Clinical note section (GENHX): The patient comes back to see me today.  She is a pleasant 77-year-old Caucasian female who had seen Dr. XYZ with right leg pain.  She has a history of prior laminectomy for spinal stenosis.  She has seen Dr. XYZ with low back pain and lumbar scoliosis post laminectomy syndrome, lumbar spinal stenosis, and clinical right L2 radiculopathy, which is symptomatic.  Dr. XYZ had performed two right L2-L3 transforaminal epidural injections, last one in March 2005.  She was subsequently seen and Dr. XYZ found most of her remaining symptoms are probably coming from her right hip.  An x-ray of the hip showed marked degenerative changes with significant progression of disease compared to 08/04/2004 study.  Dr. XYZ had performed right intraarticular hip injection on 04/07/2005.  She was last seen on 04/15/2005.  At that time, she had the hip injection that helped her briefly with her pain.  She is not sure whether or not she wants to proceed with hip replacement.  We recommend she start using a cane and had continued her on some pain medicines. The patient comes back to see me today.  She continues to complain of significant pain in her right hip, especially with weightbearing or with movement.  She said she had made an appointment to see an orthopedic surgeon in Newton as it is closer and more convenient for her.  She is taking Ultracet or other the generic it sounds like, up to four times daily.  She states she can take this much more frequently as she still has significant pain symptoms.  She is using a cane to help her ambulate.

Dialogue:
Doctor: Good morning, ma'am. You're here for a follow up, correct? 
Patient: Yes, doctor. Guess what, I just had my seventy seventh birthday. 
Doctor: Happy birthday!
Patient: Thank you, doctor. 
Doctor:  Just to confirm, ma'am, you identify as White, correct? 
Patient: Thank you. Yes, doctor. That's correct. 
Doctor: Okay, walk me through this. So, you've seen doctor X Y Z before, correct? 
Patient: Yes, that's right. I saw him for low back pain and lumbar scoliosis post laminectomy syndrome, lumbar spinal stenosis, and symptomatic right L two radiculopathy.
Doctor: You were having right leg pain when you saw him? 
Patient: Yes. 
Doctor: Have you ever had surgery on your back? 
Patient: Yes, I had spinal stenosis, so they did, um, a laminectomy. 
Doctor: How did you respond to the procedure? 
Patient: Well, I had lower back pain and some arthritis in my spine after. 
Doctor: How have you been treated for these following the surgery? 
Patient: Um, Doctor X Y Z did some injections into my lower back. 
Doctor: Do you remember which side it was in?
Patient: It was in the right side, L2-L3.
Doctor: When was the last time you had these injections into the lower back?
Patient: The last one was in March of two thousand five. 
Doctor: How did your symptoms progress following the injections? 
Patient: Well, I went back to Doctor X Y Z, and then he thought that the symptoms I was having were coming from my right hip. 
Doctor: Did he do any imaging on this hip? 
Patient: Yes, I had some done when I saw him on, um, August fourth two thousand four. 
Doctor: Okay, the x rays we took today show marked degenerative changes, and a progression since the x rays taken back in August when you saw Doctor X Y Z. 
Patient: Oh no. Oh, he also did the injections into my right hip. 
Doctor: When was that?
Patient: Um, it was on April seventh two thousand five, and the last time I saw him was April fifteenth. 
Doctor: Is that when you had the last injections? 
Patient: Correct. 
Doctor: Has anyone talked to you about doing a hip replacement?
Patient: Yes, but right now I'm not sure if I want to do it. 
Doctor: Are you still having pain in that right hip today?
Patient: Yes, it still hurts. 
Doctor: What makes the pain worse? 
Patient: Well, anything that puts weight on this hip hurts really bad. 
Doctor: Okay, if it hurts that bad you should be using a cane. Did you ever get one?
Patient: Yes, I used one to come in here today, in fact. 
Doctor: Good. Do you have any other appointments scheduled?
Patient: Yeah, I made an appointment with an orthopedist in Newton. It's closer to my house. 
Doctor: That's fine. What medicines are you taking? 
Patient: Um, I take the generic for Ultracet. Sometimes I take as many as four times a day. 
Doctor: Does this help the pain?
Patient: No, I'm still in pretty significant pain, doctor.