jshargo/medical-interview-conversations huggingface dataset:
Patient: Uhm? I'm short of breath all the time. Yeah, it's just, It's it's worse when I am moving. 

Doctor: And so you've been diagnosed with COPD. Have you had to use oxygen at home at all? 

Patient: No. 

Doctor: No OK, how about have you had any hospitalizations in the past for your COPD?
Patient: Yeah, I had a had a couple last year. 

Doctor: A couple of hospitalizations? 

Patient: Yeah, yeah. About four hospitalizations last year. 

Doctor: Oh, I see. And and did you have to use any oxygen in the hospital?
Patient: Yeah yeah I did. I did. 

Doctor: They never sent you home with any like oxygen tank or anything like that? OK.
Patient: Although they told me my COPD was pretty bad. That I might need to get oxygen at some point. 

Doctor: I see. And have you, when you in hospital, did they give you antibiotics or when you went home? 

Patient: Yeah. Yeah they did. they did. 

Doctor: Did they tell you you had pneumonia at all at any point?
Patient: I don't think so. 

Doctor: No. OK, OK any any changes or do you get any chest pain at all?
Patient: Uhm, sometimes when I breathe in very deep. 

Doctor: I see. Any any kind of sensation that your heart is racing? 

Patient: No. 

Doctor: No. OK Any kind of issues with your sleep or appetite?
Patient: Umm. Well, no, not really. It's just the difficulty breathing sometimes it's been hard to sleep. 

Doctor: OK, any any exposure to any fumes or allergens in your household, any animals, pets?
Patient: No. 

Doctor: OK. And other than COPD, have you been diagnosed with any medical conditions in the past?
Patient: No, I'm pretty healthy otherwise. 

Doctor: OK, do you have any allergies at all to medications or environmental allergies?
Patient: I'm allergic to cats. 

Doctor: To cats, OK, do you have a cat? 

Patient: No. 

Doctor: No OK. Have you been around any cats recently?
Patient: Nope 

Doctor: No OK, are you on any medications besides the puffers? 

Patient: Nope 

Doctor: OK, and so you use the ventolin and then what's the other puffer that you use?
Patient: Uhm I don't remember the name. 

Doctor: Do you know the color at all?
Patient: It's orange 

Doctor: orange OK. So you've had four hospitalizations in the past year. Any surgeries in the past? 

Patient: I had a knee replacement on my right side. 

Doctor: OK, and when was that?
Patient: 10 years ago 

Doctor: OK. Do you have any family history of any lung conditions, heart conditions, any cancers? 

Patient: My dad had COPD as well. 

Doctor: OK. And any lung cancers in the family?
Patient: no. 

Doctor: No, so currently do you work at all?
Patient: I'm retired. 

Doctor: OK, and what did you do before you retired?
Patient: I was I was a mechanic at Chrysler's. 

Doctor: OK, and during your work, were you ever exposed to any chemicals or any kind of in your
Patient: Not that I'm aware of. 

Doctor: OK. And how long have you been smoking for? 

Patient: Oh yeah, I was a teenager when I started. 

Doctor: OK, and how much do you smoke on a on a daily basis?
Patient: I smoke, I smoke a pack a day 

Doctor: OK. Have you at all tried to quit before?
Patient: I can't quit. It's not gonna happen. A lot of people have told me try to quit but I I just can't live without it and I'm 75 now, you know. Like I'm not gonna live a lot longer anyway. 

Doctor: Yeah yeah but also even if you try to cut down some of your symptoms might get better. Like even though you're 75, you can definitely have improvement in some of your symptoms that you're having, like the shortness of breath and coughing. So if at all that you you want to consider cutting down and gradually. we can talk about that more as well.
Patient: Sure 

Doctor: OK, and do you use any recreational drugs like marijuana?
Patient: No 

Doctor: Do you drink?
Patient: No 

Doctor: No, OK, so yeah, those are all the questions I have for you. Do you have any questions for me? 

Patient: No, I just I guess I need to be admitted right? Just like those other COPD exacerbations? I'm thinking this is exactly that and I'll have to stay in the hospital, right? for a couple of days 

Doctor: Yeah, so we definitely before deciding on whether or not you should be admitted, since you said the Ventolin is not working for you, we will definitely give you some some ventilation and perhaps steroid for just to get rid of some of your symptoms right now, and we want to also make sure since you're having like cough as well as shortness of breath to do a covid swab on you, just in case. I know you've been like isolating and everything, but just in case I will do that and we'll get like a chest x ray on you as well, just to see if there's any kind of pneumonia going on. And then from there we'll also get your blood work, and then from there we'll see whether or not you will require another admission.
Patient: Sure. 

Doctor: OK, and there you might, I'm not 100% sure, but you might require home oxygen if like we take your vitals and everything and your oxygenation is very low. Have you have you been talked about that at all in the past?
Patient: Yeah, they talked about it last time I've been trying to avoid it, but if it has to happen, it has to happen. 

Doctor: Hmm yeah, and it might just sometimes just, you know you've had four admissions in the past and it might actually just help you stay at home if you are on oxygen. Anyways, yeah we can talk about that. We'll do like a full physical examination everything and go from there. 

Patient: Sure. 

Doctor: Great, I'll be with you shortly.
Patient: Hey, I just, um, I just kind of came in to talk about my stuffy nose. It's yeah, it's been a problem for, I don't even know how many years it's always been there. And now that school is a little less busy and things are virtual and have more time, I decided I'll get something done, um, to get it fixed. 

Doctor: OK, and how long has this been going on for?
Patient: Since I was young, um like maybe years, couple years. 

Doctor: OK, and then do you like how often are you getting the stuffiness? Is it like every day? Is it during the day at night? When do you usually get it? 

Patient: It's kind of uhm, it's kind of all the time, to the point that I've somewhat gotten used to it. And it's just my, it's only on the left side and it's just always kind of stuffy. Initially I would have trouble falling asleep 'cause it would, I would just find it a little bit bothersome, but now I'm kind of just used to it. 

Doctor: OK, and so it's just on the left side. It never moves to the right side.
Patient: Well, like sometimes when I get ill its on both sides, but usually it's on the left side. 

Doctor: OK, and so you have stuffiness. But do you ever get any kind of discharge or drainage from your nose?
Patient: Sometimes I get a little bit bleeding. 

Doctor: Are you, OK. Um, bleeding? Is it blood mixed into the discharge or drainage? Or is it like you get nosebleeds? 

Patient: I get nosebleeds like maybe yeah. Like maybe when I'm exercising or something I'm like at the gym. Uhm, fom doing the gym class. Yeah, yeah when playing with my friends. 

Doctor: OK, and how often do you get these nose bleeds?
Patient: Uhm? Maybe once a month or once in two months. 

Doctor: OK. And umm, and is there any, do you have any other symptoms? So like, do you have any pressure, sensation in your face around your jaw, cheeks, forehead?
Patient: No. 

Doctor: No, so OK. And do you find yourself having more congestion when you wake up? 

Patient: Uhm? Not really, maybe a little bit. 

Doctor: OK, so it's not worse when you're lying flat or anything like that?
Patient: No. 

Doctor: OK, um, and do you find that you have to constantly clear your throat at all throughout the day? 

Patient: Uhm, no. 

Doctor: OK, and do you at all feel that some stuffiness drains back into your throat at all anytime during the day?
Patient: I don't think so, no. 

Doctor: So it's just the congestion that's been going on for quite some time and does it change with the seasons at all?
Patient: No, it's just there all the time. Like I can't even tell. This is like my normal now, but my mom said I should get it checked out. 

Doctor: OK, uhm. Have you tried anything for it like either medications or the neti pot or steaming and has anything helped you at all? 

Patient: I tried steaming but it didn't do much. It kind of got better. Maybe for an hour maybe, but then yeah, it didn't do much. 

Doctor: OK, and otherwise, are you having any other symptoms like fever, chills, cough, sore throat, anything like that?
Patient: No. 

Doctor: Are you having any loss of sense of taste or smell?
Patient: Uhm, no. 

Doctor: Any shortness of breath at all? 

Patient: No. 

Doctor: OK, uh. And otherwise, any recent travel or in contact with anyone who's been sick?
Patient: Uhm, no. 

Doctor: Have you previously been diagnosed with any medical conditions? 

Patient: No, I'm pretty healthy. 

Doctor: And do you know if you have any allergies to any medication?
Patient: Uhm, no, no allergies to medications. 

Doctor: OK, and any allergies to any environmental issues like factors that cause more stuffiness, sneezing, itching, red eyes, runny nose anything like.
Patient: I'm allergic to cats. 

Doctor: Cats? OK.
Patient: But I haven't been around one for awhile. 

Doctor: OK, uh, anything else like in your house or environment like carpets, dust, like anything that might irritate, give me more irritation?
Patient: No, not really. 

Doctor: OK. So it's just a cat that you know, but you haven't been around. Do you have any other animals at home? 

Patient: Uh no, I don't. 

Doctor: No OK. Do you have any headaches at all?
Patient: No. 

Doctor: Any changes in your bowel movements?
Patient: No. 

Doctor: Any urinary problems? 

Patient: Nope. 

Doctor: Has this affected your sleep or appetite?
Patient: I snore at night sometimes, but that's, that's about it. 

Doctor: OK, and do you snore, would you say most nights or is that something like has someone told you that?
Patient: My mom told me and sometimes I, I sleep with my mouth open. 

Doctor: I see, OK. And do you know how long you've been doing this for? 

Patient: Uhm, again, it's been like months or years. 

Doctor: OK. And do you ever get, do you ever wake up at night trying to take a breath like just gasping for air?
Patient: No. 

Doctor: OK. Have you ever had any surgeries or hospitalizations before? 

Patient: No. 

Doctor: Yeah, OK. On any family history of any heart or lung conditions.
Patient: Uhm, just heart disease. 

Doctor: OK, then who has it? Or who had it? 

Patient: My my dad. My dad has, had a heart attack and my mom has high blood pressure. 

Doctor: OK. And how old was your dad when he had a heart attack?
Patient: He was 50 years old. 

Doctor: 50 years old? Ok.  And I'm currently right now, uh, are you a student? Do you work? 

Patient: I'm a student. 

Doctor: And what's your living situation like?
Patient: I live with my parents. 

Doctor: Ok. And do you smoke at all?
Patient: No. 

Doctor: OK, have you ever smoked? 

Patient: No no no. 

Doctor: Uh, any, any recreational drugs like marijuana?
Patient: Oh God no, never. 

Doctor: No? Ok. And do you drink alcohol? 

Patient: No. 

Doctor: OK, and how, how's your home environment? Do you generally feel safe in your home environment as well as outside of your home?
Patient: Oh yeah, it's great. 

Doctor: Ok. So yeah, so mainly yeah. So there's all the questions I had for you. Do you have any questions or concern?
Patient: Nope. 

Doctor: Ok so there can be many different reasons for this chronic congestion and we'll do a full physical examination for you today. Uh and some of the possible things that can be happening is you might be having a sinus issue like a chronic sinusitis. You can be having an allergic rhinitis or with the snoring and just the chronic congestion. You may be also having something called obstruct, obstructive sleep apnea. And there can be structures in your mouth, throats that can cause you to kind of obstruct and snore at night as well, and that even the congestion might cause that as well. So yeah, we'll do a couple test first and then if required, we might need to do some imaging and even perhaps send you to an EMT specialist if we think it's obstructive sleep apnea there. For now, we'll just do the physical examination to go from there. 

Patient: Great, thank you. 

Doctor: Welcome, take care.
Patient: Yeah, I have this pain in my chest. 

Doctor: OK, and where is the pain exactly? 

Patient: It's just right  over on the on the left side. 

Doctor: OK, and when did this pain start?
Patient: It started just 30 minutes ago. 

Doctor: OK, and did it just come on randomly or were you doing something strenuous? 

Patient: I was just shovelling the driveway and it came on. 

Doctor: OK, and has that pain been getting worse at all over the last half an hour?
Patient: No, it just came on suddenly and it's uh, uh, I'm sorry. Yeah the pain has been there this whole time and it's gotten worse ever since it started. 

Doctor: OK, and how would you describe the pain? Is it kind of like an aching pain or is it a sharp or tight tightness kind of pain? How would you describe it? 

Patient: It feels dull. I feel like there's a lot of pressure on my chest. 

Doctor: And how do you rate the pain right now on a scale of zero to 10, zero being the least amount of pain you felt in your life, 10 being the worst?
Patient: Uh, seven. 

Doctor: Seven, OK. Have you had ny similar episodes before?
Patient: No, I've never had any chest pain before. 

Doctor: OK, and is the pain just staying in the region of the left chest area that you mentioned or is it traveling to any other part of your body? 

Patient: No, I'm kind of just feeling it right here. On the left side. 

Doctor: OK, uh, is there anything that you do that makes the pain either get worse or go away or like get better?
Patient: Uh. I think it's a bit bit worse if I'm moving around or when I was walking in here. I think it it made it a bit worse, but nothing has seemed to make it any better since it starting. 

Doctor: OK, and does it change at all from you changing positions like if you're standing up versus sitting down or laying down?
Patient: I think it's a little bit worse when I when I'm laying down. 

Doctor: OK, and other than the pain that you've been having, have you been having any other symptoms like a cough or difficulty breathing or any pain when you're breathing in or out?
Patient: Uh, I've felt a little bit uh short of breath or having difficulty breathing since yesterday when the sorry since the pain started, but uh just the difficulty breathing. 

Doctor: OK. And have you recently injured your chest or surrounding area at all? Like from a fall or anything like that? 

Patient: I do I play rugby and was tackled by another player yesterday. But but my chest felt fine after that. 

Doctor: OK so but the pain just started half an hour ago?
Patient: Yeah. 

Doctor: OK, have you have you been traveling at all recently? 

Patient: No, been at home. 

Doctor: OK, has anyone around you been sick at all?
Patient: No. 

Doctor: OK, have you been having any symptoms like nausea or vomiting or any fevers or chills? 

Patient: No nausea or vomiting, but I do feel a little bit hot today. 

Doctor: OK, but have you measured your temperature at all?
Patient: Uh I did and it was 38 degrees. 

Doctor: OK, and have you been having any kind of swelling in your legs or feet?
Patient: Uh, no swelling in my legs. 

Doctor: OK. Have you been feeling tired at all, like increasingly fatigued? 

Patient: No, my energy has been good.  D; Have you been having any kind of thumping or palpitations or feel like your heart has been racing at all?  It uhh it does feel like it's beating faster right now. It usually only feels like this when I'm playing sports. 

Doctor: OK. And have you noticed any changes in your skin at all? Any rashes?
Patient: No rashes. 

Doctor: OK, have you had any cough or runny nose or sore throat? Any kind of those symptoms and in the past month?
Patient: Uh few weeks ago I was a little runny, but that went away on its own. I haven't had any cough. 

Doctor: OK, and have you been feeling dizzy at all or have you fainted?
Patient: No dizziness and uh no I haven't fainted at all. 

Doctor: OK. Just a few more questions. Have you had any diagnosis made by any physician or any anything like diabetes or high blood pressure? 

Patient: Yeah, I've been told I have high cholesterol and high blood pressure. 

Doctor: OK, and do you take any medications for the these things?
Patient: Um, I do take medications for both blood pressure and cholesterol, Rosuvastatin and um Lisinopril and I take a multi vitamin. 

Doctor: OK, and do you have any allergies to any medications at all?
Patient: No allergies. 

Doctor: OK, have you at all in the past been hospitalized for any reason?
Patient: No hospitalizations. 

Doctor: Any previous surgeries?
Patient: No. 

Doctor: OK, and within your family, has anyone passed away from a heart attack or any cancers that run in the family? 

Patient: No. 

Doctor: OK, and currently right now, do you live alone? Do you live with someone? And where do you live, like an apartment or house?
Patient: I I live in a house with um, my parents. 

Doctor: OK, and do you currently work? 

Patient: Yeah, I I drive a bus for the city. 

Doctor: OK. And in your daily routine, would you say you get enough exercise throughout the week?
Patient: Uhh yeah, usually on Sundays I'll go for a run. 

Doctor: OK, and how about your diet? Well, how's your diet like, just regularly? 

Patient: Uhh, usually I feel like it's fairly balanced overall, I might I eat out a little bit too often, but try to eat as many vegetables as I can. 

Doctor: OK. And do you smoke cigarettes at all?
Patient: I do yes. Been smoking for the last 20 years roughly. 

Doctor: OK, how much do you smoke on an average day? 

Patient: About a half a pack to a pack a day. 

Doctor: OK. And do you drink?
Patient: No alcohol. 

Doctor: OK, and any recreational drugs like marijuana? 

Patient: Um, no marijuana, but I have used crystal meth in the past. 

Doctor: OK, and when was the last time that you used crystal meth?
Patient: Um, six days ago. 

Doctor: Six days ago, OK, and how often do you use crystal meth?
Patient: Um, I would say a couple of times a month. 

Doctor: A couple of times a month, OK. Alright, and for how long have you been using crystal meth?
Patient: Essentially, when he, so today is Friday, when he got home from school on Wednesday, he seemed fine, but he, I don't know that night he started to have a bit of like a cough. It just seemed like a little dry cough, but obviously I just wanted to keep him home, keep him safe and not like spread anything if he was sick, so he stayed at home on Thursday and he was like having a bit of a cough. Um and then, yesterday it seemed to get a little bit worse and he was really tired, or sorry it's today, today is Friday, um, he was like his cough is like getting a bit worse and I've been taking his temp the whole time and it got like a little high today. What was it? My thermometer says it was high. I'm just like trying to remember. It was it was, it was like over 100 though. 

Doctor: Oh OK.
Patient: 101 or something or maybe 100.1. But anyways, it was, so I I just thought I should probably bring him in 'cause I was really worried about him and you know thought he could have maybe got COVID and get school or something. 

Doctor: Yeah for sure. Um, OK, so just to clarify, he's had this cough and fever for the past five 5 days.
Patient: Mhmm. 

Doctor: OK. OK, so let's focus on the cough. 

Patient: Sorry, it's been more like 3 three days like Wednesday is when he came home and then, and then today's Friday, so yeah, sorry. 

Doctor: Today is Friday, OK. Um, OK, yeah sure. So, is this cough a productive cough, or is it kind of a dry cough?
Patient: Ah I think it's dry. I haven't noticed him like spitting up anything. Umm, yeah, he yeah, it's just been like little coughs. 

Doctor: OK, and he, is he, he's not bringing up any sputum or blood? 

Patient: No. 

Doctor: No OK good. OK, and does he sound wheezy at all to you?
Patient: No, no, not that I've noticed. 

Doctor: OK, how about short of breath?
Patient: Um, I don't think so like he, usually he's a really active kid and he has, he hasn't been running a lot outside in the past couple days, so maybe he maybe he could have been having a harder time breathing but also I think he's just been tired in general. 

Doctor: OK, yeah. OK, and is his coughing getting worse with certain times of the day? Like is it worse at night in the morning?
Patient: I think it kinda just there the whole day. 

Doctor: OK um. And does it, how does it sound? Does this sound like a barky cough? Does it sound? Um, like harsh, what is, what would you say the quality of it, of the sound of the cough is? 

Patient: Uh, I just sounds kind of dry. It's not like super loud. 

Doctor: OK. OK, and has he ever experienced anything like this in the past?
Patient: I don't like he's had colds before, but I haven't like, I haven't like you, this time he kind of had the fever, which is different than you know, having a regular cold. 

Doctor: OK. And are his symptoms getting worse? 

Patient: I think so. Because yeah, he first day he just seemed like little dry and then yesterday is coughing and today he actually has a fever. 

Doctor: OK, and um, is he complaining of anything like chest pain? Or feeling like his heart's racing?
Patient: No, I don't think so. 

Doctor: No OK. Does he have a sore throat? 

Patient: I don't think so. 

Doctor: OK, and is he having any issues swallowing food or fluids?
Patient: I don't know if he's having trouble swallowing, but he doesn't seem to have a big appetite right now. 

Doctor: OK, um, and is he, does he have a blocked nose or runny nose?
Patient: Maybe a bit of like a runny nose. 

Doctor: OK, and does he have any issues with smell or taste? 

Patient: Ah, this morning he really seemed like he wasn't like into his breakfast and I wonder if he's losing his sense of taste a little bit. 

Doctor: OK, how about vision or hearing?
Patient: I think those are fine. 

Doctor: OK, and is he complaining of any chills or night sweats?
Patient: No. 

Doctor: OK, any changes in his hair, nails or skin like rashes?
Patient: No, I haven't noticed anything like that. 

Doctor: OK, any changes in his bowel movements? 

Patient: Uh, no. 

Doctor: Pardon?
Patient: I'm sorry, no changes. 

Doctor: OK, no diarrhea, no constipation, no blood in the stool.
Patient: No. 

Doctor: OK, any nausea or vomiting? 

Patient: No. 

Doctor: OK, any changes in his urine?
Patient: Really been looking, but I don't think so. 

Doctor: Any dizziness or fainting spells?
Patient: No. 

Doctor: And is he an, is he an otherwise healthy child? 

Patient: Yeah, absolutely, he hasn't like decide to like vaccines, he hasn't had to go to the DOCTOR: like ever. I mean, he broke his arm once but that was it. 

Doctor: OK, so no past illnesses and I guess no hospitalizations or surgeries except for the broken arm?
Patient: Exactly, like nothing. 

Doctor: OK and were things normal with your pregnancy with him? 

Patient: Yeah totally 

Doctor: OK. Ah, and then how about as a newborn, any complications after birth?
Patient: No, no, like everything was things really good. 

Doctor: OK and then did he hit all his milestones? Up till now?
Patient: Yeah totally 

Doctor: OK. And does he have any allergies?
Patient: Uhm, no, no, I don't think so. I mean like he hasn't really taken a lot of medicine, so it's hard to say, but like nothing, so far. 

Doctor: Is he up to date with all his immunizations? 

Patient: Yep. 

Doctor: Yeah, OK. And in terms of family history, are there any lung conditions or heart conditions?
Patient: Uh, no, everyone is really healthy. 

Doctor: OK, and um, are there, and who does he live with and where does he live?
Patient: He lives with me and my husband, and he has a little sister like just in town here. 

Doctor: OK, and is she healthy? 

Patient: Yeah I like she, yeah she's healthy. 

Doctor: OK an any concerns for old carpets, mold, asbestos or any environmental issues like that in the home that you're in?
Patient: No. 

Doctor: No OK, um has he been around any sick contacts recently?
Patient: Not not like outside of school. I like we know for sure, not outside of school but he goes to school right now so kind of hard to say. They haven't like contacted us about anything. 

Doctor: OK, sure. And has he traveled anywhere recently?
Patient: No. 

Doctor: No, OK. OK, well those are all the questions I had for you today. Were, was there anything that I missed that you wanted to chat about today?
Patient: I don't think so. Like I realized that I can often times like we don't really do much for kids when you know, when it's just like a virus or something. But we do, I guess, need to have a COVID test to go back to school, even if you know either way 'cause they want us to be able to say it's like the other kids have had uh an exposure. 

Doctor: Mhmm.
Patient: So yeah yeah, like. Sorry, go ahead. 

Doctor: No go ahead.
Patient: So I just wanted to basically see if it was that and I mean he does receive you're so scared. That's kind of what made me come in, like it's scaring me a little bit. 

Doctor: Right, yeah, OK, so first thing is, first we need to do a COVID swab just to make sure that he either has it or it doesn't have it and those results will come back in 24 to 48 hours. Umm we do suggest because his symptoms overlap with symptoms of COVID that he isolate for 14 days and that includes from his his younger sister if possible. And then if the swap comes back negative, there is a chance for false negatives. But also it could be another viral illness that's going around nowadays. If his symptoms get worse, so if he has a really high temperature, if he has any neurological symptoms like seizures or if he's feeling weak, dizzy, if he has any fainting spells, please do take him to the ER and uhm, so for now I'll just wait for those COVID swabs to come back. How does that sound?
Patient: Yeah, sounds good. 

Doctor: OK great. 

Patient: Thank you. 

Doctor: Yeah, no worries. Uhm and I should have mentioned if it was just the cough or if he was just short of breath or something like that and he didn't have the fever, we would add everything's like asthma to the list of things
Patient: So I've just been having this cough that I feel has just been getting worse, and I've also been feeling a bit short of breath for the last few months. 

Doctor: OK, could you tell me when the cough started? 

Patient: So I would say it started around two months ago. 

Doctor: OK, and has the cough been dry or have you been bringing up sputum?
Patient: Uh, it's usually always, uh, produces like the sputum, and it's usually white or yellowish in colour. 

Doctor: OK, and how much sputum are you producing each day? Some, sometimes it's useful to think about like teaspoons or tablespoons.
Patient: I would say every time I cough like a teaspoon I probably have like. I don't know. Maybe 5 to 10 teaspoons a day. 

Doctor: Uh OK, and is there any particular time of day that the cough is worse? 

Patient: Um, not really. It's pretty, pretty much the same. Sometimes it is worse in the morning. Yeah, and sometimes it gets better when I go out for a smoke. 

Doctor: OK um. And have you noticed any blood?
Patient: No, um I haven't noticed any blood. 

Doctor: OK, and have you had, so you had shortness of breath, when did that start?
Patient: It's around two months ago, around the same time. 

Doctor: OK, And. Is this? Do you have shortness of breath at rest or is it when you exert yourself? 

Patient: Uh, it's it can happen like at anytime, but worse when I am exerting myself. 

Doctor: OK and then have you had a cough before?
Patient: Uh. Not as frequently. I would say not really, it just started in the last two to three months. 

Doctor: OK, and have you had shortness of breath like this before? 

Patient: Just throughout my life I've had asthma so when I am exercising too much or get exposed to like dust, sometimes get shortness of breath. 

Doctor: OK. Has there been anything, um besides exerting yourself, that's made that either the cough or or shortness of breath worse?
Patient: Uh, over the last year like I've had a couple of chest infections. After going to the ER, they gave me some antibiotics. But yeah, when that happens it usually gets worse. The shortness of breath and the cough. 

Doctor: OK, and uh, do your symptoms feel like any of those times right now? 

Patient: No, I I don't feel like I have a fever and no other symptoms, just the shortness of breath and cough. 

Doctor: OK, and have you been doing anything that's made it better?
Patient: I've been taking some Tylenol Cold, hasn't really helped too much. I've tried my inhalers, they sometimes help, but I've never had have this frequent of coughing and shortness of breath before. 

Doctor: OK, um, and how has your energy been? Have you been experiencing fatigue? 

Patient: Um, when it gets really bad then I can't really step out of the house, but other than that I feel like my energy's still there. 

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

Doctor: OK, how about at a loss of smell? 

Patient: No. 

Doctor: Um a loss of taste?
Patient: Nope. 

Doctor: OK, and have you had any chest pain? 

Patient: No, just sometimes when I'm like coughing a lot it gets a little bit uncomfortable. But other than that, no. 

Doctor: OK, um have you had any instances where you felt like your heart was racing?
Patient: No. 

Doctor: OK, how about being lightheaded or or like you were going to pass out?
Patient: Nope. 

Doctor: OK, and how about headaches? 

Patient: No headaches. 

Doctor: Alright, and have you had any wheezing?
Patient: Um, sometimes I've noticed it, but I had it before. Like with asthma as well, but not not that much. 

Doctor: OK, and how about abdominal pain?
Patient: No abdominal pain. 

Doctor: Alright, then any urinary problems? 

Patient: Nope. 

Doctor: Any bowel problems?
Patient: Nope. 

Doctor: OK, and then how about any muscle aches or or joint aches or or body aches? 

Patient: No, nothing like that. 

Doctor: Alright. And you mentioned asthma, but have you been diagnosed with any other medical conditions?
Patient: No, just asthma. 

Doctor: OK, and do you use inhalers? Are there any other medications you're currently using?
Patient: Oh no, just the salbutamol and like the steroid inhaler. 

Doctor: OK, yeah, and how often are you using both of those? 

Patient: So the steroid one I am using pretty much every day but the salbutamol I found I've been using a lot more recently. I would say probably at least six to 10 times in a week. 

Doctor: OK, um that reminded me I I forgot to ask. Have you notice any changes to your voice?
Patient: Um no, not really. 

Doctor: OK um. And I was wondering if you had any allergies to medications? 

Patient: No, not that I know of. 

Doctor: Alright, and have you been in the hospital recently?
Patient: No. 

Doctor: Alright, so when was the last time that you had antibiotics? 

Patient: I would say like six months ago. 

Doctor: OK and any surgeries?
Patient: Nope. 

Doctor: OK, and did you get the flu shot this year?
Patient: Yep. 

Doctor: OK, great um and I was wondering if you could tell me a little bit about your living situation. 

Patient: So I live in London um in a small apartment with my wife. 

Doctor: OK, do you have any pets around?
Patient: No, no pets. 

Doctor: Alright, and um, any exposures at work too, like dust or any types of like chemicals like that.
Patient: No, not really. My work is pretty much a desk job, so nothing like that. 

Doctor: OK, and do you smoke cigarettes? 

Patient: Yeah yeah, I smoke a lot of cigarettes just like I would say 30 cigarettes a day. 

Doctor: OK, and how long have you smoked for?
Patient: I'd say, probably at least 25 years. 

Doctor: OK and sorry, could you remind me of your your age again?
Patient: So I am 60 years old now. 

Doctor: OK, so you started smoking um around 35. 

Patient: Yeah yeah. 

Doctor: OK. Have you tried to quit?
Patient: Yeah, tried to quit. I've even quite a couple times but then just got back onto it. Yeah, not not really ready to quit. 

Doctor: OK. That's fair enough. If there's something that you wanted to talk about quitting smoking at another appointment, we can arrange follow up for that.
Patient: Alright 

Doctor: Do you drink alcohol?
Patient: Not much, just out say one or two beers on the weekend. 

Doctor: Alright, and you use any recreational drugs like cocaine, crystal meth, or IV drugs. 

Patient: No, nothing like that. 

Doctor: Alright, and has anything similar like this happened in your family before?
Patient: Uh, I think my um sister has a COPD, like she smokes a lot too. But that's that's about, I don't know if that's genetic. 

Doctor: Oh OK, um I. So I mean anybody in the family have cancers?
Patient: Um no, not that I know of. 

Doctor: Alright um so, that that was all the questions that I wanted to ask on history. Was there any, uh, any other questions that you had? 

Patient: No, not really. Just wanted to get to the bottom of this. 

Doctor: OK for sure so um we will run some investigations and likely get a chest X Ray because it's been a couple of months that these symptoms have been going on for. But I think it could be related to your smoking and most likely um Bronc, chronic bronchitis, but we can definitely will be looking into this, and then also with possibly some pulmonary function tests as well.
Patient: Um yeah, so I brought my 7 year old daughter here um because she's been coughing uh a lot over the past two weeks. Um she's she sounds wheezy and I'm not too sure what's going on with her so, she's been off school um 'cause they think it's Covid. Uh we got her swab, but because she still has symptoms she can't go back to school, so here she is. 

Doctor: OK, um and when did the cough start?
Patient: It started two weeks ago. 

Doctor: OK, and when did the wheezing start? 

Patient: Um that started about the same time like I should I should mention she does have like episodes like this. Um she's had episodes like this for the past like 2 years uh but they usually go away in a couple of days. But this time it's it's taking a lot like a lot longer to go away. 

Doctor: OK, so it's been uh has been more than a week, you said?
Patient: Yeah, it's been close to two weeks now. 

Doctor: Two weeks, OK. And uh were these symptoms brought on by, are they usually brought on by any kind of like activities or can they come up just by themselves?
Patient: I find it's usually worse in the winter um and if she's like doing some sort of uh like extensive physical activity, so if she's like playing tag and she's running around a lot. Um or if she's like at her gym class and they're running. 

Doctor: OK, and the cough that she's having is it like a wet cough or is it a is it a dry cough?
Patient: It's a dry cough. 

Doctor: OK, and at all, is she bringing up any yellowish or white uh or green material or any blood at all? 

Patient: Uhm, it's, no nothing like that. 

Doctor: OK, and are her symptoms uh constant or do they come and go?
Patient: Her symptoms I guess come and go, um yeah, they come and go. 

Doctor: OK, and how many days of school has she had to miss? 

Patient: She's missed almost two weeks now. 

Doctor: Wow, OK um and when she's at home, is she is she like very tired, is she um?
Patient: Yeah, yeah, she's pretty tired out um, yeah, she's pretty tired out, she's been doing a lot of like resting and uh you know watching TV. She's not really very active right now. 

Doctor: OK, uhm and have her symptom symptoms been getting worse over the last two weeks, or are they getting better at all?
Patient: Uh I can't, you know, I can't tell, it comes and goes so in that sense, it's been pretty constant. Um there hasn't been a day when she hasn't had these symptoms. 

Doctor: OK, and do they get worse at night at all or are they um the same throughout the day? 

Patient: Uh yeah, now that I think about it, when she's laying down she does have a hard time. 

Doctor: OK. And is she having any other symptoms at all, like uh shortness of breath, um or sore throat?Anything like that?
Patient: Uh, no sore throat. She sounds wheezy, so she might have like some difficulty breathing, but she doesn't sound short of breath. 

Doctor: OK, and any kind of uh runny nose or any other symptoms at all? 

Patient: No. 

Doctor: No, OK. Uh anything that helps her or makes her symptoms better?
Patient: Um no, nothing that we've tried. 

Doctor: Any recent uh travel at all?
Patient: No. 

Doctor: No, any fainting or dizziness spells? 

Patient: No. 

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

Doctor: Any um changes in her bowel movements like any constipation, diarrhea?
Patient: No. 

Doctor: Any urinary problems? 

Patient: No. 

Doctor: And any uh any kind of, do these symptoms wake her up at night at all?
Patient: Um no, no it doesn't wake her up at night. It just makes it hard for her to fall asleep. 

Doctor: I see. Is she getting enough sleep? Like how, how, how many hours would you say on average she's getting per day?
Patient: I'd say she's getting about 6 to 7 hours. She used to sleep about 8 hours before. 

Doctor: OK, um and is she having any changes in her appetite at all?
Patient: Um I don't think so, no. 

Doctor: No?
Patient: No. 

Doctor: Um any kind of changes in her weight at all over the past few months?
Patient: I haven't checked over the past month, but before that no, no changes. 

Doctor: No changes, OK. And um has she been, she had like a cold or anything like that recently? 

Patient: No, not that I can think of. 

Doctor: OK, has she been around anyone that's been sick recently?
Patient: No. 

Doctor: OK. Um does she have any past history of any medical conditions at all?
Patient: Uh no, no, nothing like that. 

Doctor: OK and um does she have any uh allergies to any medications or any environmental allergies? 

Patient: I think she might have some environmental allergies. We haven't gotten her officially tested though. 

Doctor: OK. And um has she had any previous hospitalizations or surgeries?
Patient: When she was a baby, when she was first born, she was hospitalized um for something about having like uh not fully developed lungs. 

Doctor: OK and uhm, was she premature at all? Or was she born after uh, at term? 

Patient: She was slightly premature, I believe she's 34 weeks. 

Doctor: 34 weeks, OK. And um was it a vaginal delivery or was it a C-section?
Patient: Uh it was vaginal. 

Doctor: Vaginal, OK. Were there any uh complications during the pregnancy or after she was born? C 

Patient: Um no complications after besides the hospitalization for the small lungs. 

Doctor: OK. And is there any family history of any lung conditions, heart conditions, or cancers?
Patient: Uh nope, nothing like that. 

Doctor: Has anyone in the family have, had any kind of asthma, eczema, anything like that?
Patient: Um no. 

Doctor: No, OK. Um so, and in terms of like at school, are there any kind of complaints uh and any um issues with her development over the last last few years?
Patient: No, nothing like that. 

Doctor: OK, so she's been growing well? 

Patient: Yeah, she's been growing well. She's been gaining weight like a normal amount um and she's doing well, she was doing well at school. 

Doctor: OK. And um at home, uh what is the environment like?
Patient: Um she lives at home with both of us like um her mom and her dad, and uh she has a younger sibling who is 4 years old. 

Doctor: OK. And um does anyone smoke in the house at all?
Patient: Um no, not anymore. 

Doctor: OK, um how long ago uh did someone smoke?
Patient: Um it was, um so her dad used to smoke um and he stopped when she was like 3. 

Doctor: OK, that's good. Um any kind of uh dust or mold or animals, uh anything in the household?
Patient: No, we don't have any pets and um the place is just renovated so nothing like that. 

Doctor: OK. Alright, so yeah, those were just some of the questions that I had for her today. Do you have any questions or concerns?
Patient: Um yeah, so what can we do for her right now to make these symptoms go away? 

Doctor: Yeah, so what we should do for her right now is, she's seven years old, um what I'm thinking right now with her symptoms especially coming on after uh exertion, being worse in the winter, she may have asthma. 

Patient: OK. 

Doctor: And although she doesn't have any family history of it, it can happen without family history as well. Um so we would like to uh try and do uh what's called a pulmonary function test. That will help us kind of understand uh if she has um asthma or not and then we can try her on um, it's called a short acting beta agonist, so it's a puffer.
Patient: OK. 

Doctor: And uh usually when she gets these types of symptoms, she can use the puffer to help her. Uh and if it um helps her then it's most likely that she does have asthma and she will need um that puffer and then she might also need another puffer, which is an inhaled corticosteroid, um for the future to decrease um the likelihood that this asthma gets worse in the future.
Patient: OK, OK yeah thank you. 

Doctor: Yeah, no worries. So yeah, so yeah we'll get those tests done and then go from there. 

Patient: OK, sounds great. 

Doctor: Take care.
Patient: It my name is Scott. It's nice to meet you too. 

Doctor: Alright, um so Scott. How old are you?
Patient: 15. 

Doctor: OK, What brings you in today? 

Patient: Um, I've had a sore throat now for a couple of weeks and it's just not going away. 

Doctor: Couple of weeks. OK, so about two weeks, three weeks?
Patient: Yeah, about two to three weeks. 

Doctor: OK, um what does it feel like is it, is it kind of like a burning feeling? Is it more like an itchy feeling? What does it feel like? 

Patient: Uh I would say it's kinda yeah like burnin' or burning or scratchy. 

Doctor: OK, and does it hurt when you swallow?
Patient: It does, yeah, uh, If my throat hurts when I'm eating or Um uh or swallowing like liquid's as well, but cold stuff seems to make it feel a little bit better. 

Doctor: OK, good, and does your neck hurt too? 

Patient: Um. A little tender, I've noticed the um some lumps at the front of front of my neck that have been a bit sore. 

Doctor: OK, and is it mostly sore, kind of like midline? Or is it more sorta one side versus the other?
Patient: Um I'd say, maybe the, uh, the right side is a little bit more sore, but I think I can feel it on both sides of my neck. 

Doctor: OK, and how bad would you say your discomfort is 1 to 10, 10 being the worst. 

Patient: Um. I would say maybe a two or three if I move my neck I I can feel it more, but otherwise I can just barely notice that it's there. 

Doctor: OK, so it's not preventing you from sleeping, going to school, playing, things like that?
Patient: No, it's more so the sore throat when swallowing. 

Doctor: OK. OK. Um, have you noticed a fever at all? 

Patient: Um, I have. Yeah I felt hot and Um I checked my temperature this morning and it was 38.7 I think it was. Is that a fever? 

Doctor: Yeah, I'd say that's a fever. We can also do another temperature check today.
Patient: OK 

Doctor: Um yeah, but that definitely sounds like a fever. Um, have you noticed rashes anywhere?
Patient: Um Yeah, I've had this, uh this, like red I guess pink rash that I have noticed it's come over my chest and and belly area. 

Doctor: OK, how big is it? Is it more than a centimeter?
Patient: Uh huh. Yeah, it's pretty well, I mean, it's kind of, um spread out over over an area like it's not all continuous I guess. You can kind of see patches or blotches. 

Doctor: OK and, is it raised? 

Patient: No, it's it's not raised. 

Doctor: OK. OK, is it itchy?
Patient: Uh, no, it's not itchy. 

Doctor: Painful? 

Patient: No, not painful. 

Doctor: OK and is it bleeding or oozing anything like pus?
Patient: Um no it's not, nothing like that, it's just pink and red and it's just kind of shown up over the last little while. I've noticed it on my um like hands a little bit too. 

Doctor: OK, and you said this started when like was this before the sore throat or after? 

Patient: Oh I can't like remember the onset. I I think that the sore throat started first and maybe a rash came a little bit later. 

Doctor: OK, OK and have you noticed that your that your glands are swollen?
Patient: I think so, um maybe that's what's swollen in my neck. 

Doctor: OK, OK. Um how about coughing?
Patient: No, I haven't had a cough no. 

Doctor: And how about a stuffy nose or or a runny nose?
Patient: Nothing like that. 

Doctor: OK, body aches? 

Patient: Yeah, I felt so some muscle aches for sure. 

Doctor: OK, upper limbs or lower limbs?
Patient: I say I got a whole body, I just feel like my muscles and joints are sore. 

Doctor: OK, yeah, and or do you have any headaches? 

Patient: Uh. No, I haven't really had any headaches. 

Doctor: No OK. And how's your appetite? Are you still eating well?
Patient: Um. It might be a little ah might have been a little bit down. I just kind of haven't been feeling so great, so I'm I've probably eating less the last few weeks, yeah. 

Doctor: Have you been around anyone who may have been sick recently?
Patient: Yeah, actually I think a few of my friends or there was somebody in my gym class knew that I sounded like they had similar symptoms. 

Doctor: OK, OK, and when was this?
Patient: Um, Uh, now that I think about it, probably about three or four weeks ago. 

Doctor: OK, and were they ever treated for that? Did they see a doctor? 

Patient: Um I'm not sure. 

Doctor: No, OK. No worries.
Patient: I just remember them being off for school 'cause they were they were sick. 

Doctor: OK yeah, any issues with your eyes? 

Patient: No. 

Doctor: No, nothing like crusting or pus coming out of your eyes? Red eye, anything like that?
Patient: Um. No, that well, did they might have looked maybe a little bit more more red, red then usual but I haven't noticed any anything in terms of itchiness or um discharge. 

Doctor: OK. Any nausea or vomiting?
Patient: Um, no nausea or vomiting. 

Doctor: OK, how how about your stools? Have they been normal? Have you had diarrhea, constipation, anything like that?
Patient: No changes to bowel habits. 

Doctor: OK how about urine?
Patient: Um, that's been OK. 

Doctor: OK, OK. Um, have you ever had these symptoms before? 

Patient: Um, I mean I've had sore throats in the past, but not while feeling like this though. 

Doctor: Yeah. OK, when was the last time you had a sore throat?
Patient: Um, I don't know maybe when I was a kid. 

Doctor: OK.
Patient: It's been awhile. 

Doctor: Yeah, like a strep throat kind of thing, or or more viral?
Patient: Yeah, I do remember getting antibiotics when I was younger. 

Doctor: OK, OK, and are you otherwise healthy? Do you have any medical conditions? 

Patient: I was diagnosed with uh with asthma. 

Doctor: OK, and are you on any medications for that?
Patient: Um yeah, so I, I just use ah Ventolin as needed, but otherwise oh and then I take Flovent daily so um. 

Doctor: OK. 

Patient: I think that's the one, there's there's a couple inhalers that that I take. 

Doctor: OK, OK, and any other medications?
Patient: Uh, sometimes I'll take um like Reactine or some other type of allergy pill, but that's it. 

Doctor: OK, What are you allergic too?
Patient: Um mostly seasonal allergies, bug me like um yeah, like seasonal allergies and dust, maybe. 

Doctor: OK. And are you up to date with all your immunizations? 

Patient: Yeah, my mom makes me get the flu shot every year. 

Doctor: OK, good. And it's, OK, have you seen another  for the symptoms at all? Have you been worked up for that? Any blood work testing done for it already?
Patient: No, I thought I would have felt better by now and so I haven't seen anybody but it's kind of just been going on now, not seeming to get better. So wanna come see somebody. 

Doctor: Yeah for sure. Have you tried anything for your symptoms? Any medications, anything over the counter?
Patient: Um yeah, I've tried some Tylenol and it's, I I think what is it Advil? And that definitely is helped with some of the kind of aches and pains, but they've come right back. 

Doctor: OK, um any family history of Lung issues, heart issues?
Patient: Um, No. nothing like that, um no. 

Doctor: Yeah, OK. How about cancers?