jshargo/medical-interview-conversations huggingface dataset:
Patient: No, I've been like, uh, no, no pain, no. I can walk just fine, no issues there. 

Doctor: Okay, excellent. So no antalgic gait. And when looking at um, the area, are you seeing any swelling or, or redness, or skin discolouration? 

Patient: No, no, nothing like that. It's just, uh, I can tell there's like a lump there, and if I press it, I can feel like the hard lump, but um, no changes in the skin above it. 

Doctor: Okay, and are you seeing any um, muscle atrophy around the area?
Patient: No um, nothing like that. 

Doctor: Okay, and are you seeing any, uh, like joint deformities or, or anything like that?
Patient: Um, no, not that I can tell. 

Doctor: Okay, um and, uh you don't have any, any pain, so if you press on the area or on the the knee joint, you can just feel the mass and no pain there?
Patient: Yeah, it just feels weird. I don't, I'm not in any pain or anything, but it's like, it's weird to look at and then weird to feel uh, as well. 

Doctor: Okay. Um, and um, uh okay, then no limitations with uh, with like range of motion of any of your joints including like uh, knee and ankle?
Patient: Yeah no, I can move everything just fine. 

Doctor: Okay, awesome and so that, that was everything that I wanted to ask today and uh, uh check on the physical as well. Um, so was there anything else that I maybe forgot to ask about or anything you wanted to add?
Patient: Yeah no, I um, nothing else I wanted to add, but I, I think my parents and I were just scared about it being like uh, cancer, or like a tumour, um, so I just don't know what I should do, if I need to get any tests done, or x-rays, or anything like that. 

Doctor: Okay, um, yeah, we, so um, the first thing we will want to get uh, an x-ray um, of the knee and also of the uh, long bones, so of your femur um, as well as your leg too. Uh, and because right now we, um, most likely think is called something, um, an osteochondroma, um, which is the most common uh, primary benign bone tumour. Um, however, there are other things that it, it could be, um, and so, such as like an osteoma, or um, an endochondroma, um, so we'll, we'll want to um, get that x-ray and um, kind of go, go from there. 

Patient: Okay, uh, yeah that, that sounds good. 

Doctor: Alright, so we'll get that, we'll get that ordered.
Patient: Hi, yes I've had this pain in my left elbow for a couple of weeks now and it's not getting any better so. I'm just here to kind of figure out what it is. 

Doctor: OK alright are you feeling this pain on the lateral side of the elbow, on the or on the medial side of the elbow?
Patient: It's on the medial side. 

Doctor: OK and sorry, when did this pain exactly start?
Patient: So it's been on going for like the past three months. But it's gotten worse over the last, I'd say three weeks. 

Doctor: OK, and. Has the pain been getting worse, any better?
Patient: Oh the pains been getting worse. 

Doctor: Yeah, OK. Was there any triggers or precipitating events to the pain, such as like a fall or any types of trauma to the elbow?
Patient: No, no, not that I can think of. 

Doctor: Have you had any pain or injury to the elbow in the past?
Patient: No. 

Doctor: Could you describe the character of the pain. Is it sharp, achey or dull? 

Patient: It's usually achey, but it can be sharp. 

Doctor: OK. Does the pain radiate anywhere?
Patient: No, it's pretty. It's pretty much in that one area. 

Doctor: OK, just on the medial side of the left elbow?
Patient: Yeah. 

Doctor: OK, and is there anything that you've done to help make the pain go away, or any alleviating factors? 

Patient: I am taking some NSAIDs that helps with the pain temporarily. 

Doctor: OK. And uh. Are there any factors that make the pain worse?
Patient: Um when I. I. I guess when I like extend my elbow out it gets worse. 

Doctor: OK, so it's a movement OK, and straightening the elbow?
Patient: Yeah. 

Doctor: OK, I mean, what is the severity of the pain on a scale of 1 to 10, with 10 being the worst pain you've ever felt. 

Patient: I'd say about 5. 

Doctor: OK. And um. So did you have any other symptoms associated with the elbow pain?
Patient: Um no, um not really I. I'm otherwise pretty healthy. 

Doctor: OK, so have you had any fevers or chills?
Patient: No. 

Doctor: Have you had any night sweats 

Patient: No 

Doctor: Or any any weight loss?
Patient: No. 

Doctor: OK, have you had any any headaches?
Patient: No. 

Doctor: Any sensory changes like changes to your vision or or hearing or even your smell or taste?
Patient: No. 

Doctor: OK, have you had any eye redness or eye discharge or your ear pain?
Patient: No. 

Doctor: OK. Have you had a runny nose or sore throat?
Patient: No. 

Doctor: Have you had a cough or shortness of breath? 

Patient: No. 

Doctor: Have you had any wheezing?
Patient: No. 

Doctor: OK. Have you had any chest pain? 

Patient: No. 

Doctor: Any lightheadedness or dizziness?
Patient: No. 

Doctor: Have you had any heart palpitations?
Patient: No. 

Doctor: OK, and have you had any nausea or vomiting? 

Patient: No. 

Doctor: Have you had any abdominal pain?
Patient: No. 

Doctor: Any diarrhea or constipation. 

Patient: No. 

Doctor: Have you had any urinary problems?
Patient: No. 

Doctor: OK. Have you had any skin rashes?
Patient: No, no. 

Doctor: OK, have you had any numbness or tingling? 

Patient: No. 

Doctor: And how about any muscle weakness?
Patient: No. 

Doctor: OK, and any joint pains anywhere else?
Patient: No. 

Doctor: OK, and any changes to your memory or or any confusion? 

Patient: No. 

Doctor: OK, and have you had any fatigue?
Patient: No. 

Doctor: OK and, have you had any changes to your appetite? 

Patient: No. 

Doctor: OK. Are an have you been diagnosed with any medical conditions in the past?
Patient: No. 

Doctor: OK, so do you take any medications, either prescribed or over the counter?
Patient: Um no, I just take some multivitamins. 

Doctor: OK, and do you have any allergies to medications? 

Patient: Um no. 

Doctor: OK, and have you had any hospitalizations or prior surgeries?
Patient: I I had a fracture when I was younger. It was in my humerus bone on the right side. 

Doctor: OK, so it's the to the fracture was on the other arm? 

Patient: Yes. 

Doctor: OK, and did that heal OK?
Patient: Yes. 

Doctor: Alright then. Can you tell me about your living situation? Currently, like whereabouts and who you're living with? 

Patient: I live with my partner of five years. We live in an apartment together. 

Doctor: OK, and are you working currently?
Patient: I am. 

Doctor: And what do you do? 

Patient: I work on the assembly line for Chrysler.  D : OK, uh, and uh. Do you do repetitive tasks at work?  I do. 

Doctor: OK, yeah, do you notice this, uh pain after, more so after a shift or after after a long day?
Patient: Yes, definitely. 

Doctor: OK, and what types of hobbies do you have, like do you play golf or tennis or or any kind of like, sports I guess?
Patient: Yeah, I used to play golf before this pain in my arm and my elbow, so I haven't played it in the past like six months. 

Doctor: OK, um OK and um do you smoke cigarettes? 

Patient: I don't. 

Doctor: And do you drink alcohol?
Patient: Um I'll have a glass of wine every other day. 

Doctor: OK, and how about the use of any recreational drugs like cannabis or or anything else? 

Patient: I'll smoke a joint once a week. 

Doctor: OK, alright and. Is there any family history of any heart or lung problems?
Patient: No. 

Doctor: Any musculoskeletal or neurological diseases? 

Patient: Um no. 

Doctor: OK, I got any autoimmune diseases like thyroid disease or diabetes?
Patient: No. 

Doctor: OK, um and so next I wanted to walk through a physical exam, so when you look at the elbow yourself, do you see any swelling or redness?
Patient: No. 

Doctor: OK, does it look like there is any muscle atrophy either in the forearm or the biceps or triceps? 

Patient: No. 

Doctor: OK, and how about any misalignment or joint deformity?
Patient: No, I don't see any of that. 

Doctor: OK, and are there any scars? 

Patient: No. 

Doctor: OK, and when you press on the medial part of the the elbow, do you feel pain?
Patient: I do. 

Doctor: How about over the olecranon or the, yea any pain over the olecranon? 

Patient: Um a little bit. 

Doctor: OK, and is there any pain over the lateral part of the elbow?
Patient: No. 

Doctor: OK, an any pain over the forearm, or biceps, or triceps muscles? 

Patient: No. 

Doctor: OK, and does the joint feel like it's hot?
Patient: No. 

Doctor: OK, and any pain with shoulder or elbow movements? 

Patient: No. 

Doctor: OK.
Patient: Actually, sorry with the elbow when I straighten it out all the way it hurts a little bit. 

Doctor: OK, when are you straightening it out all the way OK, But no pain with shoulder movements and full range of motion? 

Patient: No, no pain with shoulder. 

Doctor: OK. And how about pain with pronation and supination?
Patient: With pronation it hurts. 

Doctor: OK, at the medial side? 

Patient: Yes. 

Doctor: OK and how about with wrist. So with resisted uh, yeah, wrist flexion?
Patient: Wrist flexion yeah. That hurts too. 

Doctor: OK, and then how about if you passively extend your your wrist as far down as as you can go? 

Patient: Down uh yes. That hurts too. 

Doctor: OK. And is there any numbness or tingling anywhere?
Patient: No, no, no numbness or tingling. 

Doctor: OK. OK, so that was everything that I wanted to ask about today. Was there anything else that you wanted to mention?
Patient: No, that was that. What do you think I have and how can I fix it? 

Doctor: Yeah, so it. It's certainly it it sounds like with the medial aspect of your elbow having pain there over the last several months and some of the physical exam maneuvers, such as like passive wrist extension, resisted wrist flexion as well as pronation and the point tenderness over the medial elbow this could be a medial epicondylitis or a tendinopathy in that area. And so this is typically treated with activity modification, so this could be trying to avoid repetitive movements that that cause pain. And using medications such as Advil and Tylenol and doing strengthening and stretching exercises, which you can learn from a physiotherapist or or on your own as well. And also other things that that the medial side of the elbow that it could be is an ulnar ligament injury. Um or yeah, or the other thing to be considering is and ulnar ligament injury and so if the pain isn't going away, then we might consider an ultrasound or something to look at the structures there.
Patient: I've just been feeling really short of breath since this morning, and I don't, uh yeah I don't know what's going on. 

Doctor: It just started this morning. 

Patient: Yeah. 

Doctor: And uh, did you wake up feeling short of breath or was it after you had woken up and we were doing activities?
Patient: It was when I was doing activities. 

Doctor: OK, and what were you doing before you had the shortness of breath? 

Patient: Oh, I was just going to the kitchen to make breakfast. 

Doctor: OK, and uhm can you describe the shortness of breath? Is it more so that you're having trouble, deep breaths, or are you taking shallow fast breaths? How would you describe it?
Patient: Uhm? I guess just shallow, fast breaths, I feel like I've run a marathon and I just yeah and all I've done is just walked to the kitchen. 

Doctor: OK and has this happened to you before ever?
Patient: No. 

Doctor: No? OK. Are you having any other symptoms like off sore throat, chest pain, anything like that?
Patient: No. 

Doctor: So it's just the shortness of breath. 

Patient: Yeah, that's it. 

Doctor: OK. And so it it started this morning, is it still continuing, or is it, uh?
Patient: Still there. 

Doctor: OK, is it worse at all than it was this morning? 

Patient: Uhm, kind of the same, I'd say. 

Doctor: OK, are you getting any kind of chest discomfort or anything at all with breathing?
Patient: Maybe when I take a very deep breath, then yeah. It just kind of I feel like this sharp pain. 

Doctor: OK. How have you, having I've been having any chills or fever or anything like that? 

Patient: No. 

Doctor: OK, any dizziness or fainting spells?
Patient: No. 

Doctor: OK, do you feel that your heart is racing at all? 

Patient: No. 

Doctor: OK, And, and have you tried anything that's helped you improve those symptoms, like taking a rest or laying down flat? Anything like that?
Patient: No, haven't really tried much. It just started this morning so I I just decided come in. Right away. 

Doctor: Ok. Have you traveled at all recently?
Patient: Um, no. 

Doctor: Any uh contacted someone who's been sick recently? 

Patient: I don't think so. 

Doctor: OK.
Patient: I did just say sorry, I I did just get out of the hospital so maybe I could have had some contact. There's some exposure there. 

Doctor: OK, so so when did you get out of the hospital? 

Patient: Uhm, two days ago. 

Doctor: Two days ago, OK, and what were you in the hospital for?
Patient: Uhm? I had, I broke my hip. 

Doctor: OK, and did you have a surgery for your hip? 

Patient: No. They didn't think it was, surgery was needed. 

Doctor: OK, so how long were you in the hospital for?
Patient: About 4 days. 

Doctor: Four days, OK. And in those four days what were they doing for you there?
Patient: Just trying to help me just doing physiotherapy and helping me sort of get up and get out of bed. 

Doctor: OK.
Patient: And like giving me pain medications. 

Doctor: And since, or like when you went home today, set up any kind of home care for you or anything like that? 

Patient: Yeah they did. A nurse comes in once a day. 

Doctor: OK, and how about uh physiotherapy?
Patient: Yeah, I don't know. They haven't really been coming in and I I asked the nurse and she said she's gonna look into it. Maybe something went wrong there. 

Doctor: OK, Um, and after you've been discharged, have you been moving around at all, or if you've been pretty immobilized? 

Patient: I try, but it's been it's been hard like, specially the first couple of days. I don't think it did much. But since then, I've been, I've been trying to move around a little bit more. 

Doctor: OK. Have you noticed any kind of swelling in your legs at all?
Patient: Uh, no. 

Doctor: No, nothing like that?
Patient: No. 

Doctor: Have you previously had any kind of clots, like a deep vein thrombosis or pulmonary embolism? Anything like that?
Patient: No. 

Doctor: Have you had any previous diagnosis of cancer?
Patient: I did in the past. About 10 years ago I had leukaemia. 

Doctor: Leukaemia, OK. And are you still on any kind of treatment or do you see an oncologist or a mythologist?
Patient: No, not anymore. 

Doctor: Not anymore? OK. Um and so are you experiencing any kind of coughing up blood or anything like that? 

Patient: Uhm, no. 

Doctor: No. OK. Um do you feel any pain in your caps at all?
Patient: No. 

Doctor: No, OK. Alright, other than that, are you having any symptoms of nausea and vomiting at all? 

Patient: Uhm, no I don't. 

Doctor: OK, any fevers or chills?
Patient: No. 

Doctor: OK. Any night sweats or fatigue? 

Patient: No. 

Doctor: Ok. Any diarrhea or constipation?
Patient: No. None of those. 

Doctor: OK. And besides the cancer, any previous medical conditions that you've been diagnosed with?
Patient: No, I was pretty healthy before that. 

Doctor: Ok, any history of any clotting or clotting disorders at all? 

Patient: No. 

Doctor: OK. Do you take any medications currently?
Patient: No, no, not anymore. 

Doctor: OK, any allergies to any medications? 

Patient: Uhm, no. 

Doctor: Ok. Um any family history of any lung or heart conditions?
Patient: Um, no lung or heart conditions, no. 

Doctor: OK. And currently right now do you work at all? 

Patient: Yeah I do. I um, I'm a banker. 

Doctor: Banker OK. Uhm. And what's your living situation like? Where do you live with anyone or inward? Where do you live?
Patient: I live at home with my husband and my two kids. 

Doctor: Ok, and you smoke it all?
Patient: No, I don't. 

Doctor: OK. And do you use any recreational drugs like marijuana? 

Patient: Uh, sometimes I'll have marijuana with my friends, but I haven't really done that since the pandemic started. 

Doctor: OK, and you drink alcohol?
Patient: Yeah, I do come. I'll have maybe two or three glasses of beer on the weekend. 

Doctor: OK. Alright, so these are all this questions I had for you today. We'll do a full physical examination next. Do you have any questions or concerns?
Patient: No. 

Doctor: OK, so yeah, right now one of the main things we want to rule out, especially since you had the sudden shortness of breath today after a history of just recent discharge and the hip fracture or injury, and you're immobilized we need to make sure you haven't developed a clot that has traveled to your lungs. So we'll do a full physical examination and get some blood work done initially and then see if you require any medications for if you need thrombolysis for to break up the clot. We'll, we might do some imaging as well, so yeah, well, we'll just start with that, and then we'll go from there.
Patient: Sure. 

Doctor: So you'll be in here for a few hours until we get all those things done and see if you need any admission at all to the hospital. 

Patient: Sure. 

Doctor: Alright.
Patient: Thank you. 

Doctor: Welcome, take care.
Patient: So I've been, just over the last week, I've been feeling pretty sick. I have this pretty bad headache that started like probably a week ago, and then for the last few days I've been having these chills. Um, and I didn't get a chance to measure my temperature at all, um, but the worst thing has been just these muscle aches all over my body, and that's been going on for the last three to four days. 

Doctor: Sorry to hear that you're feeling so, uh, horrible over the past week. Um let's uh, let's try to understand this a little bit better. So you've had this headache for the past week or so. Where exactly is it? 

Patient: It's kind of just uh, all across my forehead. It's been going to the sides, like into my temples as well. 

Doctor: Okay, and what does it feel like? How would you describe it?
Patient: Uh yeah, it feels like, kind of like uh aching um, I, I have had headaches with throbbing before, but it's not so much throbbing it's more just constant, aching pain. 

Doctor: Um, if you had to give it a number from 1 to 10, with 10 being the worst um, pain ever, what number would you give it?
Patient: Uh, probably like a 7. 

Doctor: Oh wow, yeah, that sounds severe. How long have you, how long has it been a 7 for?
Patient: Um, it's actually a bit better now, but yeah, like over the last week it's been a 7. I would say now, it's probably around 5. 

Doctor: Okay. Um, anything that makes the headache better? 

Patient: Um I, I take like Tylenol, then like, it gets relieved for a bit, for like a few hours, and then comes back. 

Doctor: Anything that you feel makes the headaches worse? Any postures, or positions, or activity or um, any kind of exposure to light or sounds?
Patient: Uh no it's, it's just kind of there. Nothing makes it worse. 

Doctor: Do you have nausea or vomiting?
Patient: Uh no, no nausea or vomiting. 

Doctor: No. Any sensitivity to light or sounds?
Patient: No. 

Doctor: Okay. Uh, and is it only, is it only on one, on one side of your head or forehead, or is it on both sides?
Patient: Uh it, it seems like it's on both sides. 

Doctor: And have you noticed any visual changes? Any blurry vision with the headaches?
Patient: No. 

Doctor: Any other visual changes? No, okay. Um, and you've also had chills, but you said you haven't checked your temperature, right? 

Patient: No, I haven't, uh, I've been having chills for the last few nights. 

Doctor: Yeah, we can definitely check your temperature here in the, um here. Um, and you mentioned that the muscle aches have been quite bothersome for you. Is it all over your body or anyone, uh, in any one muscle group?
Patient: It seems like it's all over. 

Doctor: Okay, okay. And um, I'll ask you about a couple other symptoms just to rule out um, any other issues that you might be having. So have you noticed that you've been confused at all over the past few days? 

Patient: Uh no, I don't think so. 

Doctor: Have you had any like stiffness or rigidity in your neck?
Patient: Maybe a little bit of a stiffness in, in my neck. 

Doctor: Okay.
Patient: Then like I, I don't know if that's just the muscle pain. It's like kind of on my upper back, lower neck area. 

Doctor: We can definitely um, examine that, um, when I'm doing physical examine and see how that is. Um, okay, and uh, have you had any, um, redness in your eyes, or any teary eyes? 

Patient: No, nothing like that. 

Doctor: Do the headaches come and go, or is it always there?
Patient: Uh, they're pretty much like constant throughout the day. 

Doctor: Um, and do you have a runny nose or stuffy nose? 

Patient: Uh no, no I don't I, I think I'm kind of, I'm developing a little cough though. 

Doctor: Okay, when did that start?
Patient: Probably just yesterday I noticed myself coughing. 

Doctor: Is it like a dry cough or wet cough? 

Patient: Uh, a dry cough. 

Doctor: Any sputum or any blood come out?
Patient: No. 

Doctor: Any sore throat? 

Patient: No. 

Doctor: Uh, any chest pain?
Patient: No. 

Doctor: Any difficulties with breathing? 

Patient: Uh, no. 

Doctor: Any palpitations, or feel like your heart's beating very fast?
Patient: No. 

Doctor: Okay, any belly pain?
Patient: No. 

Doctor: Any uh, nausea or vomiting? 

Patient: Nope. 

Doctor: Any uh, diarrhea or constipation?
Patient: No, not that I've noticed. 

Doctor: Any weakness in any one side of your body? 

Patient: Nope. 

Doctor: Any numbness or tingling?
Patient: Nope. 

Doctor: No, okay. Um, any exposures uh, to anyone who could be sick? 

Patient: Um, I haven't noticed, but I, I do go to work, um, and we recently switched to like in person instead of I, I used to do um, home work, but for the last month I've been going into the office. 

Doctor: I see, and have you been wearing a mask?
Patient: Yeah, well I try to wear the mask. Sometimes like uh, in the, in the stock, like lounge, we like take take off the mask to eat and stuff but that's about it. 

Doctor: Are you maintaining social distancing when you're taking your mask off? 

Patient: Yeah, it's uh, most of the times we're pretty socially distanced when we're eating, but sometimes it's like hard to control when you know, when you're going near the microwave to heat up your food, and sometimes it gets hard. It's a, it's a fairly small room, so. 

Doctor: Yeah, well I would, I would recommend that you try to eat when people are not in the room if possible because you are putting yourself at risk.  Like if it's a small room, I think you should also talk to management or try to limit the number of people who can be in the room at a time. Um, for your own safety, you know, and for the safety of others uh, working with you. Um okay, and um, have you traveled anywhere recently?
Patient: No, we've been uh, at home. 

Doctor: Okay, good, um, and who do you live with? 

Patient: I live with my young, like uh, daughter and then my wife as well. 

Doctor: Okay, and you, do you think they might have got any contacts to anyone who is sick?
Patient: Uh no, they've been completely fine. Uh, my daughter is like, is uh, doing school from home right now, so she's not really seeing anyone. 

Doctor: Okay, that's good. And um, do you currently smoke?
Patient: I do, I do smoke um, probably half a pack a day. 

Doctor: For how long?
Patient: Um, for probably the last 20 years. 

Doctor: Okay, and do you uh, consume marijuana? 

Patient: Just um, maybe once or twice a month. 

Doctor: Okay.
Patient: Just uh, sometimes, it helps me sleep sometimes. 

Doctor: Sure. Do you take any recreational drugs like cocaine, amphetamine, LSD, ecstasy, etc.? 

Patient: No, nothing like that. 

Doctor: Any alcohol?
Patient: Yeah, I drink probably uh, a beer or two every couple days. 

Doctor: Alright, and uh, do you have any medical conditions that you've been diagnosed with?
Patient: Uh yeah, so I do, they're saying I might have um, high blood pressure. Um they like, it, it's still ongoing. Um they're testing, testing me for things. 

Doctor: Sure yeah, and have you uh, taken any medications for it?
Patient: No, not yet, I haven't been put on any medications. 

Doctor: Have you, do you take anything over the counter? Any herbal pills, vitamins, minerals, etc.?
Patient: No. 

Doctor: Okay, and do you have any allergies? 

Patient: No allergies. 

Doctor: Okay, good. Um, and have you had any surgeries in the past or any hospitalizations?
Patient: Um I was pretty young, I had my tonsils removed um, but other than that no no other surgeries or hospitalizations. 

Doctor: Good. Any family history of any medical conditions?
Patient: Um, so I think my mother, she, she has like type 2 diabetes. 

Doctor: Okay. 

Patient: And uh, my father has been pretty healthy, like no issues with him. 

Doctor: Good. Um, okay, have you had any um, have you had migraines in the past?
Patient: Um, yeah, sometimes I, when I'm like stressed at work and like I uh, it's not like anything regular that happens to me. I probably have had migraines in the past. 

Doctor: Okay, okay, and have you ever been diagnosed with asthma or um, with uh, COPD? 

Patient: No. 

Doctor: Okay, alright, um so it sounds like you've had a headache for the past week, which has been kind of constant, about 7 out of 10. And then you've also developed a fever, but you haven't, or I guess you've been feeling, you've been having chills uh, and we can measure temperature here, and you also had a cough that started yesterday. What about um, sense of taste? Have you noticed any changes there?
Patient: Uh, no, not that I've really noticed. 

Doctor: What about your sense of smell?
Patient: Um, my smell, I don't think so, but like sometimes I do feel a bit, like stuffy as well. Like not, not right now, but before when I felt stuffy I lost my sense of smell. 

Doctor: Sure, yeah, okay. Um, okay well that's all the questions I have for you. We'll do a physical exam um, get a chest x-ray done, also examine your neck as well a little bit, just to make sure there's no stiffness or rigidity, have a look inside your mouth, um, listen to your chest.
Patient: Okay. 

Doctor: We will also get a COVID swab done, simply because your symptoms sound very similar to um, or I guess a lot of these symptoms do overlap with symptoms of COVID, so we'll do that. And um, I would require, would request that you continue to uh, stay at home if you haven't been doing so so far. Um, take a leave from work, try to do work from home, and quarantine at home as much as possible and stay away from your wife and your daughter as well, at least until the swab is back and you get some more guidance from uh, public health. If it is positive, they will give you a call. Um, there are lots of guidelines on how to self isolate and I, I can share that with you. Um, it's best that you do that for now. Um, we will run a couple of tests, do labs, and based on those results, uh, we'll decide if you need to stay in the ER or if we can um, if you can be discharged later today. Do you have any questions for me?
Patient: Uh no that, that all sounds great. Thanks for explaining it to me. 

Doctor: You're welcome.
Patient: Hi I'm here with my son and he's just been feeling awful. He just has this runny nose and he's been sneezing all the time and uh I don't know maybe he has allergies or something? I just came in 'cause I wanted to get him checked out and maybe get some medications. He's just feeling horrible. 

Doctor: Yeah, for sure when did when did the sneezing and runny nose start? 

Patient: He he's had it for um, he's just always kind of, you know he's always having that runny nose. You know kids always do but it's just been pretty bad over the past um two weeks. 

Doctor: Past two weeks. OK. What started first, the sneezing or runny nose?
Patient: Uh the runny nose kind of just got worse a little bit over the past uh two weeks and then the sneezing kind of started at about the same time. 

Doctor: OK and and the runny nose is he having um like what colour is it? 

Patient: It's just clear like. 

Doctor: Clear. OK. Does he ever feel like he's uh, do you ever feel like he's stuffy?
Patient: Uh yeah, kind of. He's just been snorting and sniffing and um I don't think he knows how to blow his nose yet. But he's like clearing his throat, so I think he's he's a little bit stuffy. 

Doctor: Okay. 

Patient: But he hasn't complained about difficulty with breathing or like, he's been, like he sleeps with his mouth closed. So I think he he should be able to breathe OK. 

Doctor: OK, good, so you said no shortness of breath or trouble breathing. Has he had any coughs?
Patient: Kind of. In the morning, so I I see that whenever he wakes up in the morning, he just has to like clear his throat a lot and like cough and then um gets better. 

Doctor: OK, OK. Is he bringing up phlegm when he coughs? 

Patient: Um, a little bit. 

Doctor: What colour is it?
Patient: It's the same stuff that comes out of his nose. 

Doctor: OK yeah, so no blood or pus?
Patient: No, no. 

Doctor: No? OK. Have you, do you think he's lost his like sense of smell or taste? 

Patient: Uhh no. 

Doctor: No? OK. Any changes in his vision or hearing?
Patient: Um I don't think so. 

Doctor: No? Did like, um, have you noticed any discharge from his eyes? 

Patient: No, no. Sometimes he does have that, but no, not in the past two weeks. 

Doctor: OK so his like eyelids aren't swollen or his eyes aren't red?
Patient: No, no, no. 

Doctor: No? OK. And does he, have you noticed any swelling in his, either like face, neck, like belly area, or his limbs? 

Patient: No, no I haven't. It's just his nose is like a little bit red. 

Doctor: OK.
Patient: And uh yeah, he's just he's just itching all the time, just itching his nose, itching his um ears, yeah but no, no swelling. 

Doctor: No swelling. Have you noticed any rashes on him?
Patient: No, I checked yesterday night very carefully. 

Doctor: OK, good. Any weight loss?
Patient: No, he's been gaining weight so um good that he's been eating well. 

Doctor: Yeah, that's good. Any fevers or chills?
Patient: No. 

Doctor: No, does he look like he's like excessively tired?
Patient: He's a little bit fatigued because of the sneezing and the, and the runny nose. You know, he's not going out to play as much. 

Doctor: Mhmm. 

Patient: Um but it's not, you know he's still, he's still cheerful. He's not irritable or anything. 

Doctor: OK, OK. Um and then have you noticed that he's like, taking in like, rapid breaths?
Patient: No, no, his breathing has been good. 

Doctor: OK. How about his bowel movements? Have those been normal?
Patient: Yeah. 

Doctor: Yeah OK, any nausea or vomiting?
Patient: No. 

Doctor: Um, how about his urine?
Patient: No, no problems there. 

Doctor: OK, how about like dizziness or fainting spells?
Patient: No, no, no. I didn't notice anything like that. 

Doctor: No? Any confusion that you noticed? 

Patient: No. 

Doctor: Headaches?
Patient: No. 

Doctor: No, OK. Um has he been like excessively itching anywhere? 

Patient: Um just his uh, just his nose and I think his like, I think his mouth is itchy too, 'cause he keeps doing this thing with his tongue just kind of, I don't know, just kind of like itching the top of his mouth with his tongue or something. 

Doctor: OK.
Patient: Um yeah just like his face is itchy. 

Doctor: Hmm, OK. Um, has he come into any contact with sick people recently? 

Patient: Um, I don't, maybe. So, two weeks ago he was playing outside, um and I know that he, he does, his symptoms do get worse when he's outside, so I don't know, maybe. 

Doctor: OK.
Patient: He was playing with uh, with his brother but then this other kid from the neighbourhood also came around. 

Doctor: OK, OK. How about um travel to anywhere?
Patient: No, we've just been staying at home. 

Doctor: OK, OK good. Um is he an otherwise healthy kid at the moment? 

Patient: Yeah, yeah, he's an, he's a healthy kid. 

Doctor: OK, um any complications when you were pregnant with him?
Patient: No. 

Doctor: No? Um how about at birth?
Patient: No, no complications. 

Doctor: OK. Did he need to be hospitalized after birth for any reason?
Patient: No. 

Doctor: Any surgeries?
Patient: No. 

Doctor: Um, any allergies? 

Patient: Um I don't think so. I know he's not. 

Doctor: No? He's never been diagnosed with like eczema or asthma?
Patient: Oh he's, he's had eczema. He had it. 

Doctor: OK.
Patient: Yeah, comes and goes. 

Doctor: His eczema comes and goes?
Patient: Hmm. 

Doctor: OK, um is he on any medications?
Patient: No. 

Doctor: No? Even for his eczema?
Patient: It's pretty mild. 

Doctor: OK. Um has, have you ever like given him um Reactine or like any of the, those anti allergy medications in the past?
Patient: I've tried the, uh, yeah, the ones over the counter, um, they do help. Um, I tried it this time, but uh it didn't do much. 

Doctor: OK. OK. And, I was gonna ask you something else. Um, his symptoms, like the sneezing and the, and the runny nose, like has he experienced this before? 

Patient: Oh yeah. 

Doctor: OK.
Patient: It usually gets worse um uh I guess like around this time, uh I can tell when spring is coming up. Um, it gets pretty bad, but he always has a runny nose um and he sneezes sometimes here and there. 

Doctor: OK, and you mentioned this has been going on for more than four days this time around?
Patient: It's been, it's been going on for the past uh two weeks. 

Doctor: OK. OK, and is it like um impairing his like daily activities or like his ability to um like, sleep?
Patient: Uh it does affect his sleep sometimes he doesn't like um, just the itching really bothers him. 

Doctor: Mhmm. 

Patient: So he can't uh, he finds it hard to fall asleep. That's like, I usually, that's when I give him the the medications. To help him fall asleep. 

Doctor: OK. OK. And uh is he up to date with all his immunizations?
Patient: Yeah. 

Doctor: OK. Any family history of asthma, eczema, or something called allergic rhinitis?
Patient: Uh I have asthma. 

Doctor: OK. And is your asthma severe?
Patient: Uh no, it's it's pretty well controlled. I used to, actually, I used to have asthma as a child. 

Doctor: OK, I see. 

Patient: It's pretty well controlled right now. I don't even need medications. 

Doctor: OK, OK.
Patient: I remember I used to, I used to get allergies as well as a child. 

Doctor: Oh I see. 

Patient: But very similar, lots of sneezing and yeah. 

Doctor: Mhmm, alright. Were you ever, did you ever take like an allergy test?
Patient: No. I didn't think about it, I just never, like my my my parents didn't take me to get that testing done. 

Doctor: OK, how about your son? Has he been allergy tested? 

Patient: No, but I feel like he probably should. 

Doctor: Yeah, OK. And then, does anyone at home smoke?
Patient: No. 

Doctor: No, OK. Um do you have any, like old carpets, dust, mold, or asbestos at your place?
Patient: Uh we've got all of, we got our carpets uh removed uh two years ago. That's actually helped uh with his symptoms. Uh and I know, we tried it, we removed the curtains as well and we've used blinds. So yeah. 

Doctor: OK.
Patient: And I don't think so, I don't think there's any spores or things like that. 

Doctor: OK, good. Um, is he an otherwise healthy child like developmental wise, like he's growing, gaining weight OK, like he's, his motor skills and like social behaviours are all up to par with his peers? 

Patient: Oh yeah he's doing great. 

Doctor: OK OK good um those are all the questions I had for you today. Did you have any questions of your own?
Patient: No. 

Doctor: No, OK. So for him um it sounds more in keeping with something called allergic rhinitis than an infection, but because his symptoms do overlap with that of Covid,  we'll probably get him a swab anyways, and those results should come back in 24 to 48 hours. In the meantime, rhinitis is, allergic rhinitis is caused by allergies to certain things, so we can get him allergy tested um and that will give us a better understanding of like what his triggers are and the way to treat that is to avoid those triggers, those allergens. And if his symptoms are persistent, um we will prescribe him also like an intranasal corticosteroid. Um and there are like, there are like second line treatments as well, like antihistamines and leukotriene, like leukotriene receptor antagonists, but those are like second line. We'll we'll see how he does with the inhaled corticosteroids at first. How does that sound? 

Patient: Sounds great. 

Doctor: OK, great.
Patient: So I so I have COPD and it's usually like pretty manageable with my puffers and that. But just in the last like 3 days I feel like it's gotten a lot worse. You know, I, I feel like I'm coughing more often and I'm now, uh, kind of producing more sputum. Kind of like a green yellowy sputum uhm. I even notice that there is like a little bit of blood a couple times when I was like, really coughing hard. I’ve been finding it like harder to breathe than usual. I don’t have home oxygen or anything, and I'm not. I didn't think I was quite there yet, but this these last few days it's been. It's been really hard to breathe. 

Doctor: I see OK, so this is happened in the past three days. Have your symptoms gotten better or worse over this time? 

Patient: I feel like they've been get maybe maybe getting a little worse. They definitely haven't gotten better, 

Doctor: OK, and has this ever happened to you before?
Patient: I’ve had I had some troubles like when I've been sick before where the cough is gotten pretty bad. This is probably this is probably the worst that I've had, but I have like I have had in my COPD been made worse by being sick. 

Doctor: I see OK. Well, I guess the first thing we're going. So how's tbad, how bad is your shortness of breath?
Patient: Like I I walked here fine, but I normally like can walk around the block and I go for a walk, usually a couple times a day to walk my dog and it's been just it's been a little bit trickier to do that. 

Doctor: I see OK. And uh have you ever had any hospitalizations in the past specifically for COPD exacerbations?
Patient: Um I haven't. Uhm, like stayed over in the hospital. I like come to emerge a couple times. 

Doctor: Alright um. How many times? 

Patient: I think twice maybe over the last like three years. 

Doctor: Uhm when were you diagnosed with COPD?
Patient: Uhm 4, 5 years ago? 

Doctor: Was it formally diagnosed using the proper testing? 

Patient: Yeah, they referred me to a lung, a lung doctor. 

Doctor: I see OK. And have you had any fevers or chills?
Patient: I feel like I may have had a fever last night. I felt really hot. 

Doctor: Did you check your temperature?
Patient: I I don't have a thermometer at home. 

Doctor: No problem. We can now check your temperature.
Patient: Here by the bed. I would say had a fever. 

Doctor: Sure. And. Have you had any other symptoms? So have you had like a runny nose or stuffy nose? Any pain in your sinus? 

Patient: I think I think I have a I've had a bit of a like this pressure in the sinus area, but it's been the cough has been the thing that's been the most bothersome. 

Doctor: I see and have you had a sore throat at all?
Patient: Oh no. 

Doctor: OK. A headache?
Patient: Uhm? Maybe a little bit, yeah. 

Doctor: OK and any nausea or vomiting?
Patient: No. 

Doctor: Diarrhea or Constipation? 

Patient: No. 

Doctor: Abdominal pain.
Patient: No. 

Doctor: OK. In have you recently lost weight unintentionally? 

Patient: No no, I wish but no. 

Doctor: OK. Have you had any night sweats where you feel like you're drenched in sweat at night?
Patient: Uh, no, nothing like that. 

Doctor: Alright. And have you had any exposures to anyone who could potentially be sick? 

Patient: Um. Let me think I I meet my I meet a couple of friends to walk our dogs together outside and one of them was a bit sick for a bit. We try not to get too close, but maybe I don't know. Maybe sometimes we walk a little too close. We feel too safe 'cause we're like outside. 

Doctor: OK, OK um. And did your friend get a covid test done?
Patient: Uhm? I don’t know. 

Doctor: That's OK. OK, and you mentioned that you had COPD that was diagnosed four or five years ago. Any other medical conditions that you've been diagnosed with?
Patient: Um. Yeah I have a high blood pressure. 

Doctor: OK, and are you taking any medications? 

Patient: I’m not, I'm not I we talked about it, but I decided to try to change my lifestyle as much as I could 1st and I've also done that for the COPD. It's generally pretty like I've been really trying to take care of it, but um I feel like I maybe got sick or something this time, yeah, so my blood pressure is like OK right now. 

Doctor: OK, OK.
Patient: My pressure and then I lost weight and started this walking more. 

Doctor: That's great. That's really, really good that you're taking better care of yourself. Should definitely continue doing that. 

Patient: Right? 

Doctor: And you've mentioned that you have some puffers. How often do you use those?
Patient: Oh like I have the one that I use every day. That I'm supposed to just use no matter what, and then the one that I use when kind of just when I need it. I probably use it like once every two weeks. 

Doctor: OK. OK. Uhm? And you mentioned that your COPD’s are getting better. Do you find that it's affecting your life in any way affecting the way that you're doing your daily activities at at home or at work, if you are working? 

Patient: I like pretty OK except for like if I get sick I so yeah, it's been. 

Doctor: I see.
Patient: So I think it's like pretty well managed like I stay on top of my lifestyle now. 

Doctor: Thats good, thats good. Do you have any allergies?
Patient: Uh, no, no. 

Doctor: No, no allergies to medications ?
Patient: No. 

Doctor: OK, OK, good and. Do you, just a couple more to general questions. Have you traveled anywhere outside the province recently? 

Patient: No. 

Doctor: You, I guess I should have asked you earlier, but have you noticed any change in your sense of smell?
Patient: Uh no, I don't think so. 

Doctor: Any change in your sense of taste? 

Patient: Uhm? No, I don't think so. 

Doctor: Any confusion or fuzzy feeling?
Patient: Nope. 

Doctor: No OK, any muscle aches in your body?
Patient: Uh no. 

Doctor: OK, alright, and just kind of some questions about your living situation. Do you currently live alone? And I you mentioned that you have a dog? Are there any is there anybody, anyone else in the house?
Patient: Uh my husband. 

Doctor: OK and. Do you currently work?
Patient: Yeah, I uh, like I've been working from home. I worked for the municipality. 

Doctor: I see. Do you think you might have had any exposures to say dust or smoke or anything like that that could have worsened your symptoms? 

Patient: I don't think so. 

Doctor: And do you drink alcohol?
Patient: Oh, very rarely . 

Doctor: OK do you smoke? 

Patient: I used to. I quit once they said I have COPD. I smoked 1/2 pack a day for probably 20 years. 

Doctor: OK, OK, and do you consume marijuana or any recreational drugs?
Patient: No. 

Doctor: OK, uh, alright, well I guess one more question, are there any lung diseases or heart conditions or cancers that run in the family? 

Patient: No, nothing that I can think of. 

Doctor: Alright, well that's those are all the questions I had for you. I will now do it physical exam and look at your vitals and listen to your chest. It's likely that what you have right now is COPD exacerbation, maybe just a like an infection that you got, which worsened some of your COPD symptoms. We would also have to rule out covid, so we'll be doing a covid swab and will decide based on the on your labs in your vital signs. It's instead of other things whether you need to stay in the ER and be admitted, or if you are good to go home, I will also talk to my attending and will make those decisions together and come back and talk to you. Does that sound good to you?
Patient: Yeah, that sounds great. Thank you. 

Doctor: Your welcome.
Patient: Well, I've had this cough but the biggest issue is that I've been really short of breath. 

Doctor: OK, um, when did the cough start?
Patient: I would say about 3 days ago. 

Doctor: Three days ago, OK, and uh, around that time did you also start feeling short of breath? 

Patient: Uh, the shortness of breath has come on, I don't know within the last day or so. It's come on after that, the cough started first. 

Doctor: OK, and the cough, is it a dry cough or is it a wet cough?
Patient: Well, I've been bringing up some yellowish green, kind of like phlegm, so um I guess a wet cough. 

Doctor: OK, so yeah, yellowish green you said.
Patient: Yeah. 

Doctor: OK, any blood in the sputum? 

Patient: I haven't noticed any blood. 

Doctor: OK, and how much sputum are you coughing up each time? Like is it kind of the size of your fingertip or does it fill your whole palm?
Patient: Um, yeah, probably more like the size of like a thumb tip. 

Doctor: OK, OK um, and do you notice any, like pus or froth in the sputum?
Patient: Nothing like that I noticed. 

Doctor: OK, and if you were to describe the sound of your cough, does it sound like it's barky or like a hacking cough?
Patient: I don't know, I guess hacking. 

Doctor: Alright, and do you hear any wheezing at all?
Patient: No, well, maybe I guess when I'm really short of breath, yeah, wheezing, yeah. 

Doctor: OK, and the shortness of breath, how severe is it? 1 to 10, 10 being the worst? 

Patient: Maybe a 7? 

Doctor: At seven OK, are you having issues sleeping because of your shortness of breath?
Patient: Uh, well I can't tell if it's that or the cough. I mean between those two things it's been definitely interrupting my sleep. 

Doctor: OK, and do you find there are any triggers to your coughing like like um, a particular time of the day? Triggers like you know pollen or things in your environment like pets? 

Patient: No the cough has been kind of going on all day. Um, right when I get up in the morning and goes on all night, it's been getting worse to these last few days. 

Doctor: OK yeah, um yeah, that doesn't sound great in terms of your shortness of breath. Do you find that certain positions make it worse? Or like exerting yourself makes it worse?
Patient: Um, not really. 

Doctor: OK, and have you ever experienced anything like this in the past? 

Patient: No, I haven't. 

Doctor: OK. And any other symptoms that you have along with your coughing and sputum?
Patient: As soon as I breath, well, I just haven't felt good like, tired, kind of weakish. 

Doctor: OK yeah um, along with your fatigue and feeling weak, have you experienced any dizziness or fainting spells? 

Patient: No dizziness and I haven't fainted or anything like that. 

Doctor: OK, any confusion or memory loss?
Patient: No concerns with my memory. 

Doctor: OK. And how about um, muscle aches or any sort of body aches? 

Patient: Alright, yeah, maybe a bit, kind of, and weak. 

Doctor: Yeah, alright, so let's go back to your shortness of breath. Do you have any chest pain associated with that?
Patient: Uh, no. 

Doctor: OK, and do you ever feel like your heart's racing?
Patient: No, nothing like that. 

Doctor: OK, and how about changes to your bowel movements? 

Patient: No, those have been normal. I haven't had any diarrhea or constipation. 

Doctor: OK and no blood in your stool?
Patient: I haven't noticed any blood, no. 

Doctor: OK, how about abdominal pains? 

Patient: Oh yeah, I don't know why, yeah, my belly's been a bit achy maybe. 

Doctor: OK, and how about a sore throat?
Patient: No, my throat felt OK. 

Doctor: OK, good and have you experienced any loss of taste? 

Patient: No loss of taste, but I've noticed, yeah, my smell has been kind of funny. 

Doctor: Your smell has been kind of funny, like you can't smell or do things smell differently than you expect them to?
Patient: Yeah, there was a candle on earlier today and I guess I couldn't really smell it, so I guess I haven't been able to smell. 

Doctor: Ok, do you have a runny nose or a blocked nose? 

Patient: No, I haven't had to blow my nose or anything. 

Doctor: OK, any changes in your vision or hearing?
Patient: No, that's been normal. 

Doctor: OK, any discharge or pain in your eyes or ears?
Patient: No, that's been OK. 

Doctor: OK, and then any changes to your urine?