jshargo/medical-interview-conversations huggingface dataset:
Patient: Uh, no I can't say that I did. 

Doctor: Nothing like that, OK, and did you feel yourself becoming out of breath at all? 

Patient: Uh I I feel like it was kind of harder to get a whole breath, um so yeah, yeah, I guess. 

Doctor: OK, and was this tightness all across your chest or was it in one particular area?
Patient: Kind of just all over. 

Doctor: OK. And since then, that happened when you were out for a walk, how many times does it happen a day would you say? 

Patient: Well, I feel like it's kind of always there, but it gets worse when I go for my walk. Um and well sometimes I go for more than one walk, right, 'cause I walk my dog. It's always kind of there, and especially when I'm like getting up out of the chair, I can feel it more, or when I take a big like a big breath in, as I said. 

Doctor: OK, so it's been there pretty constantly for the past three days, but it's more noticeable, if not worse, when you're going for a walk?
Patient: Exactly. 

Doctor: OK. Have you had any cough at all in the last little while?
Patient: Uh no like I feel a little more hoarse and like there's maybe some more phlegm, like I'm clearing my throat more, but I haven't actually been coughing. 

Doctor: OK, any fevers?
Patient: No, can't say that, no. 

Doctor: OK, any night sweats, so waking up and the sheets are soaked?
Patient: No. 

Doctor: Any chills?
Patient: No. 

Doctor: Any unexplained weight loss at all? 

Patient: Nope. 

Doctor: OK, and have you ever had anything like this happen to you before?
Patient: Uhm, I mean I have asthma um so I've had some trouble breathing before, it, this feels feels uh different than other times. I I guess it could be related, but uh I don't know, this this feels a bit different, that's why I wanted to come in and get it checked out. 

Doctor: OK, so you have asthma, do you use any puffers at the moment?
Patient: Yeah, I just use the one that um I take every day. I don't really use the uhm, the one thats as needed because I just haven't had to in a really long time so I didn't refill my last one. 

Doctor: OK, so you don't have any anymore of the as needed, but you have used it in the past? 

Patient: Yeah, exactly like it's been a couple of years since I needed that, but I still I still take the daily one. 

Doctor: OK. And you haven't stopped taking the daily one in last three days either?
Patient: No, I always take it um so I'm supposed to actually take it morning and night, um for a while though sometimes I was skipping the night one because I didn't feel that I was needing it. Um so so lately I've been taking it everyday, but I've just been taking it in the morning. 

Doctor: OK, uh, what makes you say you haven't really needed the one at night? Have you just been doing well without it?
Patient: Exactly, like I haven't needed the rescue one in a few years and even when I was just taking it in the morning, I I haven't had any problems. 

Doctor: OK, understood. And then have you had, I should have asked, do you work currently? 

Patient: Uh I I, I'm a financial advisor, I'm like semi retired so I do some stuff from home. 

Doctor: OK, got it. I suppose just, has this kind of chest tightness stopped you from doing activities that you normally would do, any missed time from work?
Patient: I haven't missed any work, but I'm not I'm not doing a ton of work right now. I don't think it would stop me, it just would make me uncomfortable um during work and it keeps me, maybe this, the last few days, it's kept me from, I usually go on a couple of walks a day, the last couple days I've just gone on one usually so yeah, it's a little bit, yeah. 

Doctor: So it's really not stopping too much of your day to day functioning, but it's noticeable?
Patient: Exactly, yeah. 

Doctor: OK. Now, is there any other issue that you see your  regularly for aside from the asthma? 

Patient: Uhm, I have uh high blood pressure, I don't really see my DOCTOR: very much, I just am on um medication. 

Doctor: OK, how about we just talk about your medications a little bit? What are you taking currently?
Patient: Uh I take the, uh, salbutamol. 

Doctor: Yeah.
Patient: That we talked about, and I take um Ramipril. 

Doctor: Yep.
Patient: And, uh, sometimes a Tylenol if you know, if I have a headache or something, but not very often. 

Doctor: OK understood, so aside from the high blood pressure you're really not taking medications for much else? 

Patient: No, no. 

Doctor: OK. Do you have any other lung issues or any trouble with your lungs in the past?
Patient: No, nothing major, just the asthma. But you know, like I said, it's been a few years since it has bothered me. 

Doctor: OK, got it, and just in terms of your life itself, so do you smoke at all? 

Patient: No, never. 

Doctor: OK, so no smoking, any other recreational substances, drugs?
Patient: Oh no, no. I mean I I have um you know a few beers on the weekend, but I don't do very, I don't do any drugs and I don't drink much other than that. 

Doctor: OK, got it. Any allergies that you have?
Patient: Uhm no, no, like I, uh, when I was younger I got some seasonal allergies sometimes in the springtime, but other than that, I I like I, it's really been uh many years since I've noticed that. 

Doctor: OK, and so nothing new in the environment? You haven't changed where you've been living or you haven't introduced a new pet or a new dog? 

Patient: Exactly. 

Doctor: OK, so sounds like you're pretty much staying the course last little while, just kind of a new onset of this new chest tightness, and aside from that, seems that it comes on mainly on walks outdoors, but you've kind of been limiting the, some of the medication you're taking for asthma the last couple of years because you haven't really felt that you needed it as much.
Patient: Yeah, like just the morning was, it was enough. 

Doctor: OK. Alright John, I think I've got most of the information I need just to go talk to the doc and talk about your story. Next of course we're going to do a quick physical exam, going to take a listen to your lungs and see what else we might want to do in terms of investigations. I have a feeling that this actually might be your asthma reoccurring in some capacity or that would be on the top of the differential for now, barring any other new findings. So I think maybe what we would like to do is, we'd like to try having those rescue puffers available to see if that helps at all when you are on walks, and if they don't help, then we'll come back to the table and see what other possible directions we could head in in order to help you next. Does that sound good John?
Patient: Sounds great, I'm just, you know, glad to know that it's probably not my heart. 

Doctor: No, it sounds well, I suppose you said that you didn't really get out of breath with exercise, more sounds like a chest tightness, and you haven't had any pain associated with it, so that puts more cardiac ischemic pictures kind of lower on the differential. But of course we're going to try one thing at a time, and then we'll come back to the table um depending on how you're feeling after that, OK? 

Patient: Sounds great, thank you. 

Doctor: No problem. OK, I'll go talk to the doctor, I'll be back with you in a moment.
Patient: Yeah, so I just came in today uh a bit concerned. Uh I've been just having this nasty cough for like the last week and then today morning uh, like I thought the cough would just go away, but today morning I also noticed I'm coughing up some blood. 

Doctor: Oh, OK.
Patient: Yeah. 

Doctor: So when did you first start coughing?
Patient: Um, so let me think uh I just returned from a mission trip uh to the Philippines 2 weeks ago. This cough started uh just last week, so I would say around six to seven days. 

Doctor: OK. And that and the blood in your cough, um that was about yesterday, you said? Or?
Patient: Yeah today, uh. 

Doctor: Today, OK. OK. Um are you bringing up any phlegm at all, besides the blood? 

Patient: Uh no it's just uh like I saw it on my hand, like there wasn't anything, like my cough is like pretty dry. 

Doctor: OK, are you short of breath at all?
Patient: No, I'm not short of breath. Um just, it's just the cough. 

Doctor: OK, and are you having any wheeziness? 

Patient: Uh no wheeziness. 

Doctor: OK. Um any runny nose or stuffy nose?
Patient: No, no uh runny or stuffy nose. 

Doctor: Changes in vision, hearing, smell, or taste?
Patient: Nope. 

Doctor: Uh weight loss?
Patient: Um I have noticed uh weight loss over the last uh, I would say few months. So I've been I've been doing like like I I came back from Philippines last week, but um, I had gone earlier, like during this year or two and I've kind of noticed this weight change, probably lost around 15 pounds within the last few months. 

Doctor: 15 pounds OK. Wow, that's a lot, yeah. Um any night sweats?
Patient: Um no, I don't think so, no. 

Doctor: Any fevers or chills?
Patient: I did have a, I did have some chills over the last week, um but I didn't really think too much of it. 

Doctor: OK, we'll take your temperature today just to make sure. Um any rashes?
Patient: No chest pain. 

Doctor: Uh swelling in your limbs? 

Patient: No. 

Doctor: Fainting spells or dizziness?
Patient: No, nothing like that. 

Doctor: Confusion or memory loss?
Patient: No. 

Doctor: Headaches?
Patient: No headaches. 

Doctor: Uh, joint pain? 

Patient: No. 

Doctor: Fatigue?
Patient: Uh, no. 

Doctor: Um, changes in your bowel movements? 

Patient: Uh, no. Not at all. 

Doctor: No, changes in your urine?
Patient: Nope. 

Doctor: Uh, nausea or vomiting?
Patient: No nausea or vomiting. 

Doctor: OK, how about abdominal pain? 

Patient: No, nothing like that. 

Doctor: OK, are you otherwise healthy? Do you have any longstanding medical conditions?
Patient: Yeah no, I'm otherwise I um I don't, I'm really healthy. I don't take any medications so this was something that happened out of the blue. 

Doctor: OK, any um hospitalizations or surgeries in the past? 

Patient: No. 

Doctor: No, um medications, are you on any?
Patient: No, I haven't um tried any medications. 

Doctor: OK. Um are you up to date with all your immunizations?
Patient: Uh I I've been yeah, pretty up to date with all my immunizations. 

Doctor: OK, uh, allergies, do you have any? 

Patient: No. 

Doctor: Sorry, forgot to ask, immunizations. Did you get the flu shot this year?
Patient: Yeah I did. 

Doctor: OK, good. Any family history of lung conditions? 

Patient: No, not at all. 

Doctor: No, any lung cancers?
Patient: No. 

Doctor: No, OK. Do you smoke?
Patient: No, I have never smoked a day in my life. 

Doctor: OK, recreational drugs? 

Patient: No I would never take drugs. 

Doctor: OK. Do you drink alcohol?
Patient: No, no, not at all. 

Doctor: OK. Um where do you live right now? 

Patient: So I I just live in a small apartment by myself, uh just been moving around a lot. 

Doctor: OK, for sure. Um any like asbestos, mold, or like old carpets, dust, anything like that at your apartment?
Patient: No, I don't think so. 

Doctor: No, any sick contacts recently? 

Patient: Um not uh, I don't think so like we um, maybe in the Philippines, we do provide a, so I go on like these mission trips with the Church and um we do sometimes go to the hospital as well. 

Doctor: OK.
Patient: Sometimes yeah, we we do see some sick people. 

Doctor: Mhmm, OK.
Patient: But other than that, not since I've been here, no. 

Doctor: Any travel outside the Philippines recently?
Patient: Uhm, so I think. So this year has just been the Philippines, before I used to go to India as well. Um but recently nothing outside of the Philippines. 

Doctor: OK. OK, um those were all the questions that I had for you. Do you have any questions for me?
Patient: Yeah, I I was very worried um uh about the blood. I was just reading some things up and uh, about tuberculosis, so I was really stressed out today. 

Doctor: Yeah so um, that's definitely high on our differential. So, we'll do a couple of things. We'll do a Covid swab on you um just to rule that in or out, you should hear back for, about those results, in 24 to 48 hours. While you're here in the hospital, we're also going to do a chest X-Ray and or like an AFB smear to see if you have active TB or latent TB. If those come back positive um we will require you to isolate because this uh, because TB is highly infectious and it's airborne. Um so we have a couple of uh, we have like a regimen that we'd put you on. It's called the RIPE medications that we keep you on for two months and then we continue a couple of those for another four months. Um but we will uh keep you here until we have more answers on um like from this TB standpoint. How does that sound?
Patient: Yeah, I've had this sore throat. It started, really, yesterday and I've been having problems with eating and drinking. 

Doctor: OK, so it just started yesterday. Has it occurred before? 

Patient: Not this painful before. 

Doctor: OK, are you were having any trouble swallowing just solids or liquids as well?
Patient: It hurts to swallow both. When I have something really cold it helps, I mean, it's easier to drink, but it still hurts. 

Doctor: OK, and are you having any other symptoms besides the sore throat? 

Patient: Yeah, I've been nauseous and I vomited a couple of times. 

Doctor: OK, just within the last day?
Patient: Yeah, this is over the last day. I vomited three times yesterday and once today. 

Doctor: OK, and uh, what was the color of the vomit? Was it just food that you had eaten? Or was it green? Can you describe it a little bit? 

Patient: Yeah, so the first two times it was more of what, like, the food that I had eaten and then the last two times it's been more yellowish green, cause I haven't really eaten much since yesterday afternoon. 

Doctor: OK, and did you notice any blood in it at all?
Patient: No blood. 

Doctor: OK, and do you have any idea what caused the nausea or vomiting? Was it after eating? Or, like, were there any triggers? 

Patient: I think the first time was associated with like, after eating, but I'm not sure about the other ones. 

Doctor: OK, and with your sore throat, are you having any kind of like a gag reflex or anything like that?
Patient: Yeah, maybe a little bit, maybe that's what prompted it. 

Doctor: OK. And has your sore throat been just constant or does it come come and go? 

Patient: It's been pretty constant, yeah. 

Doctor: And how much would you rate the pain out of 1 to 10? 1 being the least pain you've felt in your life, 10 being the worst.
Patient: Uh, I would say, uh, a 6, it's pretty painful. 

Doctor: OK, um, have you noticed any kind of like swelling around your neck? Or any redness in your throat?
Patient: Yeah, I felt my neck this morning in the front of it, it does feel swollen. 

Doctor: OK. And are you coughing at all? 

Patient: No, I haven't had a cough. 

Doctor: OK, so no cough but are you producing any sputum or yellow material?
Patient: No, nothing like that. 

Doctor: OK, are you coughing up any blood at all?
Patient: No. 

Doctor: Is there anything that makes it better or worse that you have tried? 

Patient: Just cold drinks. 

Doctor: OK. And, uh. So you've also had nausea and vomiting. Are you having any kind of diarrhea or Constipation?
Patient: No, but I've had a sore stomach. 

Doctor: OK, and did that also start yesterday?
Patient: Yeah, it's just been, like, fairly generalized. Feels sore. 

Doctor: OK, so not in any particular area, just kind of all over your stomach?
Patient: Yeah, like, I mean, I guess sort of like in the center, more so, but I can't really put one finger on the spot. 

Doctor: OK, and is it constant or does it come and go?
Patient: It kind of comes and goes. 

Doctor: OK, and uh, is it associated with eating food at all, or does it get better when you defecate? 

Patient: I haven't noticed anything like that, maybe it's worse after vomiting, those few times. 

Doctor: I see OK, yeah. So yeah, sometimes with the vomiting you can also get some some discomfort. So no diarrhea or Constipation though, right?
Patient: No. 

Doctor: Uh, so are you having any other symptoms like shortness of breath or chest pain, or like a runny nose? Any any of those symptoms? 

Patient: No, nothing like that. I've just had a headache as well, but it's pretty mild. 

Doctor: OK, have you tried any medications at all, over the counter?
Patient: yeah, I took a Tylenol cause I started feeling a little bit hot as well, to help me sleep last night 

Doctor: OK, have you been having any fevers or chills?
Patient: Yeah, I felt hot but no chills. 

Doctor: And did you manage to get like a temperature at all?
Patient: No. 

Doctor: OK, we can do that here today. So you just felt like a bit hot last night? 

Patient: Yeah, last night I felt pretty hot, sweaty. 

Doctor: OK, have you been in contact with anyone who's been sick, or any recent travel at all?
Patient: I mean, not that I can think of. 

Doctor: OK, uhm, so I'm just going to list a few symptoms just let me know if you have any of them. Do you, do you feel fatigued? 

Patient: No. 

Doctor: Do you feel that you have any kind of swelling in your extremities, or any rashes or skin changes?
Patient: No, I haven't noticed anything like that. 

Doctor: OK, any changes in your urinary pattern? 

Patient: No. 

Doctor: OK, any changes in your sleep or appetite?
Patient: No. 

Doctor: OK, any significant weight loss over the last month?
Patient: No, my weight has been the same. 

Doctor: OK, and have you, before this all started, have you had any like, Congestion, runny nose, or any other cold like symptoms? 

Patient: No, I've felt well otherwise. 

Doctor: OK. Uhm, do you have any past medical conditions like asthma Or anything else?
Patient: Uh, no. 

Doctor: OK, so you're healthy?
Patient: Yes. 

Doctor: OK, do you have any allergies? 

Patient: No, I don't. 

Doctor: OK, are you currently taking any medications regularly?
Patient: No. 

Doctor: Any previous hospitalizations or surgeries? 

Patient: No. 

Doctor: Any family history of any lung conditions or heart conditions or any cancers?
Patient: No, nothing like that. 

Doctor: OK, and currently do you work?
Patient: No, I'm just going to school. 

Doctor: OK, and so, currently where do you live and Who do you live with?
Patient: Yeah, so we live in a house with my parents and younger brother and we've been both back at school now Part time and doing some of it at home online as well. 

Doctor: OK, so anyone at all that you notice at school that was sick around you?
Patient: No, not that I am aware of. 

Doctor: OK. So yeah, this is just a question that we ask everyone. Do you drink alcohol or smoke cigarettes or use any recreational drugs?
Patient: Uh, no. 

Doctor: Ok, so those are all the questions I had to ask you. Anything that I may have missed or anything you want to tell me?
Patient: No, that's everything that's been happening over the last couple of days. 

Doctor: OK. Alright, so yeah it seems that, from your age and some of your symptoms we will definitely do a testing for strep throat. It seems that you meet that criteria. And we also want to make sure that, since you're having other symptoms as well, just to do a covid test, just in case. We'll take your temperature as well, and we might give you some antibiotics as well to treat you and relieve some of those symptoms. So yeah, just hang tight, we'll get the swab done for you for the Covid test, as well as strep throat and then we'll go from there.
Patient: Hi, I'm Rob and I just feel like I can't catch my breath. 

Doctor: OK, how old are you Rob?
Patient: I'm I'm 50 I'm gonna be 50 soon. 

Doctor: OK, OK, when did this start?
Patient: Well, like last night I kinda had like an ache on my chest, kind of like here like on the left. I just I didn't do anything really last night and you know I just went to sleep and I got to sleep fine like I just thought maybe I pulled a muscle on this side. But then I woke up and I was like walking up the stairs and I like was kinda having a hard time breathing and I took some Tylenol. It didn't really do anything. Um, and then it just got worse and then a few hours ago is like I could barely walk. And if I'm breathing deep it's like it just hurts. And I feel like I can't like catch my breath like I can't get a good like a good breath in. 

Doctor: Um, OK, so I just want to state at this point I would do ABC's, like I would do the vitals and make sure you're stable and then do airway breathing circulation if you weren't before I continue with the history. OK, so. OK, so that's how it started. Um, are you having any chest pain at all associated with that? 

Patient: Like when I breathe in, I get like and it's like an ache. And then if I breathe really deep it feels like a little sharp. 

Doctor: OK.
Patient: I have never had anything like this before. 

Doctor: No? OK, that was going to be my next question. On a scale of 1 to 10, how severe is your shortness of breath, 10 being the worst?
Patient: Um, I don't, I don't know, um. Like I can breathe right now, I can't get like a deep breath, like... 

Doctor: Does it? Oh sorry, go ahead. 

Patient: Maybe like you know five or six. 

Doctor: OK, OK. Does it hurt when you take a deep breath in?
Patient: Yeah. 

Doctor: Yeah?
Patient: Yeah, it's like it's like sharp. 

Doctor: OK, sorry, sounds like you're having some pleuritic chest pain. Do you have any coughing associated with that? 

Patient: No no. 

Doctor: No? You're not coughing up any blood?
Patient: No. 

Doctor: Any swelling in your legs? 

Patient: I I don't think so. 

Doctor: No? OK, how about on exertion? Like when you walk or run, or you know, does it hurt more or does I mean sorry, does your shortness of breath get worse?
Patient: Oh yeah, it was like going up the stairs, can't really breathe in after. 

Doctor: OK, how about when you're laying down?
Patient: I don't know. I don't think that's any different. No, I slept fine last night. I got up and when I went up the stairs I was like holy... 

Doctor: OK. How about wheezing? Are you experiencing any wheezing? 

Patient: I don't think so. 

Doctor: OK, how about fevers or chills?
Patient: No, not that I've noticed, no. 

Doctor: OK. Any abdominal pain?
Patient: Uh, no, no, it's like it aches kind of it, but it's all up here and like kind of in my back a little bit. 

Doctor: OK and, do you think anything triggered this? 

Patient: I don't know. 

Doctor: No? OK. And you said this has never happened to you before, right?
Patient: Right, yeah. 

Doctor: Does it get better with you sitting forward? 

Patient: I don't know, like I, I feel like that it's still kind of aching like it doesn't, it's not really like changing very much. 

Doctor: OK. OK. OK, any changes in your vision, hearing or smell?
Patient: No. 

Doctor: No? Any rashes?
Patient: No. 

Doctor: No? Weight loss? 

Patient: I, I mean, I've been trying to to lose weight. 

Doctor: OK.
Patient: They told me a year ago I have like high blood pressure so I've been cutting out like salt and trying to walk more. 

Doctor: OK, OK, good. 

Patient: So I've lost like 15 pounds but like not... Like I've been trying to. 

Doctor: OK, OK. 15 pounds, that's good. Are you experiencing any dizziness or you feeling faint?
Patient: No, just like a I can't get like a good breath. 

Doctor: OK, and are you otherwise healthy? You mentioned you have high blood pressure, anything else?
Patient: No, that's that's like it. I've never had any like chest problems. 

Doctor: OK. Have you had any investigations done for your chest like pulmonary function tests, ECG's, chest X-rays? 

Patient: No, no, they just they just put the thing on my arm. But my doctors office and said that it was high. So they said to you know, eat better and I don't I don't wanna start any drugs so, I didn't do anything. I've been fine ever since. 

Doctor: OK, so you're not on any medications?
Patient: No, just yeah, no that's it. I mean I, you know sometimes take like a Tylenol if I'm not feeling well but... 

Doctor: And do you smoke?
Patient: I, like I, smoke a little bit. Maybe like a pack a week. 

Doctor: A pack a week, OK? For how long? 

Patient: Oh like since college. 

Doctor: OK OK. Um, do you smoke marijuana?
Patient: Uh. No, no and I I smoke, I'm trying to smoke less, you know, since they told me I have the high blood pressure. So I used to smoke a little more but this is this is less but not since I've been having trouble breathing. Is it, yeah. 

Doctor: Yeah, OK. Any other recreational drugs? 

Patient: No no. 

Doctor: No, OK. How about alcohol? Do you drink alcohol?
Patient: Oh like, maybe you know, a beer on the weekend. 

Doctor: OK, and are you up to date with all your immunizations? 

Patient: Like I don't I think I got all the ones when I was like a kid. What else should I have? 

Doctor: OK, so like the flu vaccine every year?
Patient: Oh, I get that, like my wife, my wife makes me get that. 

Doctor: OK that's good. Any family history of lung or heart disease?
Patient: Oh like my, uh, my mom and dad have high blood pressure too, so I wasn't surprised when I heard that I did. 

Doctor: OK. OK. Um, OK so Rob, is there anything that you wanted to tell me that I haven't asked you already today? 

Patient: I am really like nervous 'cause I haven't felt anything like this before. Um, like it's scary, like do you think it's like cancer or something like I don't I don't really know? 

Doctor: Um, I mean, it's hard to tell right now what it is. It sounds like it's it started pretty suddenly, um, like it started a day ago, correct?
Patient: Mhm. 

Doctor: Yeah, so it's unlikely that cancer would present itself like this so acutely, you know? And, but it could it could be a number of things like, it could be something like a pulmonary embolism, but you said you don't have any swelling. Um, but you did say you have some chest pain when you're breathing pretty, when you take a deep breath in. So I mean, that's a possibility. It doesn't sound like it's an infection because you don't have a fever or chills or any any other symptom really. And you mentioned there weren't any triggers like no trauma to the area. And then, other things could be like COPD because you which is a chronic obstructive pulmonary disease because you have been smoking since college and that's basically just inflammation in your lungs that causes your airways to narrow, and so you may have a hard time breathing. So for all of these things, we first start by doing some blood work and then we'll do some imaging like a chest X-ray and a pulmonary function test if indicated, and so that will give us a better idea of what you have and how we can best help you. Sounds good? 

Patient: Yeah yeah, I just really want to get a good breath so yeah, whatever we can do. 

Doctor: Yeah for sure, and then in the meantime we'll keep monitoring you to make sure your vitals are OK and if we need to give you oxygen, we will.
Patient: So yeah, I've just been having a cough for the last week and I think I had a little bit of a fever in the last few days. 

Doctor: OK, so you said the cough started a week ago? 

Patient: Yeah, around a week ago OK and the fever started two to three days ago. Yeah, I haven't really measured it, but like I definitely have been feeling chills.I've been wearing like multiple blankets over the last few days. 

Doctor: Ok, have you taken your temperature? You said you haven't taken your temperature right?
Patient: No. 

Doctor: OK. So let's focus on the cough. Is it persistent or does it come and go?
Patient: I think the cough is pretty persistent over the last week. 

Doctor: OK, and does it get worse with like cold air or dust? Like maybe pets or anything like that?
Patient: No, I think it stays around the same. 

Doctor: OK, umm, does it get better with anything? Have you tried any over the counter cough syrup? 

Patient: Yes, I tried tylenol cold and liked it. I think it made it a bit better, like it helped me sleep. Other than that, during the day, it's still around the same. 

Doctor: OK, and how would you describe this cough? Is it barky? Is it harsh? Does it sound muffled?
Patient: How I would say is that it's kind of like it's not too harsh. It's more like a wet cough. I'm definitely bringing up some some sputum. 

Doctor: OK, um, what color is the sputum?
Patient: It's usually like a, uh like a white and sometimes like a little bit yellow as well. 

Doctor: OK, is it ever green or do you ever see blood in there?
Patient: No, I haven't seen any of that. 

Doctor: OK. And have you ever had a cough like this before?
Patient: Umm, yeah, probably like in the last year, maybe I have gotten sick like once and had a similar cough. 

Doctor: OK, do you have a sore throat? 

Patient: No, I don't have a sore throat. 

Doctor: Is this cough getting worse?
Patient: It's, I think not really, it stayed around the same and I definitely feel a bit better with the tylenol cold. 

Doctor: OK, good. Any changes in your taste or smell? 

Patient: No, no changes. 

Doctor: OK, any changes in hearing or vision?
Patient: Nope. 

Doctor: And did you have in the past week a runny or stuffy nose?
Patient: No. 

Doctor: OK, any weight loss over the past month?
Patient: Umm, no, not really. 

Doctor: How about changes in your hair, nails or skin like rashes? 

Patient: No, no changes to the skin. 

Doctor: OK, any shortness of breath?
Patient: No, no. 

Doctor: How about wheezing?
Patient: No, I don't think I've recently.  DOCTOROK, chest pain?  No chest pain. 

Doctor: How about swelling? Have you noticed any swelling in like your legs or arms or your belly area?
Patient: No, I don't think so. 

Doctor: OK, how about you feeling like your heart's racing?
Patient: No, no, nothing like that. 

Doctor: OK, how about a calf pain?
Patient: No, no. 

Doctor: Any dizziness or fainting spells?
Patient: No, nothing like that. 

Doctor: Headaches?
Patient: No. 

Doctor: Confusion or memory loss? 

Patient: I don't think so. 

Doctor: Have your bowel movements been normal?
Patient: Yeah, I like go three times a day and I don't have any diarrhea or anything. 

Doctor: OK, how about urinating wise? 

Patient: Everything normal there. Yeah, no trouble. 

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

Doctor: Joint pain or muscle ache? 

Patient: No, I don't think so. 

Doctor: OK. Any Contacts with sick people around you recently?
Patient: My wife was actually just sick last week, but she recovered. She did have a fever for one of the days and she also had a cough. 

Doctor: OK, did she get it checked out in a clinic?
Patient: No, I don't think so. She did get that COVID test done, but it came back negative and she didn't go to the DOCTOR: or anything. It kind of just went away on its own. 

Doctor: OK, any travel recently?
Patient: No. 

Doctor: Are you otherwise healthy? Do you have any longstanding medical conditions? 

Patient: Just as a child. I had, probably in my teens, had my appendix removed, but nothing other than that. 

Doctor: OK. OK, no hospitalizations other than that too, right?
Patient: No, No. 

Doctor: Are you on any medications?
Patient: No, I just take some multi vitamins. 

Doctor: OK, and are you up to date with all your immunizations?
Patient: Yeah, as far as I know. 

Doctor: OK, how about allergies?
Patient: I do have like some, I get some runny nose around spring time probably I think I'm allergic to pollen. 

Doctor: OK. And any family history of lung conditions? 

Patient: No, not that I know. 

Doctor: How about heart conditions?
Patient: No, I think my father has high blood pressure if that's like a heart condition. 

Doctor: OK, sure. And how old was he when he got that?
Patient: He's around like 60s right now, so probably like in his 40s. 

Doctor: OK. Any cancers in the family? 

Patient: I do have an aunt on my mother's side who had ovarian cancer. 

Doctor: OK, how old was she when she was diagnosed with ovarian cancer?
Patient: I think probably in her 50s. 

Doctor: OK, and do you smoke?
Patient: No, I don't smoke. 

Doctor: How about marijuana? 

Patient: Marijuana just maybe like one or two joints in a month, just when I'm feeling that I need to relax a little. 

Doctor: OK, sure and by joint, you said once a month right?
Patient: Yeah, once per month. 

Doctor: OK, any other drugs? 

Patient: No, no other drugs. 

Doctor: And where do you live right now?
Patient: I live in London right now. I live with my wife in an apartment. 

Doctor: OK, any reasons to think you have old carpet mold or asbestos?
Patient: No, it's a fairly new apartment. 

Doctor: OK, and well those are all the questions that I had for you today. Did you have any questions for me? 

Patient: You don't think it could be COVID right? Like my wife got tested and it was negative. 

Doctor: Are you concerned about that?
Patient: I um. I just haven't been feeling very well over the past couple months. And I have decided I just come in and see what's happening, so I've just I've been feeling short of breath. And I kind of passed out sometimes and I'm really worried about it. 

Doctor: OK. Uh, so when the shortness of breath start. 

Patient: I say about five or six weeks ago. 

Doctor: OK, and and do you get short of breath at rest?
Patient: No. 

Doctor: And has it been getting worse or staying the same?
Patient: Uhm? Kind of the same maybe a little bit worse, but I yeah maybe the same. Definitely not getting better. 

Doctor: OK, how far are you able to walk or exert yourself before you're short of breath? 

Patient: I can walk quite a bit, um, but I, I guess like when I go for my my runs in the morning, I start feeling short of breath. It's maybe like, two blocks or three blocks. 

Doctor: OK, and any any symptoms where you get short of breath at night and where you had to get up and and put your feet over the bed?
Patient: No. 

Doctor: Are you able to lay flat without being short of breath? 

Patient: Uhm, yeah 

Doctor: Or does it.. OK. And every had any swelling in your feet or ankles.
Patient: No. 

Doctor: OK, and you mentioned that you you passed out as well. Can you tell me a little bit about a little bit about that? 

Patient: Yeah, uh, it just happened two or three days ago. And I was just, I was-I wasn't really doing much I was I guess just like going up the stairs. And when I got to the top, I just kind of suddenly collapsed. And then I got back up. 

Doctor: Were you really short of breath at the top of the stairs?
Patient: I felt like my heart was like beating kind of fast. And I felt little bit dizzy. 

Doctor: OK, see, where you sweaty at the time as well? 

Patient: I don't remember, maybe? 

Doctor: OK, did you feel like you were going to pass out?
Patient: Yeah. 

Doctor: OK, has anything like that happened to you before?
Patient: No. No. 

Doctor: OK and did you bite your tongue during this or?
Patient: No. 

Doctor: OK, and did you wet yourself at all? Like pee your pants or anything like that? 

Patient: No. 

Doctor: OK. And how long did it last for?
Patient: Maybe a couple of seconds, it's. Yeah. I don't know, I I can't really tell. I was alone at home at the time. And I'd like I couldn't tell how long it took for me to get back up. 

Doctor: OK, you picture that your heart was racing. Did it feel like it was like did you have heart palpitations or is your heart beating really fast?
Patient: Yeah it was. 

Doctor: OK. And did you hit your head or or hurt yourself when you fell? 

Patient: No, no. 

Doctor: OK, and recently, have you been otherwise feeling well or if you had any viral infectious symptoms like red eyes or itchy eyes or runny nose, sore throat?
Patient: No. 

Doctor: OK, nothing like that and have you had a cough? 

Patient: No. 

Doctor: OK. And have you had any wheezing?
Patient: No. 

Doctor: And if you had any chest pain. 

Patient: No. 

Doctor: OK, have you had any instances where you felt as though you were having heart palpitations at any other times? And not just during the time that you had the fainting episode?
Patient: Um, I kind of did when I was. When I was like running outside, but I just thought maybe maybe I was exerting myself too much. 

Doctor: I see, alright. And any chest pain? 

Patient: No. 

Doctor: And. Uh, OK. Have you had any, any nausea or vomiting?
Patient: No. 

Doctor: Any abdominal pain? 

Patient: No. 

Doctor: Any urinary problems?
Patient: No. 

Doctor: OK, any muscle aches or body pains?
Patient: No. 

Doctor: Any fevers or chills?
Patient: No. 

Doctor: Have you had any changes to your weight in the last several months? 

Patient: No. 

Doctor: Have you had any changes to your appetite?
Patient: No. 

Doctor: And have you notice any skin changes like rashes or or anything like that? 

Patient: No. 

Doctor: OK. And. Uh. In the past, have you been diagnosed with any medical conditions?
Patient: No, I've been very healthy. 

Doctor: OK, I do you so do you take any medications, either prescribed or over the counter?
Patient: Uhm, I just take some puffers for asthma, but I haven't had asthma in awhile. I actually thought maybe my asthma was getting worse over the past two three months. I didn't really. I just I didn't think too much of it. But then when I fainted, I was just kind of scared. 

Doctor: Yeah, for sure. Umm, certainly would be frightening. OK, and do you use the inhaler everyday?
Patient: No. I used to when I was young. I didn't have asthma for a couple of years for like, I'd say 20 years or so. So then I stopped taking inhalers. 

Doctor: OK, so you haven't used them recently. 

Patient: No. 

Doctor: And any allergies to medications or, uh, environmental?
Patient: No. 

Doctor: OK, and if you had any hospitalizations or surgeries?
Patient: No. 

Doctor: OK. And have you been pregnant in the past? 

Patient: Uhm, I I was yeah. I have a son. About eight years ago. He was born eight years ago. 

Doctor: Ok. Was this a vaginal delivery or a C-section?
Patient: Vaginal. 

Doctor: And any complications, either during pregnancy or delivery or afterwards? 

Patient: Oh no, everything was good, no problems. 

Doctor: OK, and could you tell me a little bit about where you're living and and who you're living with?
Patient: Yeah, I'm living with my husband and my son. We live in a house about 30 minutes from here. 

Doctor: OK, uh, has anybody been sick in the house?
Patient: No, everyones been well. 

Doctor: Alright, have you traveled anywhere recently?
Patient: No. 

Doctor: OK, any exposures in the house like carpets or rugs or it's like like things like that? 

Patient: We do have carpets, but I mean I, I don't think that's a problem. Like we've had it for like years and we've had the same carpets for years and years. 

Doctor: OK, I see and are you working currently or or at home?
Patient: Yeah, I'm at home but I work from home. I'm a writer. 

Doctor: OK cool, yeah I do you smoke cigarettes? 

Patient: No. 

Doctor: Do you smoke cannabis or use any cannabis products?
Patient: No. 

Doctor: OK, and do you drink alcohol?
Patient: I do, I'll just drink on the weekends. 

Doctor: OK, and I like how many drinks would you typically have in a week?
Patient: Uhm, not much. I'd say one or two glasses of wine. 

Doctor: OK, do you use any recreational drugs? 

Patient: No. 

Doctor: OK, And like you said, you're a writer currently. In the past, did you work any jobs where you were exposed to asbestos or like any chemicals or fumes in the air?
Patient: No, no, I haven't. 

Doctor: OK, And in the family is there is there anybody who has any heart or lung conditions? 

Patient: No. 

Doctor: How about any clotting disorders or or cancers?
Patient: Uhm, prostate cancer. My uncle had it. 

Doctor: I see, OK. So it sounds like over the last little month, you've been having some more short shortness of breath as well as well this fainting episode more recently. So we will. Was there anything else that you wanted to add?
Patient: Hum, no. 

Doctor: Alright, so we will do some pulmonary function testing and get some imaging of your lungs today as well as an ECG and maybe a monitor for your heart as well to just check your heart racing for the next 48 hours. Mentioning that your heart was racing and so to rule out that any abnormal rhythms of your heart, or to check for that. And we will kind of go from there, did you have any questions?
Patient: Hi, um, I'm here because I, I had this cough for a couple days and now my voice still hasn't recovered. It sounds really hoarse and I can't speak as well, so I was just wondering if you can give me something for that. 

Doctor: Possibly we will see just gotta ask a few questions first, and we'll, we'll do a physical exam as well afterwards, but certainly, we'll look into what is causing your symptoms. So you mentioned a cough. When did that exactly start? 

Patient: That started three days ago. 

Doctor: Okay, and have you had a cough before?
Patient: Um, like before the three days you mean? 

Doctor: Yeah.
Patient: Um, no, I was pretty healthy before then. 

Doctor: I see and uh, with the cough, are you producing any phlegm or sputum? 

Patient: No, it's pretty dry. 

Doctor: Okay, have you noticed any blood?
Patient: No. 

Doctor: Alright, and have you had a wheeze? 

Patient: No, uh, no, nothing like that. 

Doctor: Alright, and have you had any uh, chest pain with the cough?
Patient: No. 

Doctor: Alright uh, and you noticed that your voice is, voice changed, and that was about 3 days ago as well? 

Patient: Yeah, that, so, well no, actually that started about yesterday. Yeah, yesterday in the afternoon. 

Doctor: Okay, and uh, any triggers for this? Like were you at any events that you had to be uh, kind of speaking loudly or talking a lot or anything where you're straining your voice?
Patient: Um no, no, I wasn't. I was like, I had school, I came home, I didn't do anything like that. 

Doctor: Okay. Yeah, so it sounds, yeah, just sort of came on on its own. Alright, and have you had any like, eye redness, or discharge, or a runny nose?
Patient: I have had uh, I've had a runny nose before, but no eye discharge. 

Doctor: Okay. With the runny nose, what, what, what could you describe the uh, mucus that was coming out?
Patient: Uh, it was, it was clear. 

Doctor: And has that gone away now and then when was the runny nose?
Patient: Yeah, that's gone, yeah that's gone. That went away but like, um, yeah, two days ago maybe. 

Doctor: I see, and have you had a sore throat or do you have a sore throat?
Patient: Um I have, so, it hurts because I'm coughing, but it doesn't seem like it's my actual throat. 

Doctor: Alright, is there any pain with swallowing food or liquids? 

Patient: No. 

Doctor: Okay. Um, and have you had any fevers or chills?
Patient: No. 

Doctor: Or any, any night sweats? 

Patient: No. 

Doctor: And any changes to your weight recently?
Patient: Um, I've had some weight gain over the past like six months. 

Doctor: Okay, well that's great. And about how much? 

Patient: Uh just, maybe like 5, 10 pounds. 5 to 10 pounds, somewhere around there. 

Doctor: Okay, well that's good. And um, have you had any nausea or vomiting?
Patient: No. 

Doctor: How about any abdominal pain?
Patient: Uh no. 

Doctor: Any uh, diarrhea? 

Patient: No. 

Doctor: Or any urinary problems?
Patient: No. 

Doctor: Have you had any muscle aches or, or joint pains? 

Patient: Uh, no. 

Doctor: Okay, and have you had any loss of your taste or sense of smell?
Patient: No. 

Doctor: Okay, um, and any skin changes or rashes? 

Patient: Nope, nothing like that. 

Doctor: Okay, uh, and um, so you've been experiencing, so you had a runny nose that's gone away um, and now you've been having this cough for the past, dry cough, past three days and lost your voice yesterday. Have you been experiencing any other symptoms?
Patient: Um no, no other symptoms. 

Doctor: Alright, in the past, have you been diagnosed with any medical conditions? 

Patient: Uh no, I've been pretty healthy. 

Doctor: That's great, and u, have you been, um, have you had any allergies before?
Patient: No. 

Doctor: Okay, and uh, do you take any medications regularly?
Patient: Uh, I just take some multivitamins. 

Doctor: Okay, and uh are you aware if your immunizations are up to date? 

Patient: Uh, so I have everything except for that HPV vaccine. 

Doctor: Okay, um, is it, do you have a plan to get that one or?
Patient: I think so. I'm just uh, waiting to follow up with my family DOCTOR: about that. 

Doctor: Okay, well that, that's a good idea for sure. So it's great that you have a plan for that, um, for that. Yeah, it can be really helpful for preventing cervical cancer, as, as I'm sure you'll talk to the, with the family  about. Yeah, and have you had any hospitalizations or any surgeries?
Patient: Uh no. 

Doctor: Okay, um, where about are you living right now, and who are living with?
Patient: I live uh, with my parents um, and my two younger siblings. We live in a house. 

Doctor: Has anybody else been sick or have similar symptoms? 

Patient: Uh no, no one at home's been sick. 

Doctor: Okay, and uh, how about anybody at school or, or work, or anything like that that you've been around who's been sick?
Patient: So one of my friends actually had like a runny nose and a cough as well a couple of days ago, but uh, she seems to be better now and her voice is okay. 

Doctor: Okay, and um, have you traveled anywhere outside of the city or province? 

Patient: No, no, not recently. 

Doctor: Alright, and, um, in the home, is there any uh like, are you exposed to any violence of any sort, like physical or emotional, either yourself or, or witnessing?
Patient: No. 

Doctor: Okay, and what grade are you in?
Patient: I'm in grade 7 or, yeah grade 7 now. 

Doctor: Oh awesome, and uh, I don't, is there any smoking in the home?
Patient: Uh no, no one smokes at home. 

Doctor: Okay um, and then, um, anybody in the family uh, have any heart or lung conditions? 

Patient: Heart or lung? I know, um, like, heart disease, runs on my father's side of the family. I'm not really sure like exactly what, what kind of diseases though. 

Doctor: Okay, um, and I, sometimes people that, kind of in this age group, might experience with either drugs or alcohol. Have any of your friends done that or, or yourself?
Patient: I know like some of my friends have uh, tried alcohol and try marijuana, but I haven't experimented yet. 

Doctor: Okay, that's good and um, I, that's all I wanted to ask today on history. Was there anything else that you wanted to add?
Patient: Oh, nothing that I want to add. I just, what do you, how do you think I can make this, make my voice better? And how long will I have, have this horse voice? 

Doctor: Yeah, so uh, right now it's sounding like um, a viral type illness where there's inflammation of the vocal cords, uh, with having the cough and the runny nose a couple of days ago. Actually, this reminds me that. Have you, I'm not sure if I asked about fevers or chills, if you have any? 

Patient: Uh no, I haven't. 

Doctor: Okay, um, and so for, if it is a viral infection then, um, it's just supportive kind of management. So that will mean trying to stay as hydrated as you possibly can over these next um, next few days and then also you can use things like, if they help, like lozenges or something along those lines. Um, but it will, it will just take some time for it to come back on its own, a few days to a couple of weeks sometimes. And the cough could possibly last for um, two to four weeks after um, after having a viral type illness.
Patient: Okay. 

Doctor: Yeah, so it could be quite a few weeks that the symptoms last for. But since you're having a cough, and these symptoms could overlap with COVID we'll want to get a COVID swab today as well um, and kind of go from there.
Patient: Hi, yeah, so I've had this uh back pain that's been going on now for the last uh two weeks, it's just kind of right in the lower back and it just hasn't gone away. 

Doctor: OK, um last two weeks you said, is it getting worse? 

Patient: Uh no, it's not really getting any worse, uh it's just been uh limiting my abilities at work. 

Doctor: Right, OK, and what do you do for work?
Patient: So I work um at a butcher shop. 

Doctor: OK. 

Patient: Yeah, and we're like always like carrying heavy things and yeah, it's a lot a lot of like lifting and standing. 

Doctor: OK. Did anything trigger this back pain two weeks ago? Did you have some sort of injury or trauma to the area?