X7-qP2-mN9-v4/MTS_Dialogue-Clinical_Note huggingface dataset:
Patient: Oh doc, I've had a lot of trouble breathing lately.
Doctor: I'm sorry to hear that. We'll get to the bottom of it. 
Patient: Yeah, I lose my breath so quickly with just one to two flights of stairs.
Doctor: When did you first start noticing this? 
Patient: I believe two weeks ago. 
Doctor: Any chest pain or tightness with the shortness of breath? 
Patient: No, thankfully. 
Doctor: Any fever, chills, or sweats? 
Patient: No. 
Doctor: Any cough or coughing up blood? 
Patient: No. 
Doctor: How about wheezing or swelling in your legs?
Patient: No.

Clinical note:
Symptoms: trouble breathing, dyspnea on exertion
Diagnosis: N/A
History of Patient: started experiencing trouble breathing two weeks ago, no other associated Symptoms
Plan of Action: N/A
Doctor: Can you tell me more about your family medical history, sir? How's your dad doing? 
Patient: Well, doctor, he passed away. He had mesothelioma.
Doctor: I'm so sorry to hear that, sir. How is your mother? 
Patient: It's okay, thank you. I lost her too. She had A L S. 
Doctor: I'm sorry, that must be so hard.
Patient: Yes, it is, but I manage.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: father passed away from mesothelioma, mother passed away from ALS
Plan of Action: N/A
Doctor: So, tell me did anyone in your family have Idiopathic pulmonary fibrosis? 
Patient: Actually, my father passed away due to this disease.
Doctor: Oh, sorry to hear that.
Patient: Yeah.
Doctor: Anything else that he or any other family member might have. 
Patient: Oh, he also had this spastic colon problem and irritable bowel syndrome.
Doctor: Hm, I see. 
Doctor: Anything else? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Significant for his father who died of IPF and irritable bowel syndrome.

Plan of Action: N/A
Doctor: How are you today? 
Patient: I am doing okay. 
Doctor: Do you have any medical conditions? 
Patient: I have diabetes. 
Doctor: When were you diagnosed with diabetes? 
Patient: It was two thousand and three, I think. I also have high blood pressure, asthma and high cholesterol. 
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: diabetes, asthma, hypertension, hypercholesterolemia
History of Patient: N/A
Plan of Action: N/A
Doctor: I do not feel any swellings in your neck or groin area. 
Patient: Oh yeah, I don't notice anything either.
Doctor: Okay yeah, I was just trying to look for any lymph nodes.
Patient: Okay.
Doctor: Let me check.
Patient: Sure.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: LYMPH: There was no appreciated node that I could feel in the groin or neck area.

Plan of Action: N/A
Doctor: Your bloodwork came back from the Coumadin sensitivity test. The results showed a high level of sensitivity. I am going to adjust your dosage of Coumadin to a much lower dose. This will help reduce the bruising and the bleeding episodes. Do you have any questions?
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: hypersensitivity to Coumadin
History of Patient: N/A
Plan of Action: adjust dosage of Coumadin to a much lower dose to reduce bruising and bleeding episodes
Doctor: Hello. You must be his mom.
Guest_family: Yeah, he started having a sore throat last night. And that's why we are here. His eyes have been really puffy. Uh, we gave him some Benadryl. 
Doctor: Hm. 
Patient: I had a stuffy nose and it was hard to breathe. 
Doctor: When did it all start?
Guest_family: It started yesterday. All of a sudden, he started complaining saying, “Mama my nose is not working,” and yeah, I noticed he was breathing from his mouth. 
Doctor: Any fever or any other symptoms?
Guest_family: Yeah, he had some low grade fever. He looked very tired and when I asked him he said that, “I feel like I cannot stand. I have no energy. I want to just lie down.” 
Doctor: I can notice that his voice is a little bit hoarse. How's he eating and drinking?
Guest_family: He's eating and drinking normally. 
Doctor: Any shortness of breath or pain in your stomach? 
Patient: No. 
Doctor: Any diarrhea or vomiting? 
Patient: No.

Clinical note:
Symptoms: sore throat, puffy eyes, congestion, low-grade fever, feeling run down, tiredness, hoarse voice
Diagnosis: N/A
History of Patient: sore throat starting last night, eyes very puffy, congestion started suddenly yesterday, low-grade fever, feeling very tired and run down, hoarse voice, no coughing, no shortness of breath, vomiting, diarrhea, or abdominal pain
Plan of Action: N/A
Doctor: Do you use tobacco, alcohol, or recreational drugs? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Denied Tobacco/ETOH/illicit drug use.

Plan of Action: N/A
Doctor: What's a young thirty one year old like you doing in my office today, ma'am?
Patient: Well, I got referred to P T after I had a fall. 
Doctor: When was your fall?
Patient: Um, it was on October third two thousand eight. 
Doctor: What happened when you fell?
Patient: I tripped over my dog's toy. 
Doctor: Did you twist your foot or ankle? 
Patient: Yeah, my left foot inverted. 
Doctor: Have you had any imaging done on this foot?
Patient: Yeah, um, I've had x rays and an M R I already. 
Doctor: What were the impressions of those images?
Patient: They told me that it was unremarkable. 
Doctor: How was the pain progressed since the onset? 
Patient: Well, after a month or so, the pain is still so bad I can't do any of my activities. 
Doctor: How long have you been wearing this walking boot?
Patient: Um, it's been about a month now.

Clinical note:
Symptoms: significant debilitating pain in left ankle
Diagnosis: N/A
History of Patient: fell on 10/03/08 after tripping over dog toy, left foot inverted, received unremarkable x-rays and MRIs, continued significant pain after 1 month, wearing walking boot for past month
Plan of Action: N/A
Doctor: Do you smoke cigarettes?
Patient: No, that never really appealed to me, doctor.
Doctor: Good, what about more illicit substances? 
Patient: Oh, most certainly not. 
Doctor: What about alcohol, do you drink?
Patient: Well, I'd say I'm an occasional drinker. 

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: The patient is a nonsmoker and does not use illegal drugs.  Occasionally drinks.

Plan of Action: N/A
Doctor: Do you mind elaborating more on your family history? Did either of your parents suffer from any medical problems? 
Patient: Sure. My dad had heart disease. He passed at seventy five. He had a sister with diabetes and I think my mom may have had diabetes as well. 
Doctor: Got it.  
Patient: As for my mom, she had a long history of mini strokes. She didn't have any memory problems or dementia when she passed at eighty five. They believe she passed due to old age. 
Doctor: Thank you for further elaborating. I'm so sorry for your losses. Losing a parent let alone two is profoundly difficult.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Reportedly significant for TIAs in his mother, although the patient did not report this during our evaluation and so that she had no memory problems or dementia when she passed away of old age at the age of 85.  In addition, his father had a history of heart disease and passed away at the age of 75.  He has one sister with diabetes and thought his mom might have had diabetes as well.
Plan of Action: N/A
Doctor: Any muscular pain?
Patient: No, not really. 
Doctor: Any problem in walking? 
Patient: No, it's normal. 
Doctor: Let me check your toes and fingers. Can you move them for me?
Patient: Yeah.
Doctor: Everything looks fine. Nails looks fine too. No bluish discoloration no sign of any infection. Can you push your legs against my hand.
Patient: Both legs?
Doctor: Yes, both. Well, your muscular strength is equal and stable in both legs, so that's fine. Motion looks adequate.
Doctor: Any tenderness? 
Patient: No. 
Doctor: And I don't see any swelling or fluid accumulation.
Patient: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient:  Normal gait and station.  No pathology to digits or nails.  Extremities move times four.  No tenderness or effusion.  Range of motion adequate.  Strength and tone equal bilaterally, stable.
Plan of Action: N/A
Doctor: Do you have a known- 
Patient: Drug allergy? 
Doctor: Oh no, I meant family history of disease.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Have you experienced any headaches or blackouts recently?
Patient: No.
Doctor: Dizziness or seizure?
Patient: Nope.
Doctor: Any history of stroke? 
Patient: No. 
Doctor: Okay, good.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: NEUROLOGIC: Normal; Negative for blackouts, headaches, seizures, stroke, or dizziness.
Plan of Action: N/A
Doctor: Hi there! I am Doctor Kim. Nice to meet you, miss. 
Patient: Hi! Nice to meet you. 
Doctor: How are you feeling today? 
Patient: I am feeling much better today. 
Doctor: How old are you? 
Patient: I am forty six. 
Doctor: How is your pain in the left side? 
Patient: It is much better. It is more like a dull pain now.
Doctor: Are you still having trouble with urination? 
Patient: It has gotten better but is still a little difficult. 
Doctor: Okay. It looks like Doctor X did an exam yesterday. Doctor X consulted me on your status but I have a question for you. I see in your medical history that you had a bruised left kidney. Can you tell me more about the bruised kidney? 
Patient:  Yes. I was in a car accident, years ago. The doctor told me that I had a bruised left kidney. They thought it was due to the accident, but they could not be certain.

Clinical note:
Symptoms: Left flank pain (now dull), difficulty urinating (improving)
Diagnosis: N/A
History of Patient: Presented to the emergency room with left flank pain and difficulty urinating, vague history of bruised left kidney in a motor vehicle accident, feeling much better today
Plan of Action: N/A
Patient: Well, I have a long family history of heart problems. My mom died quite young at the age of fifty due to heart attack and my father was detected with heart failure, he has a pacemaker. 
Doctor: Oh, I am sorry to hear about your mom. 
Patient: Yeah. Also, high blood pressure runs in my family.
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient:  described a family history of hypertension. Her mother died after a myocardial infarction at age 59. Her father was diagnosed with congestive heart failure and had a pacemaker placed.

Plan of Action: N/A
Doctor: Where are you experiencing the most pain? 
Patient: All over my belly. 
Doctor: How long has this been going on? 
Patient: Two to three weeks.  
Doctor: Does the pain come and go? 
Patient: It does. 
Doctor: And how would you describe- 
Patient: The pain? 
Doctor: Yes. 
Patient: Hm I'd describe it as a gnawing sensation. 
Doctor: Is this sensation new? 
Patient: I believe so. I don't ever remember feeling this way before. 
Doctor: Any past abdominal surgeries? 
Patient: None.

Clinical note:
Symptoms: Abdominal pain (all over the belly), gnawing sensation
Diagnosis: N/A
History of Patient: Pain has been ongoing for two to three weeks, described as a gnawing sensation which is new to the patient, no past abdominal surgeries
Plan of Action: N/A
Doctor: Hi, there. 
Patient: Hi. 
Guest_family: Hi! It is nice to meet you. 
Doctor: It is nice to meet you as well. You are the husband, correct? 
Guest_family: Yes. I am the husband. 
Doctor: How long have you two been married? 
Guest_family: We have been married for forty eight years. 
Doctor: Do you live in the same household? 
Patient: Yes. 
Doctor: Do you have a primary care physician?
Patient: No, I am currently looking for someone. I have also been looking for someone to see for my mental health issues. 
Doctor: I have a few recommendations I can give to you if you would like.
Patient: I would like your recommendations for both.
Doctor: Are you working currently? 
Patient: No, I am not. I used to work as a registered nurse. It has become too much for me right now. 
Doctor: Do you drink alcohol or use any recreational drugs? 
Patient: I don't do any drugs. I drink very rarely. I only drink is social situations. 
Doctor: Have you ever taken any prescription drugs, muscle relaxants or sedative medications? 
Guest_family: I don't think that she has ever taken muscle relaxants or sedative medications without prescriptions. I give her, her medications every day so she doesn't forget. 
Doctor: Oh, okay. 
Guest_family: She does have a pattern of self-prescribing for minor illness. She loves WebMD. 
Doctor: Okay. How have you been feeling lately? Have you been participating in social activities? 
Patient: Since this last March I have been feeling more social and have been doing things on my own more. 
Guest_family: She used to never leave the house unless I go with her. She has defiantly been more independent lately. She even went and met a friend for coffee the other day. 
Doctor: That is great to hear.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient:   She rarely drinks socially.  She denies any illicit substance usage.  Her husband reportedly gives her medication daily.  Has been proactive in terms of seeking mental health care and medical care.  The patient and husband report that from March 2009, she has been relatively independent, more socially active

Plan of Action: N/A
Doctor: Do you have a history of surgeries? 
Patient: I had a bone fragment removed from my right arm. I had a D and C done a long time ago. It was a treatment for H P V. More recently I had an ovarian cancer staging biopsy done. I have not heard back with the results yet. I only had it done less then a week ago. 
Doctor: How are you feeling after the biopsy? 
Patient: I had a significant amount of pain for two to three days after. I feel better now.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: History of surgeries including a D and C for HPV treatment, removal of bone fragment from right arm, recent ovarian cancer staging biopsy with post-procedural pain
Plan of Action: N/A
Doctor: Anybody else in your family suffers from this condition?
Patient: No.
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Noncontributory
Plan of Action: N/A
Doctor: Hello Miss Jane, how are you?
Patient: I am good, thank you for asking.
Doctor: So, tell me what brings you here?
Patient: I have so many issues and problems, where do I start?
Doctor: Start by telling the one troubling you the most. 
Patient: I have this pain in my toes on the right side and I also feel this numbness there.
Doctor: Okay and do you feel any tingling sensation? Or feeling like your leg is giving away?
Patient: Yes, I feel the tingling and sometimes. I feel like my leg has fallen asleep.
Doctor: Hm, tell me about your pain. Is it mild, moderate, or severe?
Patient: Well, I will say it's moderate. 
Doctor: Would you define it as sharp shooting pain or dull kind of radiating pain? 
Patient: Maybe sharp pain but I am not sure how to describe it. But it radiates up the leg.
Doctor: Okay. How long have you had this problem?
Patient: It's been there for almost one year but now it started to get worst. 
Doctor: I see, does it get worse when you walk?
Patient: No, mostly when I am in bed. And sometimes I feel it on my left toe as well.
Doctor: It looks like you have paresthesia in the toes of your right foot and I feel your left toe also has the same problem.
Patient: Yeah, I thought so. I read over the internet. But anyways, I am also having this shoulder pain on both sides, plus I am not able to sleep at night.
Patient: I have high blood pressure and hypothyroidism. 
Doctor: Well-
Patient: Well, that's not it. I have thrombo-
Doctor: Thrombocythemia.
Patient: Yeah, that. 
Doctor: How are your allergies by the way?
Patient: I have no sinus allergies, thankfully.

Clinical note:
Symptoms: Numbness, tingling, and pain primarily in the toes of the right foot (moderate, sharp quality pain), mild paresthesias in left toe, pain worsens when in bed, some radiation of pain up the leg, bilateral shoulder pains
Diagnosis: Hypothyroidism, thrombocythemia, insomnia, hypertension
History of Patient: Symptoms present for about a year, worsening recently, pain not exacerbated by walking, worsens when in bed
Plan of Action: Further evaluation of foot pain and numbness, consideration of imaging or nerve studies if warranted, assessment and management of shoulder pain, evaluation and management of insomnia, monitoring and management of hypothyroidism, thrombocythemia, and hypertension, reassurance regarding sinus allergies
Doctor: Do you have any known allergies to medications?  
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No known drug allergies.

Plan of Action: N/A
Guest_family: He is coughing for one week now.
Doctor: How about any congestion? Is it one week or more?
Guest_family: No did I say that? I meant two to three weeks. I am so worried. He is just one year.  
Doctor: Don't worry let me see, can you tell me everything from the beginning?
Guest_family: Sure. It started off as a congestion, but then he started coughing about a week ago and it is getting worse.
Doctor: Okay, what else?
Guest_family: Actually, he had Pop Can just three days ago and I never found the top of that and was wondering if he had swallowed that.
Doctor: It is possible, have you seen any change in his breathing?
Guest_family: His breathing has not gotten worse since that happened.
Doctor: Any fever?
Guest_family: No. No fever.
Doctor: Okay.

Clinical note:
Symptoms: Cough, congestion
Diagnosis: N/A
History of Patient: Symptoms present for two to three weeks, started as congestion and progressed to coughing, worsened over the past week, concern about possible ingestion of pop can top three days ago but no change in breathing noted, no fever present
Plan of Action: Further evaluation to assess for any potential respiratory issues, consideration of imaging or further investigation for possible foreign body ingestion if warranted, monitoring for any changes in Symptoms or breathing, reassurance to the family
Doctor: Hi, how are you?
Patient: I am good, Doctor. 
Doctor: So, I see you recently moved to U S A from Brazil, right?
Patient: Yes, about one year back. I was an engineer manager back there, but my job was so stressful that when I got admitted in the M B A program here in the states, I took it.
Doctor: Wow, that's quite a move!
Patient: Yeah.
Doctor: How about your family; wife or girlfriend? 
Patient: I am a one women man. I married my childhood sweetheart. 
Doctor: Nice. Did you travel outside the country recently or have risk of any kind of exposure? 
Patient: No, I haven't traveled anywhere not even within the country. 
Doctor: Okay. Tell me something, do you smoke or drink?
Patient: No, I don't. 
Doctor: And have you in the past used any recreational or illegal drugs? 
Patient: No, never. 
Doctor: Okay, good.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: The patient was from Brazil. He moved to the United States one year ago. He denied any history of tobacco, alcohol, or illicit drug use. He was married and monogamous. He worked as an engineer/manager, and stated that his job was "very stressful". He had recently been admitted to an MBA program. The patient denied recent travel or exposures of any kind.

Plan of Action: N/A
Doctor: Do you drink, sir? 
Patient: No, I don't drink at all. 
Doctor: How about tobacco? Do you smoke?
Patient: Well, yes.
Doctor: How much do you smoke, sir? 
Patient: I smoke about a half a pack of cigarettes a day.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: He does admit to one half pack of cigarette consumption per day.  He denies any alcohol consumption.

Plan of Action: N/A
Doctor: How are you feeling? You have been sick?
Patient: Yes, I am not feeling well for the last three days.  I have bad body aches, cough and a sore throat.  
Doctor: Do you get wet cough or it's dry? What color sputum comes out?
Patient: It is wet and green colored stuff comes out.
Doctor: Okay we will need to send it out to culture, maybe an infection.
Doctor: How about fever, chills, nausea, vomiting, diarrhea anything like that? Are you sleeping well?
Patient: Everything is fine except some chills? I am sleeping okay.
Doctor: Do you need anything for cough?
Patient: I don't need anything for the cough. I did call yesterday and got a refill of my Keflex. Then I took two Keflex this morning and I am feeling little bit better now. 
Doctor: Okay then why are you crying, ma'am?
Patient: I am just tired of feeling like ran down.
Doctor: I am so sorry.
Patient: Hm.

Clinical note:
Symptoms: Body aches, cough, sore throat, productive cough of green colored sputum, chills, tearfulness
Diagnosis: Possible respiratory infection
History of Patient: Patient has been feeling unwell for the last three days with body aches, cough, sore throat, productive cough of green sputum, chills, tearfulness, no vomiting or diarrhea, sleeping okay, obtained refill of Keflex yesterday and took two doses this morning, feeling slightly better
Plan of Action: Send sputum for culture to assess for infection, monitor Symptoms, provide supportive care, address emotional distress
Doctor: Hi there, what's going on with you? 
Patient: Well, I am having this weird jerky movement in my arm and leg. 
Doctor: Oh okay, let me take a look.

Clinical note:
Symptoms: Arm and leg jerking
Diagnosis: N/A
History of Patient: Arm and leg jerking.

Plan of Action: N/A
Doctor: Hi there, how is it going?
Guest_family: Hi doctor, I am his son Ethan.
Doctor: Nice to meet you. 
Doctor: So, I see your father has a history of drug abuse, right?
Guest_family: Yes.
Patient: Not abuse, I just used to do drugs. The last time I really made a big mistake I injected the heroine directly into both of my thighs and unfortunately, I got these ulcers which are not going away.
Doctor: Yeah, this is really unfortunate. I can see these open wounds, it's because of the chronic abscesses.
Guest_family: The right thigh looks worse than the left one.
Doctor: Yeah, I see that. How old is your father?
Guest_family: He is sixty two. 
Doctor: Does he have any other medical issues like sugar or blood pressure?
Guest_family: No. 
Doctor: Okay, I think we need to surgically remove this whole area and then do a reconstruction.
Guest_family: And is that the only way?
Doctor: According to me, yes! I mean the wounds are not healing and it is only getting worst. 
Guest_family: Okay then we will follow whatever you suggest. 
Doctor: Okay.

Clinical note:
Symptoms: Chronic abscesses, open wounds on bilateral thighs
Diagnosis: Chronic abscesses with open wounds, likely resulting from injection drug use
History of Patient: Patient has a history of drug use, specifically injecting heroin into bilateral thighs, resulting in chronic abscesses and open wounds, worse on the right thigh
Plan of Action: Radical excision followed by reconstruction surgery recommended due to non-healing wounds and worsening condition
Doctor: Do you smoke cigarettes or use any tobacco products, miss? 
Patient: No. 
Doctor: Do you drink alcohol and if so, how many drinks do you consume in a typical week? 
Patient: I don't drink. 
Doctor: Do you use any recreational drug or other substances?
Patient: No. 
Doctor: Do you have children? 
Patient: Yes. I have three kids. 
Doctor: Do your children have any health conditions? 
Patient: No. 
Doctor: Are you married? 
Patient: Yes.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Married, 3 children who are healthy. She denied any Tobacco/ETOH/Illicit drug use.

Plan of Action: N/A
Doctor: How is your family doing?
Patient: They all are good.
Doctor: Are you aware of any medical issues in your family?
Patient: No, not to my knowledge.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Denies knowledge of any medical issues in the family.
Plan of Action: N/A.
Doctor: Have you ever had spine problems before? 
Patient: What, like an injury? 
Doctor: Well, it's broad. It could be an injury, or just any kind of pain. 
Patient: Oh, no. I've never had any problems.

Clinical note:
Symptoms: N/A.
Diagnosis: N/A.
History of Patient: Denies any past spine problems, including injuries or pain.
Plan of Action: N/A.
Doctor: Any past medical history? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: Nonsignificant
History of Patient: N/A
Plan of Action: N/A
Doctor: With ten being the worse pain ever, how would you rate your pain out of ten today, ma'am? 
Patient: Um, out of ten, I'd say it's about a two. 
Doctor: That's good. What helps the pain feel better? 
Patient: Um, it gets better with elevation, and when I just rest.

Clinical note:
Symptoms: N/A
Diagnosis: The patient rates the pain at 2/10 on the pain analog scale.  The patient states that with elevation and rest, her pain subsides.

History of Patient: N/A
Plan of Action: N/A
Doctor: Do you drink? 
Patient: I used to drink before, but now I have stopped it completely. 
Doctor: How would you rate your pain? 
Patient: It is tolerable, like five out of ten but I do need some pain medications.
Doctor: Then why do you need more pain medications? 
Patient: Sometimes it gets hard, I really need some more pain medications. 
Doctor: Do you have morphine? Do you need more? 
Patient: I don't like morphine. Can you change it to Dilaudid? I like that medicine. That one works for me great.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: History of alcohol use in the past, requesting more pain medications, preference for Dilaudid over morphine
Plan of Action: Considering changing medication to Dilaudid based on patient's preference and reported effectiveness
Guest_clinician: She has a vast history of surgeries. 
Doctor: Yeah, I am looking at her reports. She had surgery for spina bifida when she was a baby and they had to put a shunt. 
Guest_clinician: Yeah, later she had her uterus removed and also had to undergo a breast reduction surgery. 
Doctor: Hm.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Back closure for spina bifida, hysterectomy, breast reduction, and a shunt.

Plan of Action: N/A
Doctor: Are you married or divorced? 
Patient: I am married.
Doctor: Okay.
Patient: Hm.
Doctor: Do you smoke cigarettes or drink alcohol?
Patient: No, I have never.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: She is married and does not smoke or drink nor did she ever.

Plan of Action: N/A
Doctor: What is your family medical history? 
Patient: I am not sure. Everyone is healthy as far as I know.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Good morning, ma'am. My chart says that you're forty nine years old, and White, is that correct? 
Patient: Yes, that's all correct. 
Doctor: What do you do for a living? 
Patient: I'm a secretary. 
Doctor: Great, welcome back to the Dermatology office, do you remember when your last appointment was? 
Patient: Um, I think it was on August tenth two thousand four. 
Doctor: Good, that's what I have here as well, so has your acne improved since your last visit? 
Patient: Well, not really, and I think I have a rash too. 
Doctor: How long have you been dealing with this? 
Patient: Um, at this point it's been about two months. 
Doctor: Where do you see this rash? 
Patient: Um, it's right here, on my chest, stomach, neck, and back, it's all over my upper body. 
Doctor: I see, it appears that your acne is flaring, and there are small lesions on the follicles as well. Have you been taking your Amoxicillin and using your Tazorac? 
Patient: Yeah, I taken five hundred M G of amoxicillin twice a day, and I use the cream as well. 
Doctor: Good, the acne on your face appears to be clearing. 
Patient: Thank you, I've been out of medicine for about three days now though. 
Doctor: Okay, we might refill that. Have you had any other treatments aside from what I've done? I
Patient: Um, my husband drove me to Healing Waters and they did, um, photofacials. Is there anything that can be done in the office today, like, um, cosmetic procedures, or do you have any skin care products? I want to keep up my appearances since I work the front office as a secretary.

Clinical note:
Symptoms: Flaring of acne with small folliculitis lesions, rash on chest, stomach, neck, and back
Diagnosis: Acne with folliculitis flare, rash
History of Patient: Patient experiencing acne flare for the past two months, currently taking amoxicillin 500 mg b.i.d. and using Tazorac cream 0.1, out of medication for three days, has been receiving photofacials at Healing Waters
Plan of Action: Refill prescription for amoxicillin and Tazorac, discuss cosmetic procedures and skin care products for maintaining appearance, potential in-office treatments for acne
Doctor: It looks like your Xrays show bronchitis.  
Patient: Is there anything I can take for it? 
Doctor: Yes, I'm going to prescribe you something that will help clear your lungs.

Clinical note:
Symptoms: N/A
Diagnosis: Bronchitis/URI (Upper Respiratory Infection)
History of Patient: N/A
Plan of Action: Prescribing medication to clear lungs
Doctor: How's it going X Y Z? I see you're in a walking boot. What happened? 
Patient: I hurt my foot pretty bad yesterday. 
Doctor: How'd it happen? 
Patient: Basketball. I play for the University of Houston. I went up for a three and came down and landed on this guy's foot. I was so pissed. 
Doctor: Dang, that sucks. Were you guys playing a home game? 
Patient: We were traveling to Duke. We could've won the game if I didn't get hurt. 
Doctor: You'll get them next time. Did you keep playing? 
Patient: Yeah, I did. I got taped up by the trainer, and I went back into the game. 
Doctor: I see. Who was the trainer that helped you? 
Patient: His name is John Houston. Do you know him? 
Doctor: Oh, John! He's a good friend of mine. 
Patient: Yeah, he told me to come see you. He checked my foot. Here's the notes he wrote. 
Doctor: It looks like you have some tenderness around your navicular, which is a bone in your ankle. 
Patient: Dang, that's whack. 
Doctor: Which way did you twist your ankle? 
Patient: My foot twisted inwards. Kind of like this. 
Doctor: I see. Your foot inverted. Did it swell up right away? 
Patient: Aw, man. My foot was huge right after it happened. It hurt so much too. 
Doctor: Continue to keep that tape on. Are you limping or anything? 
Patient: Yeah, I am. I can't really put weight on my foot because it'll hurt a lot. 
Doctor: I see. Well, I examined your foot, and it looks like the pain is around the top, back and middle of your foot.

Clinical note:
Symptoms: Swelling, pain onset immediately after injury, pain with weightbearing activities, limping
Diagnosis: Inversion injury, tenderness around the navicular
History of Patient: Injured foot during basketball game while traveling to Duke, landed on another player's foot, taped by trainer John Houston, continued playing after injury
Plan of Action: Patient has been in a walking boot, foot taped firmly, advised to continue wearing the tape, continue monitoring for pain and swelling
Guest_family: So apart from constipation what is his problem? What is up with his lungs?
Doctor: Yeah so, we call it foreign body impaction. It is mostly affecting his right nostril and as you said there is constipation.

Clinical note:
Symptoms: N/A
Diagnosis: Infected foreign body, right naris, Mild constipation
History of Patient: 1.  Infected foreign body, right naris. 2.  Mild constipation.

Plan of Action: N/A
Patient: I was working when it happened so we are going through workers comp.
Doctor: Okay. Don't worry. Let's see. Oh wow!
Patient: Yeah, this arm, it was a hot oil.
Doctor: Yeah, too bad, looks like from elbow to wrist. The whole medial side is burnt.
Patient: I am using cool packs since it happened. My friend is helping me so much, he drove me to Emergency Department.
Doctor: Okay, how old are you?
Patient: I am forty one. 
Doctor: What is your job? I mean what do you do?
Patient: I am a cook at coffee shop.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: 41-year-old male experienced a Workers' Compensation injury at a coffee shop where hot oil splashed onto his arm, causing burns from the elbow to the wrist on the medial aspect. Presenting to the Emergency Department for care.
Plan of Action: N/A
Doctor: Do you have any medical conditions that I should know about? 
Patient: Um, I have high blood pressure, and asthma. 
Doctor: I also see here that you have cervical cancer, can you tell me more about that?
Patient: Yeah, I got diagnosed at fifteen years old.  
Doctor: How would you describe the progression of your cancer? 
Patient: Now, um, I'd say it's dormant.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Significant for hypertension, asthma, and cervical cancer diagnosed at 15 years old. Patient describes the cervical cancer as "dormant."
Plan of Action: N/A
Doctor: You can take Ibuprofen as needed for pain.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Ibuprofen PRN.

Plan of Action: Ibuprofen can be taken as needed for pain relief.
Doctor: Do you take anything for acid reflux? 
Patient: Yeah, I take Aciphex. 
Doctor: Is that twenty M G once a day? 
Patient: It is. I also take one baby Aspirin in the mornings.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient takes Aciphex 20 mg once daily for acid reflux and aspirin 81 mg once daily.
Plan of Action: N/A
Doctor: Do you smoke? 
Patient: Yes. 
Doctor: How much do you smoke? 
Patient: I smoke about two packs of cigarettes a day. 
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient smokes approximately two packs of cigarettes per day.
Plan of Action: N/A
Doctor: Any numbness or tingling? 
Patient: No.
Doctor: Are your experiencing any muscle weakness?
Patient: No.
Doctor: Any problem walking, or did you lose balance or fall?
Patient: Nope. 
Doctor: So, your gait is fine. Any stroke in the past? 
Patient: No, nothing like that.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No gait problems, strokes, numbness, or muscle weakness reported.
Plan of Action: N/A
Doctor: Past surgeries I should know of? 
Patient: I had my gallbladder, appendix, and uterus removed. 
Doctor: Oh wow, I see. When did you get these surgeries? 
Patient: I had my gallbladder removed in O eight, appendix removed in twenty twelve, and uterus removed this past year. 
Doctor: Any other medical history? 
Patient: My bladder was sagging the last time I saw the urologist. 
Doctor: Does the diagnosis bladder prolapse sound familiar? 
Patient: Yeah, I believe so. They said it was grad four last time. 
Doctor: Have you followed up with your urologist recently? 
Patient: Chip Winkel? No, not as of late.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Significant for cholecystectomy (2008), appendectomy (2012), and hysterectomy (recent). Long history of grade 4 bladder prolapse, previously seen by Dr. Chip Winkel but not recently consulted.
Plan of Action: N/A
Doctor: Do you have allergies? How old are you, young man?
Patient: Yes ragweed. I am twelve. 
Doctor: So basically, you are just congested?
Patient: Yes that's right. The last ten days.
Doctor: Any headache? What comes out of your nose?
Patient: Yes I had a little yesterday. Clear boogers.
Doctor: You feel hot?
Patient: No.
Doctor: Anyone sick at home?
Guest_family: No.

Clinical note:
Symptoms: sinus congestion, headache (mild), clear nasal drainage
Diagnosis: N/A
History of Patient: 12-year-old male with 10 days of sinus congestion, significant allergies including ragweed. Reports mild headache yesterday. Clear nasal drainage. No fever. No other family members ill at home.
Plan of Action: N/A
Doctor: Are you married?
Patient: I'm divorced.
Doctor: Do you have any kids?
Patient: Yes, I have two boys and they live with me.
Doctor: Any abnormal pregnancy. Any abortions?
Patient: No, none of them. 
Doctor: Do you smoke or consume alcohol or have ever used any illicit drug?
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Divorced, lives with children. No spontaneous abortions reported. Denied alcohol, tobacco, or illicit drug use.
Plan of Action: N/A
Doctor: I want to go over your medical history. I see here you saw the dermatologist a month ago.
Patient: Yeah. She said that I um have an overactive sweat gland.  
Doctor: Does hidradenitis suppurativa sound familiar? 
Patient: It does. 
Doctor: I ask because it's also included in your last visit with your dermatologist. 
Patient: Those are the red bumps, right? 
Doctor: Yes. There's a note here that you could've potentially had Staph with it as well. 
Patient: Oh yeah. I've also had a lot of abscesses in the past.  
Doctor: It looks like you've had them in your upper mid thigh, vulva area, and the area between your vulva and anus. 
Patient: For about two years now. 
Doctor: Right. And a history of asthma? 
Patient: Correct.

Clinical note:
Symptoms: recurrent abscesses in the perineum, upper medial thigh, and vulva area for about 2 years, red bumps, history of asthma
Diagnosis: hidradenitis suppurativa, potentially associated with Staphylococcus infection
History of Patient: Patient has a history of recurrent abscesses in the perineum, upper medial thigh, and vulva area for about 2 years. Dermatologist suggested hidradenitis suppurativa with a potential Staphylococcus infection. Also reported history of asthma.
Plan of Action: N/A
Patient: Hello, how are you?
Doctor: I am good, tell me what brings you here?
Patient: I am having this chest pain. I was hospitalized last year in October and at that time they put this catheter in my heart. I also underwent a heart scan. It's here in this report. 
Doctor: Yeah, I see that you got nuclear and myocardial perfusion scan, which was normal. They were looking for some heart artery lesion but then it was thought to be due to spasm.
Patient: Right.
Doctor: It is also mentioned here that you have hyperlipidemia.
Patient: Yes.
Doctor: And are you still smoking?
Patient: Yes, in fact I have been smoking actively from pass three to four days because I am really stressed.
Doctor: Hm. And would you say, you might have had some exertion recently or did some steep hiking or some cardio exercises which might have caused some additional stress on your heart causing chest pain?
Patient: No, I did not do any exertion. Just actively smoking that's all.

Clinical note:
Symptoms: joint pain all over, decreased mobility in hands and wrists, discomfort, diarrhea (improving), less urinary incontinence, less pedal edema, feeling disturbed about mobility, sleeping all the time
Diagnosis: N/A
History of Patient: Patient, a 77-year-old white female, experiencing worsening joint pain, especially in hands and wrists, leading to decreased mobility. No significant swelling but discomfort. Generic Daypro not effective. No fever, chills, or erythema. Improvement noted in diarrhea, urinary incontinence, and pedal edema. Blood sugars slightly improved. Patient restarted Zoloft for suspected depression due to decreased mobility and increased sleepiness. No polyuria or polydipsia reported. No recent blood pressure checks.
Plan of Action: N/A
Doctor: I am sorry about that.
Patient: Yes, for assault, that's why I was in detention.
Doctor: Okay.
Doctor: When was this?
Patient: Around December of two thousand nine.
Patient: Not sure if I am under legal contraints right now. 
Doctor: Okay so we don't know.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient experienced an assault in December 2009, leading to previous detention. Current legal constraints are unknown.
Plan of Action: N/A
Doctor: Do you smoke cigarettes?
Patient: Yes, I do.
Doctor: How many packs a day.
Patient: Maybe one a day.
Doctor: Okay, you should think about quitting.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient is still a smoker, consuming approximately one pack of cigarettes per day.
Plan of Action: Advised patient to consider quitting smoking.
Doctor: What happens when you take Sulfa drugs? 
Patient: Oh man, I get a really ugly looking rash. 
Doctor: I'll make note of that so we have it in your chart.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient experiences a rash when taking Sulfa drugs.
Plan of Action: N/A
Doctor: Any known drug allergies? 
Patient: Nope, none whatsoever.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No known drug allergies.
Plan of Action: N/A
Doctor: Do you smoke cigarettes or drink alcohol? 
Patient: No. 
Doctor: Any use of recreational substances or IV drug abuse? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Denies any alcohol, IV drug abuse, tobacco, or recreational drug use.
Plan of Action: N/A
Doctor: Tell me what brings you here today? 
Patient: I'm having some issues with my right hand. 
Doctor: What kind of issues? 
Patient: I'm having these pins and needles kind of feeling in my hand and it has been going on for several weeks. Sometimes I feel it gets numb. I think it might be carpal tunnel, but I'm not sure. I'm just worried.
Doctor: Did you do anything for it? 
Patient: At work I recently moved my keyboard down. I just hope it will help. You know, I do a lot of the same kind of activities all the time. All of it I typing based. 
Doctor: What is more difficult, day or night? 
Patient: It gets worse at night. If I sleep on it, like in a certain way, it will just wake me up and it starts hurting. These tingling sensations are the worst. It helps if I shake it then the sensation goes away. It irritates me all the time. 
Doctor: Is it complete hand or is there any part of hand that is worse than others?
Patient: It is mostly my middle finger, but maybe my first or second finger of the hand also, but mostly my middle finger. 
Doctor: Is there pain anywhere else? 
Patient: In my thumb as well. I'm just afraid it can be arthritis. I don't want that, too, on my plate.

Clinical note:
Symptoms: Tingling and numbness in right hand, worse at night, involving mostly middle finger but also first and second digits. Pain in thumb, possibly due to arthritis.
Diagnosis: N/A
History of Patient: Patient reports tingling and numbness in right hand over several weeks, worsened at night and exacerbated by certain sleeping positions. Recently moved keyboard at work hoping for relief. Concerned about carpal tunnel syndrome and potential arthritis in thumb.
Plan of Action: N/A
Doctor: Have you been in any accident?
Patient: I have been a truck driver for some time but luckily have not been in any major auto accident. I had hit a moose once, where I bumped my head but do not remember getting hurt anywhere else. I had broken my ankle in the past. 
Doctor: Hm, I see here you mentioned to the nurse, that a car fell on your chest six years back?
Patient: Oh yes, I was repairing my car and it fell off the car jack stand and fell on my chest but fortunately I was not hurt.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Patient mentions having hit a moose and bumped his head but does not remember any chest injury. Previously mentioned to the nurse that a car fell on his chest six years ago, but states that he was not hurt.
Plan of Action: N/A
Doctor: Did you ever had pneumonia?
Patient: No, never. 
Doctor: Do you have any history of lung disease? 
Patient: No.
Doctor: Any history of tuberculosis? 
Patient: No.
Doctor: Are you feeling any shortness of breath or difficulty breathing?
Patient: No.
Doctor: Okay. Do you have any wheezing? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No history of pneumonia, lung disease, tuberculosis, shortness of breath, wheezing, dyspnea, or past pneumonias.
Plan of Action: N/A
Doctor: Tell me about your past medical history. Is there anything that I should be aware of? 
Patient: No, I don't think so. 
Doctor: Any known allergies? 
Patient: No. 
Doctor: Have you ever been diagnosed with diabetes or high blood pressure? 
Patient: Oh, last year I did have some incidents of high blood pressure, but I didn't take any medications for it. 
Doctor: Have you seen any variation in your weight? 
Patient: How do you know? It's been up. About fourteen pounds since last year.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No known allergies. History of episodes of high blood pressure, with weight up approximately 14 pounds from last year.
Plan of Action: N/A
Doctor: How did your treatment for the thrombosis go? I believe we did it on February nineteen of two thousand and seven. We finished the note the next day in order to send to your other following doctor. 
 Patient: The treatment went well. Thanks!

Clinical note:
Symptoms: N/A
Diagnosis: thrombosis
History of Patient: Treatment for thrombosis was documented on 02/19/2007 and 02/20/2007.
Plan of Action: N/A
Doctor: Where are you having numbness? 
Patient: In my left hand. 
Doctor: And no other symptoms? Any coughing or chest pain?
Patient: No. Just that weird feeling in my left hand.
Doctor: Any visual changes or motor changes. 
Patient: Nothing. 
Doctor: Great. What about any phlegm or shortness of breath?
Patient: Nope.

Clinical note:
Symptoms: numbness in left hand
Diagnosis: N/A
History of Patient: No coughing, sputum production, dyspnea, chest pain, vomiting, abdominal pain, visual changes, or neurologic deficits other than numbness in left hand.
Plan of Action: N/A
Doctor: How are you feeling? 
Patient: I've been having a lot more joint pain lately. 
Doctor: You're seventy seven, correct? 
Patient: Don't remind me. 
Doctor: When did you first start experiencing joint pain? 
Patient: Couple years ago. 
Doctor: In what ways has it worsened? 
Patient: It's caused me to become less active in general. My hands and wrists aren't as mobile. 
Doctor: Have you noticed any increased swelling? 
Patient: No, but it's all gotten to be a little too uncomfortable. 
Doctor: I see here that you take the generic of Daypro. Is that helping? 
Patient: No. 
Doctor: And no redness to the area, right? 
Patient: No. 
Doctor: Fever or chills? 
Patient: I had diarrhea for a few days, but it's gotten much better. I was also having trouble holding my bladder. 
Doctor: Are you going to the bathroom more often, experiencing excessive thirst, or other problems?  
Patient: No. My incontinence is a bit better and so is my ankle and foot swelling. 
Doctor: How has your blood sugar been? 
Patient: A little better. 
Doctor: Have you checked your blood pressure recently? 
Patient: Not recently. 
Doctor: Any new medications? 
Patient: I'm back on Zoloft again because I think I might be depressed. Ever since losing most of my mobility, I haven't been feeling like my usual myself. I'm also sleeping all the time.

Clinical note:
Symptoms: joint pain all over, decreased mobility in hands and wrists, diarrhea (improving), less urinary incontinence, less pedal edema, sleeping all the time
Diagnosis: N/A
History of Patient: Patient is experiencing worsening joint pain, decreased mobility in hands and wrists, diarrhea (improving), less urinary incontinence, less pedal edema. Patient suspects depression and has restarted Zoloft.
Plan of Action: N/A
Doctor: Anyone in your family been sick lately?
Patient: Yes, my sister has sinus problems. She was seen today.
Doctor: Okay that means she will be treated.
Patient: Yes.
Doctor: How about other family members?
Patient: No, my mom and dad are healthy.
Doctor: Good. Good.
Patient: Hm!

Clinical note:
Symptoms: N/A
Diagnosis: Clinical sinusitis (in sister)
History of Patient: The sister is in today with clinical sinusitis.  Mother and father have been healthy.

Plan of Action: N/A