction to any medication given? Any known allergies?
Patient: No.
Doctor: Was there any swelling where your lymphnodes are?
Patient: No.
Doctor: Was there ever any complaint of abnormal lymph nodes? 
Patient: No.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: No history of systemic allergy, abnormal lymph nodes, or swelling.
Plan of Action: N/A.
Doctor: Do you have anyone with psychiatric symptoms in the family?
Patient: No, I don't have family!
Doctor: What do you mean?
Patient: My mom dad died and I was raised in the Philippines.
Doctor: Adopted?
Patient: No by myself.
Doctor: Wow that must have been tough.
Patient: Oh it's a story for another day.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Listed as unknown in the chart regarding other psychiatric illnesses, patient's parents are deceased, patient raised himself in the Philippines.
Plan of Action: N/A.
Doctor: Do you have any chronic conditions I should know about, sir?
Patient: No, not that I can think of. 
Doctor: What about injuries, have you ever broken a bone?
Patient: Yes, I have. I've broken my hand and tibia before.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: Welcome to the clinic. 
Patient: Thank you. 
Doctor: Do you have any family history of cancer? Either solid tumors or blood malignancies? 
Patient: No. None that I know of.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: No history of solid tumor or hematologic malignancies in the family.
Plan of Action: N/A.
Doctor: Can you tell me what surgeries have you had in the past?
Patient: I have had appendix surgery when I was twenty one years old and eight years back I had C Section.
Doctor: Okay. I want to know how many pregnancies you had and how many babies?
Patient: Sure, I have only two.
Doctor: Okay. Do you have any issues with your periods?
Patient: Yes, I get heavy periods because of fibroids in my uterus.
Doctor: Oh. When was your last menstrual period?
Patient: Oh, you can say about three weeks back.
Doctor: Okay. Good.

Clinical note:
Symptoms: heavy periods due to fibroids.
Diagnosis: fibroids in the uterus.
History of Patient: appendectomy at age 21, C-section 8 years ago, G2P2 (2 pregnancies, 2 babies), last menstrual period 3 weeks ago.
Plan of Action: N/A.
Doctor: Hello, sir. Before we begin your visit, could you verify your age and ethnicity for me, please?
Patient: I'm forty nine years old, and I identify as white.  
Doctor: Thank you. What brought you in today?
Patient: I was referred to you so that I could get whatever's wrong with me under control. 
Doctor: I see. What seems to be happening? 
Patient: I hurt the back of my leg pretty bad this past year when I was in A B C D. 
Doctor: What part of your leg? 
Patient: The back of my left thigh. 
Doctor: I see. So just the leg? 
Patient: I also hurt my kneecap from a boat when I was out in the water fishing. 
Doctor: Was that severe? 
Patient: It was a whole show. A helicopter came down and swooped me to X Y Z Hospital, where I got surgery. 
Doctor: I can see you still have an external fixation on your knee so that the fracture heals. Did the hospital give you a report on the surgery? 
Patient: Yeah, they did. Here you go. 
Doctor: Thank you. Let me take a look. So, it looks like you underwent grafting and full thickness skin grafting for closure for a large defect in your left posterior thigh. That seems to be healed in the gluteal fold on the left area. 
Patient: Yeah. Whatever that means. 
Doctor: Let me examine the area. 
Patient: Go for it. 
Doctor: I can see several areas that have hypergranulation tissues around the graft site and low in the leg.
Patient: Is that bad? 
Doctor: I don't think so. Are you feeling any symptoms of a fever or anything? 
Patient: No, I'm not. 
Doctor: That's good. You don't have any infections then.

Clinical note:
Symptoms: pain and injury to the back of left thigh, knee injury from a boat accident, hypergranulation tissue around graft site, drainage from areas with hypergranulation tissue.
Diagnosis: N/A.
History of Patient: traumatic injury to left posterior thigh, surgery for large defect in left posterior thigh, ongoing external fixation for healing fractures in leg, grafting and full thickness skin grafting for closure of defect, nearly healed in gluteal fold area.
Plan of Action: referred to clinic for management of hypergranulation tissue and drainage from graft site.
Doctor: And are you working?
Patient: Ah yes, I am a painter. 
Doctor: Okay good.
Doctor: Do you smoke?
Patient: Yes, I do. 
Doctor: Hm and how much do you smoke? 
Patient: Well, about two packs a day. 
Doctor: And how about alcohol, do you drink?
Patient: No sir, I don't drink.
Doctor: Any drugs? 
Patient: You mean like cocaine and stuff?
Doctor: Yeah.
Patient: No, no drugs.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: Welcome to the clinic, ma'am. I am Doctor Smith. 
Patient: Thank you. It is nice to meet you. 
Doctor: Doctor X referred you to us, is that correct? 
Patient: Yes. He is my primary care doctor. 
Doctor: It looks like you have a birthday coming up. Happy early birthday! 
Patient: Thank you. Yes, I am going to be seventy seven. 
Doctor: Doctor Kim's notes said that you have had pain in the left flank pain. Can you tell me more about the pain? 
Patient: Yes. The pain started four or five days ago. It has been in my stomach and through to my back, on the left side. Right here.  
Doctor: Okay. Have you had any nausea or vomiting? 
Patient: Yes. I had some nausea, and I threw up a few times. 
Doctor: Have you noticed any blood, pain and or burning during urination? 
Patient: No. 
Doctor: Any fever or chills? 
Patient: No. 
Doctor: I have the ultrasound results that Doctor X ordered the other day.  The ultrasound found a stone in your left ureteral. The stone is about one point three C M in size. 
Patient: Is there some thing we can do to remove it? I really want this taken care of. 
Doctor: Yes. Let us go over the treatment options.

Clinical note:
Symptoms: left flank pain, pain in abdomen and back, nausea, vomiting.
Diagnosis: left ureteral stone (1.3 cm in size).
History of Patient: pain started 4-5 days ago, nausea and vomiting present, no hematuria, dysuria, burning, or pain during urination, no fever.
Plan of Action: discuss treatment options for removal of the ureteral stone.
Doctor: Good afternoon, ma'am. You're forty one years old, correct? 
Patient: Good afternoon, doctor. Yes, that's correct. 
Doctor: Thank you, have you followed up with Doctor X since your surgery? 
Patient: Why would I do that? 
Doctor: Oh, just because she referred you to me. 
Patient: Oh, no, I haven't yet. 
Doctor: That's fine. Have you heard the details behind your surgery? 
Patient: I heard it once, but I can't remember anything. Can you remind me? 
Doctor: Well, you had a complicated case, but we did an anterior cervical discectomy, two level corpectomy, with a spinal decompression and fusion with fibular strut and machine allograft in your large cervical plate. 
Patient: Oh, that's a lot, doctor. 
Doctor: Yes, how are you doing today? 
Patient: Well, I've felt good for the last two days.
Doctor: Have you been able to move your arms and legs for the last few days?
Patient: Yeah, I can actually move all four. 
Doctor: Good, are you having any issues breathing? 
Patient: No, nothing of note there. 
Doctor: Okay, today, I think you'd be a good candidate for a halo vest placement. 
Patient: Yeah, doctor, I'm not going back to the O R. 
Doctor: Okay, we can do it here. 
Patient: Okay doctor, I'd like to do it here. 
Doctor: Let me get A B C to help me with this. Also, we're going to move you to S I C U room one. 
Patient: Can you tell me the details about what you're going to do? 
Doctor: Well, this is a P M T halo, I like this one better than the Bremer halo vest, and I'll use morphine and Versed.
Patient: Are you going to use anesthesia? 
Doctor: Yes, I have local anesthetic, it's xylocaine and epinephrine, um, it's somewhere between fifteen and twenty C C.

Clinical note:
Symptoms: N/A.
Diagnosis: severe cervical spondylosis and myelopathy, post-surgical status following anterior cervical discectomy, 2-level corpectomy, spinal decompression and fusion.
History of Patient: N/A.
Plan of Action: performed halo vest placement (PMT halo) using morphine and Versed for anesthesia, local anesthetic (xylocaine and epinephrine) for the procedure, done at bedside in SICU room #1.
Doctor: Is everything fine?
Guest_family: My mom is not well.
Doctor: When did this start?
Guest_family: I don't know but she is not in her correct state of mind.
Doctor: Okay let's see what we can do, how old is she?
Guest_family: She is around seventy four years old.
Doctor: Okay. Don't worry, we will see what we can do.
Guest_family: Thanks!
Doctor: Of Course.

Clinical note:
Symptoms: altered mental status.
Diagnosis: N/A.
History of Patient: N/A.
Plan of Action: N/A.
Doctor: Welcome in, sir. 
Patient: Thank you. 
Doctor: Let us start off with a little background. 
Patient: Okay. 
Doctor: What is your current living status? Do you live with others or on your own? 
Patient: Well, right now I am living with my sister in Sacaton. I am currently looking for my own place, but I am staying with her for now. 
Doctor: Are you looking for a place in Sacaton? 
Patient: No. I will probably look for a place back in Coolidge. 
Doctor: Back in Coolidge? Have you lived there before? 
Patient: I recently separated from my wife. We lived in Coolidge together. Sacaton is too far away from everything, but it is fine for now. 
Doctor: I am so sorry to hear that. 
Patient: Thank you. My sister has been a saint. I am not working right now so my sister is letting me stay with her for free. She gave up her home office and made me a nice room to stay in. 
Doctor: Your sister is very generous. Are you and your sister close?
Patient: Not when we were growing up but now that we are older, we have become very close. She has been a great support for me in these hard times. 
Doctor: That's wonderful. Are you a tobacco user? 
Patient: I smoke cigarettes. I only smoke a little bit. 
Doctor: How much do you smoke per day? 
Patient: I only smoke about one or two cigarettes a day. 
Doctor: Do you or have you ever used drugs or alcohol? 
Patient: I have never used drugs. I used to be a heavy drinker. I quit drinking a year ago. 
Doctor: That's great. Do you attend A A meetings? 
Patient: No, but I might start. Things have been very stressful lately with the separation and being on unemployment. 
Doctor: I think it could be beneficial to you. 
Patient: Okay. 
Doctor: I have a list for different support groups in the area that I can give you. 
Patient: Great. Thank you.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Separated from wife, living in Sacaton with sister, former heavy drinker now abstaining from alcohol, currently unemployed, smokes 1-2 cigarettes/day, denies drug abuse.
Plan of Action: Considering attending A.A. meetings and seeking support groups for stress management.
Doctor: How are you feeling after that insulin drip, Miss A B C? 
Patient: I am feeling much better. My sugar levels are normal.
Doctor: Yes, between one hundred fifteen and one thirty four. So, on the second day after your admission they did laparoscopic removal of your gallstones. You were very difficult to intubate. But everything went well with surgery. There was some swelling and adhesions around your gallbladder, but all is well that ends well.
Patient: What was my blood sugar during surgery?
Doctor: Great question. After surgery they were around two thirty three. 
Patient: I am getting a special insulin?
Doctor: Yes, sliding scale insulin. 
Patient: Can I go home?
Doctor: Yes, you are all set to go home, everything is stable.

Clinical note:
Symptoms: N/A.
Diagnosis: Chronic cholecystitis, difficult intubation.
History of Patient: Admitted to hospital, insulin drip initiated, laparoscopic cholecystectomy performed due to gallstones, postoperative blood sugar measured at 233.
Plan of Action: Managed with sliding scale insulin, discharged home in stable condition following surgery.
Doctor: Good morning, ma'am. 
Patient: Good morning, doctor. 
Doctor: Welcome to A B C D General Hospital. My nurse says that you are forty one years old, and you identify as a White female, is that correct? 
Patient: Yes, that's all correct. 
Doctor: Thank you, so, what seems to be the trouble today?
Patient: Well, I'm having some pain in this foot, it's right over this bone. 
Doctor: Is your pain right here?
Patient: Yes, it really hurts right there. 
Doctor: Okay, this is known as your navicular bone. What makes the pain worse? 
Patient: Usually wearing shoes makes it worse. 
Doctor: Do you have any past history of problems with this foot?
Patient: Well, I have a history of multiple osteochondromas. 
Doctor: Do they know what caused these? 
Patient: No, no one ever figured it out, they just said it was hereditary.  
Doctor: Have they done surgery on these in the past? 
Patient: Yeah, I had a surgery for this a while ago. 
Doctor: Have you ever had this problem in your feet or spine?
Patient: No, this is new. Can we do that surgery again? I can't take this pain.

Clinical note:
Symptoms: extreme pain over the navicular bone with shoe gear.
Diagnosis: hereditary osteochondromas, previous dissection of osteochondromas.
History of Patient: pain in the foot, multiple osteochondromas of unknown origin, desire for surgical treatment.
Plan of Action: surgical treatment for pain in the foot caused by osteochondromas.
Doctor: On April twenty two four we went over your list of medication and allergies.
Patient: Okay.
Doctor: Let me check something.
Patient: Sure.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: How's the low fat and low cholesterol diet going? Have you been finding it manageable? 
Patient: Yeah, I guess. I've tried to also reduce my salt intake to about two grams.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: low fat, low cholesterol diet; reduction of salt intake to about 2 grams (2g sodium).
Doctor: Hello. Before we begin your visit, could I ask a few questions to fill in some missing information? 
Patient: Yeah, that's fine. 
Doctor: Does your family have any health related problems? 
Patient: Yeah, we do. We have a strong history of heart disease. I think it could be because we drink a lot. 
Doctor: So, would you say alcoholism runs in your family? 
Patient: Oh, yeah. We drink a lot every day. Beer, liquor, you name it.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: strong history of heart disease and alcoholism.
Plan of Action: N/A
Doctor: Are you working these days?
Patient: No, sir. I've been retired for a couple years now.
Doctor: Congratulations. I hope you're enjoying your time off.
Patient: You bet.
Doctor: You mentioned having a smoking history. When did you quit and approximately how much did you smoke?
Patient: Uh I quit about twenty seven years ago. If I had to guess, I smoked about two packs a day.
Doctor: Did you smoke only cigarettes?
Patient: Cigars, too.
Doctor: How about alcohol?
Patient: Hardly ever. 
Doctor: Great.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: stopped smoking 27 years ago after smoking approximately two packs a day (cigarettes and cigars), hardly ever uses alcohol, currently retired.
Plan of Action: N/A
Doctor: Good morning, sir, welcome to A B C D General Hospital. 
Patient: Thank you, doctor. I hope you can fix me up quickly. 
Doctor: We'll do our best. Um, before we begin, I just need some background information. So, how old are you?
Patient: I'm forty seven years old. 
Doctor: Good, and what race do you identify with?
Patient: I identify as white, sir. 
Doctor: Thank you, so, what seems to be the problem today?
Patient: Well, I have this, um, mass of my left foot, it's been getting worse too.
Doctor: I see it. How long has this tissue mass been there on that foot?
Patient: It's been about two weeks now, but it's getting worse way faster now. 
Doctor: Do you have any history of cancer?
Patient: No, but I've had an, um, shave biopsy in the past. 
Doctor: I see. 
Patient: Is there any surgery we can do for this to cut it off? I really want it gone.

Clinical note:
Symptoms: mass on the left foot, worsening over two weeks
Diagnosis: tissue mass on the left foot, history of shave biopsy
History of Patient: N/A
Plan of Action: surgical excision of the tissue mass on the left foot
Doctor: What do you do for a living? 
Patient: Actually, I'm retired now, but I was an engineer, and I did some real estate brokering as well on the side. 
Doctor: Wow, that's a lot. Congratulations on your retirement! 
Patient: Thank you, now I get to spend more time with my wife.
Doctor: Wonderful, do you have any children?
Patient: Yes, five in total, it's a full house. 
Doctor: Fantastic, do you drink or smoke?
Patient: I don't smoke, but I drink a little.
Doctor: How many drinks would you say you have a week? 
Patient: Um, I'd say up to three drinks a week. 
Doctor: Okay, and is there any history of drug or illicit substance abuse, sir?
Patient: No, never anything like that.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: As per your chart I am going to put some of the following things in your diagnosis.
Patient: Yes, I have diabetes, hypertension and gallstones.
Doctor: Yes I can see that in your chart over here.
Patient: What are the new things?
Doctor: We now have added hyperglycemia and obstructive sleep apnea.

Clinical note:
Symptoms: N/A
Diagnosis: hyperglycemia, obstructive sleep apnea, diabetes mellitus, hypertension, cholelithiasis, cholecystitis.
History of Patient: N/A
Plan of Action: N/A
Doctor: Do you smoke? 
Patient: Nope. I quit like fifteen years ago.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Quit smoking 15 years ago.
Plan of Action: N/A