jshargo/medical-interview-conversations huggingface dataset:
Patient: I I would say maybe 100 meters. But before I was able to run uh like I was running a few days per week so. So this is not like me. 

Doctor: OK and the chest pain. Is it sharp or is a dull crampy? What does it feel like? 

Patient: I say it's sharp. 

Doctor: OK, have you ever experienced this before?
Patient: No, nothing like like this before at all. I I have never had any, any problems like this before? 

Doctor: OK um, and has it changed since it started a week back or has have your symptoms been pretty much the same? 

Patient: They've been pretty much the the the same. 

Doctor: OK, OK Um, do you have anything like COPD, Congestive heart failure, anything like that?
Patient: No, I've never had any heart problems, uh in the past. I've been healthy up to this point though, nothing I see a DOCTOR: regularly for. 

Doctor: OK, OK. This you mentioned, no fevers, no chills. And no night sweats too I guess? 

Patient: Yeah, no night sweats. 

Doctor: OK, and how about weight loss? Any weight loss?
Patient: No weight loss 

Doctor: No, OK. Um, have you experienced any changes in your vision? 

Patient: Yeah no, my visions been been, been fine. 

Doctor: OK hearing?
Patient: Hearing has been OK. 

Doctor: OK, how about smell?
Patient: No changes in smell. 

Doctor: No, um have you had a stuffy nose or runny nose in the past week or so.
Patient: No, it's just that the dry cough. 

Doctor: OK, dry cough. Any changes in your skin like rashes?
Patient: no rashes. 

Doctor: OK, and you mentioned some chest pain. Any palpitations like you feel like your hearts racing? 

Patient: Uh, actually I did feel like that a little bit. Especially when I was moving a little bit more, I felt like my heart was racing. 

Doctor: OK, um, any calf pain.
Patient: Um yeah my left, my left leg's actually a little bit sore. 

Doctor: OK, any swelling in the area?
Patient: um uh nope, I don't see any swelling there. 

Doctor: OK, no? 

Patient: Um, Yeah, we'll say that there is swelling. 

Doctor: Oh, OK. And, and you mentioned shortness some shortness of breath on exertion, how about when you're laying down?
Patient: Not when I'm laying down. 

Doctor: No OK, and not when you're OK, not when you're laying down, OK. Um alright and in terms of like your stool, so bowel movements and urination. Like all of that's normal? 

Patient: Yeah, all that's been normal. 

Doctor: OK, any headaches?
Patient: Um no headaches. 

Doctor: no, no confusion?
Patient: No confusion. 

Doctor: OK, how about dizziness or fainting spells?
Patient: Um, No fainting spells. 

Doctor: OK, OK, and have you already received any sort of imaging or pulmonary function tests or anything like that for this recently?
Patient: Oh no. I I I haven't. 

Doctor: OK and are you otherwise healthy? Do you have any past medical history of any conditions really?
Patient: No, like I've been um previously healthy, but I I guess I did have a hysterectomy a few weeks ago. I know it was, I I didn't bring it up before 'cause it's just a day procedure, but I was definitely spending a lot more time um relaxing at home after that, a few weeks ago. 

Doctor: OK, OK, so you haven't been moving around as much. I guess since the hysterectomy?
Patient: yeah exactly it's starting to it was starting to get, the pain was starting to improve but it was keeping me on the couch a lot of days. 

Doctor: OK, yeah. Um, are you on any medications?
Patient: Um no I try, I've tried some Tylenol and Advil for the pain throughout this week, and it didn't really help much. But other than that, don't take any any medications, nothing for blood pressure or anything like that. 

Doctor: OK, and sorry. What was the hysterectomy for? 

Patient: Um I I was having a lot of bleeding. 

Doctor: OK, so were they thinking it was like a cancer or something?
Patient: Um I think it was um. It was from Fibroids. 

Doctor: OK, OK and then,  So you mentioned no medications, any allergies?
Patient: Um no allergies to medications . 

Doctor: no. And are you up to date with any with all your immunizations?
Patient: Um, I am yeah. 

Doctor: you are OK. Any family history of lung conditions?
Patient: No lung conditions. 

Doctor: But how about heart?
Patient: Yeah, it's just my mom had a heart attack when she was 56. 

Doctor: OK, OK. I'm sorry to hear that. And. Any history of family history of something called pulmonary embolism or DVTS.
Patient: Uh, no, I haven't heard of a heard of pulmonary embolism before. 

Doctor: OK, so it's basically blood clots in your lung. And then DVT's are deep vein thrombosis. So also blood clots but in different parts of your body. 

Patient: OK. 

Doctor: Yeah, anything like that that you know of?
Patient: Uh no, I I have might have heard of something like that happening in my mom actually, it might have been related to her heart attack, but I'm not specifically sure. 

Doctor: OK, sure. Um an then do you smoke? 

Patient: Um I I smoke, I may be about half a pack of cigarettes per day. I've smoked ever since I was a teenager. I've tried to quit multiple times I I was smoking about a pack per day before, so I have cut it down, but still something that I'm working on. 

Doctor: OK good, I'm glad you're trying to cut down. Um, we have resources available if you're interested
Patient: No, I don't. 

Doctor: OK. Any use of other recreational drugs? 

Patient: No, no. 

Doctor: OK. And how about alcohol? Do you drink alcohol?
Patient: Uh may be a glass of wine on the weekends, but other than that no. 

Doctor: OK. I mean, have you had any sick contacts recently? People around you? People you live with at work.
Patient: I can't think of any anybody who's been sick no. 

Doctor: OK, OK, and and what do you do for work Jenn?
Patient: I work as an administrator at at a bank. 

Doctor: OK, OK. I'm and I have you traveled anywhere recently?
Patient: Um, no I I can't remember the last vacation. 

Doctor: OK, alright, and so those are all the questions that I had for you. Did you have anything that you wanted to add? Anything that I hadn't touched on?
Patient: Um No, I think you covered everything. Thank you. 

Doctor: OK yeah, no worries. So I guess at this point we would do a physical exam. Just take a listen to your lungs and your chest. After that, so right now it sounds like it could be something vascular you know, like a pulmonary embolism like we talked about. That's kind of high on my list of things to
Patient: Yeah, whatever, whatever you think we need to do. 

Doctor: OK sounds good. Thank you for your time.
Patient: Um I just uh I have, I have a cough that I've had for a couple of days and like normally if I had a cough or cold, I would just like stay home and rest, but just because you know there's like Covid I I wanted to make sure, like I wanted to get checked out. 

Doctor: Yeah, of course that that was a great idea. Thanks for coming in. Um how long have you had this cough for? 

Patient: Uh it's like 2 days. Like maybe three days ago, I started to feel like my throat was dry and I was like, oh, maybe I need to drink more water or something and then the next day I started like actually coughing. 

Doctor: OK, is it a dry cough or a wet cough?
Patient: Yeah it's really dry. 

Doctor: Really dry, OK. So no sputum, no blood that you're bringing up? 

Patient: No, nothing like that. It's just kind of annoying. 

Doctor: Yeah, um do you have any wheeziness associated with your coughing?
Patient: I don't think so. 

Doctor: No, OK. No shortness of breath?
Patient: No, no, I've been, I feel like I've been tired, but I don't think it's been actually hard to breathe. I just feel overall like really tired. 

Doctor: OK, OK, and have you tried anything for the cough, like um over the counter cough syrup or anything like that?
Patient: Uh like I have, I've just been drinking tea and just like tea with honey just to like make it feel better. I I didn't like take any medicine. 

Doctor: OK, and do you, have you noticed that there are any triggers for your cough, like the cold, or dust, or any like environmental triggers?
Patient: I mean, I've been, just because of Covid and stuff, I've been staying home ever since I had it. Uh so, I don't, I can't think of anything, but I don't think so. 

Doctor: OK, and do you find that it's constantly there or um is it worse during a particular time of day, like morning, afternoon, or evening?
Patient: It's kind of just been there all the time right now. 

Doctor: OK, and um is it getting worse, do you think?
Patient: I think so. I think like today is worse than yesterday, and the day before that, it just felt like dry and then and then like the next day I started coughing, so yeah. 

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

Patient: I mean, I've had coughs before, um this one feels like particularly dry, but uh like it, it's not too different than like when I'm just like, like had a cough in other years. 

Doctor: OK, OK. Um and you mentioned that your throat was also dry. Do you have a sore throat?
Patient: Maybe a little bit this morning, yeah, like at first it just felt dry like I was thinking like, oh it's like you know I need to take a sip of water or something and now it just feels, now it's starting to think, I feel a little bit sore, I think. 

Doctor: OK, um is it hard for you to swallow foods or fluids?
Patient: Oh sorry, could you repeat that? I just missed the last part. 

Doctor: Oh no worries. Is it hard for you to swallow food or fluids? 

Patient: Uh no, it's not hard. It's not hard to swallow things. 

Doctor: OK um, and then have you had a runny nose or a stuffy nose?
Patient: No, not particularly. 

Doctor: No, OK. How about any changes to your hearing or vision?
Patient: No. 

Doctor: No, how about changes in smell or taste?
Patient: Uh, no, that's like a Covid thing, right? Like I was hoping because I could still, I could still like taste my coffee this morning, I was hoping that that means I don't have Covid, but yeah, I don't really know. 

Doctor: I mean yeah, some people have it, some people don't. Um I guess people with Covid present in different ways, yeah yeah, do you have a fever at all? 

Patient: Um like when I came in here, when the nurse took my temperature, she said I had um, like she said I had a fever. Uh I don't have a thermometer at home, um but like I've been feeling really hot so would probably, I've probably been having it for a couple of days. 

Doctor: OK, OK, we can take, yeah we can take your temperature. Sorry, did you say you already took your temperature today and?
Patient: The nurse took it, yeah, I don't know what it was, but the nurse kept coming in and she said it was a little high like I don't know if it was like a fever but I've been feeling hot, so. 

Doctor: OK OK yeah so yeah we'll double check to make sure that um you either do or don't have a fever. Um have you experienced any chills or night sweats over the past few days? 

Patient: Uh, no. 

Doctor: No, OK. OK, how about um any weight loss?
Patient: No, like I don't weigh myself regularly, but I don't think so. 

Doctor: OK, um any changes to your hair or uh nails or skin, like rashes?
Patient: Uh no. 

Doctor: No, OK. How about um chest pain?
Patient: Uh, no. 

Doctor: No chest pain, OK. Um swelling in your limbs?
Patient: Uh, no. 

Doctor: No, do you ever feel like your heart's racing? 

Patient: Uh, no. 

Doctor: No, OK. Um how about um, how about any dizziness or or fainting spells?
Patient: Um, no, like I've been just tired. 

Doctor: Just tired, OK. 

Patient: Yeah I don't, I don't, I haven't fainted or anything. 

Doctor: OK, any headaches?
Patient: No. 

Doctor: No, OK. Uh how about confusion or memory loss?
Patient: Um, no, I don't think so. 

Doctor: OK, um any changes to your bowel habits?
Patient: Um, no. 

Doctor: No, OK. So no constipation or diarrhea or blood in your stool? 

Patient: Yeah, exactly. 

Doctor: OK, any changes to your urine?
Patient: No. 

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

Doctor: No, OK. And um no abdominal aches? 

Patient: No. 

Doctor: No, OK. Um are you otherwise healthy?
Patient: Um like I have um, I have uh Like some um Like digestive problems generally, like I haven't had any changes to that, but they think it might be like Crohn's or something. Um but other than that, no. 

Doctor: Um you said you had digestive problems. Did you say it might be Crohn's?
Patient: Yeah, like I, I've been seeing my family DOCTOR: and they they said they thought it might be, um but we don't really know, just like in general, I guess they've been calling it IBS. 

Doctor: Oh, I see, OK. Um, OK.
Patient: I wish I knew exactly, but they just said, yeah, they don't really know. 

Doctor: OK.
Patient: But there haven't been any changes right now. 

Doctor: Oh yeah, I see, OK. Um have you ever had any hospitalizations or surgeries? 

Patient: No. 

Doctor: No, OK. Um are you on any medications?
Patient: No. 

Doctor: OK, and how about um any allergies? 

Patient: Um, just uh pineapple, like not any medications or anything. 

Doctor: Pineapple, OK. Um are you up to date with all your immunizations?
Patient: Uh yeah yeah. 

Doctor: OK. Um any family history of lung conditions or heart conditions? 

Patient: Um, like my my uncle had a heart attack. 

Doctor: OK.
Patient: I don't, like, not my parents. 

Doctor: OK, I see. Um any cancers in the family? 

Patient: Uh, no. 

Doctor: OK. Um and do you smoke?
Patient: No. 

Doctor: No, OK. How about marijuana? 

Patient: No. 

Doctor: No, OK, um any other recreational drugs?
Patient: Um no, no 

Doctor: OK, how about alcohol? 

Patient: Uh, like I drink, I don't know maybe I'll drink like a bottle of wine on like a weekend, like over a whole weekend or something so like, I don't know maybe like 3 or 4 drinks over the weekend. 

Doctor: Three or four drinks a weekend, OK.
Patient: Yeah, something like that. 

Doctor: Sure, OK.
Patient: I'm not at all like. 

Doctor: OK, so occasionally? 

Patient: Yeah. 

Doctor: OK. And where do you live?
Patient: Uh I live in town here. 

Doctor: OK, do you live in a house, in an apartment?
Patient: Um my fiancé and I live in a townhouse. 

Doctor: In a townhouse, OK, um, any um concerns for like old carpets or mold or asbestos, anything like that?
Patient: Uh no, it's like a new a new building. 

Doctor: OK, OK, and do you think you may have been in contact with anyone who's been sick recently?
Patient: Well, so um, I work uh in like, I work in an office that's attached to a factory um and I, so like I have to actually be there, I haven't been able to work from home. Um and there was someone else in my office that I think was coughing in that, like last week and I I don't know, I questioned it but I I didn't actually get to talk to them and ask them, or like I don't know if they were actually sick or something. So, I might have been, and we wear masks and everything, like we're really good, but I don't know, I feel like the offices aren't like super, like the air flow's not that great. 

Doctor: Yeah. 

Patient: So yeah, I think that's another reason I was concerned, that I I feel like some people might have been sick and I didn't really know the whole story. 

Doctor: Right, OK, so potentially, from from the workplace then, OK.
Patient: Yeah. 

Doctor: And, OK, um have you traveled anywhere recently? 

Patient: No. 

Doctor: No, OK. Well those were all the questions that I had for you today, was there um anything that I missed that you wanted to discuss today?
Patient: Uh not that I can think of. 

Doctor: No, OK. So right now it seems like, if I'm going through my differential diagnosis list for you, at the top is, the thing that we have to rule out is Covid, so we'll take a swab and send it off for those PCR results and you'll hear back either tomorrow or the day after, about the results. But in the mean time, and I guess even if the test is negative, um and you're still having symptoms, please do isolate for 14 days. Um and if your symptoms get worse, um like you know, you're having trouble breathing, uh your fever, your temperature is off the charts, um or you're having any sort of neurological symptom, please do um go to the ER and seek out help. Um if it's not Covid, it could be another viral illness that's going around at, during this time of year, um, and usually the treatment for that kind of stuff is supportive, so make sure you're staying well hydrated, you're eating nutritious foods, uh you're getting good sleep. Um and if not, and your symptoms, you know you're having a productive cough, um you're really short of breath, uh we can test you to see if you have some sort of bacterial pneumonia, and those are usually treated with antibiotics, so that's kind of the plan right now. Um so we'll just start with that Covid swab for now. How does that sound?
Patient: Yeah, that that sounds great. That's really what it, like, I I don't feel super sick, I just really wanna know if I have Covid or not. 

Doctor: Yeah for sure and I, and I think it's good that you came in.
Patient: Hi, I've I've had um this pain in my left knee that's been going on now for the last uh three or four months um but it's gotten a bit a bit worse, it used to only really bug me while I was doing activity, and now its started to uh hurt even more um afterwards as well, so I'm getting the pain at at rest. and so I wanted to come and get that checked out. 

Doctor: OK yeah, for sure. Um and you said it started a few weeks ago?
Patient: Uh well, I think it first started a few months ago, but in the past couple of weeks it has started to um kinda like last longer and and happen at rest as well. 

Doctor: Yeah, and so does anything make it worse or better? I assume doing any sort of physical activity makes it worse and rest makes it better, but how about anything other than that?
Patient: Uhm not really, yeah, it's mostly just the the activity, if I'm going upstairs or um downstairs or uh during running is really where it hurts the most and that's what's bugged me the um yeah, the most, running. 

Doctor: OK, OK, and if you were to describe the quality of this pain, would you say sharp, dull, achy, crampy? 

Patient: Uh it's a sharp pain, uh almost like every time my foot hits the ground I get like a sharp stabbing pain and while I'm at at rest it feels a bit more dull, while, yeah, yeah while I'm at rest. 

Doctor: OK, OK, and 1 to 10, 10 being the worst pain ever, how bad is this pain?
Patient: A six. 

Doctor: OK, alright, and have you ever experienced this type of pain before?
Patient: Uh I did have something similar like many years ago. I used to be a rower uh in undergrad and I got some similar pains before, and I mean with some stretching and um other I don't know kind of strengthening stuff, it it kind of helped but I didn't go see anybody for it at that time because it it kind of went away after a little while, 

Doctor: OK, OK, um and you said you were, are you still rowing?
Patient: No, no, the only activity that I'm doing now is is running. 

Doctor: Running, OK and from when it started to now, in the past couple of weeks has it changed like dramatically, um is it affecting your day to day life? 

Patient: Uh a little bit, yeah, like even now, just walking I can I can feel it. Um the pain's not as severe but like as when I'm running but I can, I'm starting to notice it uh daily. 

Doctor: OK, alright, and um are you otherwise healthy? Do you have any um symptoms like fevers or chills?
Patient: No, nothing like that. 

Doctor: No, any weight loss?
Patient: Uh no weight loss. 

Doctor: No, any rashes? 

Patient: Uh no rashes. 

Doctor: No, uh changes to your uh vision, hearing, taste or smell?
Patient: Uh no changes there. 

Doctor: OK. How about a cough, shortness of breath, or um wheezing?
Patient: Nothing like that. 

Doctor: OK. How about uh chest pain, heart palpitations?
Patient: No, I haven't had anything like that. 

Doctor: OK. Um any changes to your bowel movements?
Patient: No, I haven't had any diarrhea, or yeah, everything's been normal there. 

Doctor: OK, nausea or vomiting? 

Patient: Nope. 

Doctor: No, um how about abdominal pain?
Patient: No, I haven't had any uh any abdominal pain, nothing like that. 

Doctor: OK, any changes to your urine?
Patient: No, uh no I haven't had any issues with that. 

Doctor: OK, how about uh headaches?
Patient: No, I haven't had any headaches. 

Doctor: OK. Um any pain elsewhere on your body? 

Patient: Uh nope, I've, it's just my, yeah just my knee. 

Doctor: OK, any numbness or tingling in the area?
Patient: No, I haven't had anything like that, it's just the uh sharp pain. 

Doctor: OK. How about confusion or memory loss?
Patient: No, I haven't had that. 

Doctor: OK. Um any um muscle aches around the knee, like so just above your knee where your quads are or just below? 

Patient: Um no, nothing, nothing like that. 

Doctor: OK, and are you otherwise healthy? Do you have any longstanding medical conditions?
Patient: Um yeah, I'm otherwise healthy, I it's nothing that I see the DOCTOR: for, I've never been diagnosed with anything. 

Doctor: OK. Um how about hospitalizations or surgeries in the past? 

Patient: Um nothing like that. no. 

Doctor: No, OK. Um any medications that you're on?
Patient: Um nope, I I don't take anything just well, no medications, but I do take a like a multivitamin. 

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

Patient: I am yeah, I'll get the flu shot each year. 

Doctor: OK, how about allergies? Do you have any?
Patient: Um, no, I I don't. 

Doctor: No, OK. Um any family history of musculoskeletal issues?
Patient: Uh nope, I don't think so. 

Doctor: How about um heart or lung conditions? 

Patient: Uh I think my dad has like high blood pressure um and high cholesterol, but uh nobody's had a heart attack or, and no cancer. 

Doctor: OK, um how about autoimmune conditions?
Patient: Uh no, I don't think so. 

Doctor: No, OK. Um any um, do you do you do any smoking?
Patient: Uh no, I've tried uh like smoking marijuana in the past, but didn't really like it, so I've stayed away from that. 

Doctor: OK, how about um other recreational drugs?
Patient: Uh no, no, I I I haven't used anything like that before. 

Doctor: OK, um and then where do you live right now? And who do you live with? 

Patient: So um right now I just live on my own, actually I'm um just finishing up my my my Masters um and just live in a small apartment. 

Doctor: OK alright. And have you been in contact with anyone sick recently?
Patient: No, I don't believe so. 

Doctor: OK. Um how about um travel?
Patient: Uh no, I've just been yeah finishing up the the thesis and running. 

Doctor: OK, alright, um those were all the questions I had for you, um we'll move on to the physical exam component of this. Um so if you can take a look at both your knees, um do you see any visible redness or swelling in the area?
Patient: Uh no no swelling or yeah, nothing visible that I can see. 

Doctor: OK, so no bruises? 

Patient: Uh no, no no bruises 

Doctor: OK. Do you notice any like muscle atrophy, any deformities or skin changes otherwise?
Patient: No, everything looks looks normal. 

Doctor: OK, and if you can just um place your hand just kinda at the top of your, on top of your kneecap on both sides, do you notice any temperature changes from your, uh between your right knee to your left knee? 

Patient: No, no temperature changes, they they feel the same. 

Doctor: OK. Um and then when you palpate your knee cap as well as um yeah, just if you could palpate just at the center of your kneecap, do you feel any pain there?
Patient: No pain over the kneecap, that feels fine. 

Doctor: OK. How about when you palpate kind of like the medial ligaments of your kneecap, do you feel any pain there?
Patient: No, everything on the medial side feels feels normal and fine. 

Doctor: How about when you palpate the lateral ligaments of your kneecap?
Patient: Yeah, the ligaments feel feel OK, on the lateral side though I I do get some pain along the um like above the joint line. 

Doctor: Above the joint line? 

Patient: Yeah. 

Doctor: OK, OK, and how about when you palpate uh that big muscle group on your thighs like the quadriceps?
Patient: That feels OK, no pain in the muscles. 

Doctor: OK, how about like the patellar tendon? 

Patient: Uh no pain there. 

Doctor: OK. And then when you go lower below your kneecap, um when you palpate like the top part where the proximal parts of your tibia and fibula are, do you feel any pain there?
Patient: Uh, yeah, no pain there. 

Doctor: OK, and now let's do some um movements with your leg. Um are you sitting down?
Patient: Uh, yeah, I am. 

Doctor: OK, I'm gonna get you to stand up from a sitting position, does that, is that painful? 

Patient: It is, yeah it's, I get a sharp pain if, when doing that. 

Doctor: OK yeah, uhm how about when you um sit back down, does that hurt?
Patient: Um yeah, that hurts too. 

Doctor: That hurts too, OK. Um and then how about when you flex your knee inwards, um so that your heel is touching your bum like does that hurt?
Patient: Uh like I, I'll get up, uh no that doesn't hurt, that feels OK. 

Doctor: OK, how about when you extend your knee back out, straighten it all the way?
Patient: Yeah, that feels OK too if I'm just sitting and doing that, I can um, I can do that OK. 

Doctor: OK. Um how about when you, so you're standing and then you uh you abduct your hip so you basically, um you flex your hip but laterally and you kind of bring it upwards so that it's almost, so that your your, the action is like you're uh trying to touch the ceiling.
Patient: OK yeah I um, it, if, it does feel, it feels like it's kind of pulling um like it feels tight when I do that uh like on that side, it's, I don't get the same sharp pain, but it's uncomfortable. 

Doctor: OK, uhm, so I'm gonna try a special test, it's called the Ober test. So can I get you to lie on the side um with the injured knee? 

Patient: Yep. 

Doctor: OK, and then I'm gonna get you to flex your knee at 90 degrees and um abduct and extend the hip uh while your thighs maintain in line with your trunk. Um so I'm gonna get you to adduct your thigh, so bring it back towards you, the the median, um as far as possible.
Patient: Sure, I'm I'm just having a lot of chest pain and and so I thought I should get it checked out. 

Doctor: OK, before we start, could you remind me of your gender and age? 

Patient: Sure 39, I'm a male. 

Doctor: OK, and so when did this chest pain start?
Patient: It started last night, but it's becoming sharper. 

Doctor: OK, and where is this pain located?
Patient: It's located on the left side of my chest. 

Doctor: OK, and, so how long has it been going on for then if it started last night? 

Patient: So I guess it would be a couple of hours now, maybe like 8. 

Doctor: OK. Has it been constant throughout that time, or uh, or changing?
Patient: I would say it's been pretty constant, yeah. 

Doctor: OK, and how would you describe the pain? People will use words sometimes like sharp, burning, achy. 

Patient: I'd say it's pretty sharp, yeah. 

Doctor: Sharp OK. Uh, anything that you have done tried since last night that's made the pain better?
Patient: Um not laying down helps. 

Doctor: OK, so do you find laying down makes the pain worse? 

Patient: Yes, definitely. 

Doctor: OK, do you find that the pain is radiating anywhere?
Patient: No. 

Doctor: OK, and is there anything else that makes the pain worse besides laying down? 

Patient: Not that I've noticed, no. 

Doctor: OK, so not like taking a deep breath or anything like that?
Patient: Maybe taking a deep breath. Yeah. 

Doctor: OK. And when the pain started, could you tell me uh, could you think of anything that you were doing at the time?
Patient: I mean, I was moving some furniture around, but, that I've done that before. 

Doctor: OK, so you didn't feel like you hurt yourself when you were doing that?
Patient: No. 

Doctor: OK, and in regards to how severe the pain is on a scale of 1 to 10, 10 being the worst pain you've ever felt, how severe would you say the pain is?
Patient: I'd say it's like a seven or eight. It's pretty bad. 

Doctor: OK, and with the pain, do you have any other associated symptoms?
Patient: I feel a little lightheaded and I'm having some trouble breathing. 

Doctor: OK. Have you had any loss of consciousness? 

Patient: No. 

Doctor: OK. Uh, have you been experiencing any like racing of the heart?
Patient: Um, a little bit, yeah. 

Doctor: OK. And have you been sweaty at all?
Patient: Just from the from having issues breathing. 

Doctor: OK, have you been having issues breathing since the pain started?
Patient: Yes. 

Doctor: OK. Um recently have you had any periods of time where you like have been immobilized or or, you haven't been like able to move around a lot? 

Patient: No no. 

Doctor: OK. And have you been feeling sick at all? Any infectious symptoms?
Patient: No. 

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

Patient: No. 

Doctor: Any fevers or chills?
Patient: No. 

Doctor: OK, how about any abdominal pain? 

Patient: No. 

Doctor: Any urinary problems?
Patient: No. 

Doctor: Or bowel problems?
Patient: No. 

Doctor: OK, have you had a cough?
Patient: No. 

Doctor: OK. You haven't brought up any blood? 

Patient: No. 

Doctor: OK, have you had a wheeze with your difficulty breathing?
Patient: No, not that I've heard. 

Doctor: OK, any changes to the breath sounds at all like any noisy breathing?
Patient: No. Well, I guess if when I'm really having trouble breathing, yeah. 

Doctor: OK. Has anything like this ever happened to you before? 

Patient: No. 

Doctor: No, OK. And have you had any night sweats?
Patient: No. 

Doctor: Alright, and then how about any rashes or skin changes?
Patient: No rashes, but I guess like my neck seems to be a little swollen. 

Doctor: OK, do you have any neck pain?
Patient: No. 

Doctor: OK, have you had any like accidents like a car accident or anything where you really jerked your neck?
Patient: No. 

Doctor: OK. Um any any trauma at all to the chest or or back? 

Patient: No. 

Doctor: OK, so just in regards to past medical history, do you have any prior medical conditions?
Patient: No. 

Doctor: OK, any recent hospitalizations?
Patient: No. 

Doctor: OK, any prior surgeries?
Patient: No. 

Doctor: OK, do you take any medications regularly? Are they prescribed or over the counter?
Patient: No. 

Doctor: Alright, how about any allergies to medications?
Patient: None. 

Doctor: Alright, any immunizations or are they up to date? 

Patient: They are all up to date. 

Doctor: Excellent. Alright, and could you tell me a little bit about your living situation currently?
Patient: Sure, I live in an apartment by myself. I, uh, yep, that's about it. 

Doctor: OK, and how do you support yourself financially?
Patient: I'm an accountant. 

Doctor: OK, sounds like a pretty stressful job or that it can be. Do you smoke cigarettes?
Patient: I do. 

Doctor: OK, and how much do you smoke? 

Patient: I smoke about a pack a day. 

Doctor: OK, how long have you been smoking for?
Patient: For the past 10 to 15 years. 

Doctor: OK, and do you smoke cannabis? 

Patient: Uh sometimes. 

Doctor: Uh, how much marijuana would you smoke per per week?
Patient: Per week, maybe about 5 milligrams. Not that much. 

Doctor: OK, and do you use any other recreational drugs like cocaine, crystal, meth, opioids?
Patient: No. 

Doctor: OK. Have you used IV drugs before? 

Patient: No. 

Doctor: OK. And do you drink alcohol?
Patient: I do. 

Doctor: OK. How much alcohol do you drink each week?
Patient: Uhm about I would say I have like one or two drinks a day, so about 10 drinks a week. 

Doctor: OK, uh, yeah and um alright, and then briefly, could you tell me a little bit about your like diet and exercise? 

Patient: Sure, I try to eat healthy for dinner at least, but most of my lunches are, uh I eat out. And then in terms of exercise, I try to exercise every other day, I run for about half an hour.  D; OK, well that's great that you've been working on the the activity and the diet as well. So has anything like this happened in your family before?  No. 

Doctor: OK, has anybody in the family had a heart attack before?
Patient: Actually, yes, my father had a heart attack when he was 45. 

Doctor: OK, and anybody in the family have cholesterol problems?
Patient: I think my father did. 

Doctor: I see OK, and how about anybody in the family have a stroke? 

Patient: No strokes. 

Doctor: OK, and then any cancers in the family?
Patient: Hi, yes. Thank you for seeing me. I just came in today because I've been having for the last week this cough and recently also started noticing that I've been having some diarrhea as well. 

Doctor: Hm, when did the cough start?
Patient: The cough started around 5 days ago. And it's it got worse, but now I think it's a little bit better. 

Doctor: What about the diarrhea? 

Patient: The diarrhea started just two days ago and I'm having to go like almost 8 to 10 times in the last two days. 

Doctor: And what is, what does your stool look like? Is it completely watery?
Patient: Yeah, it's mostly watery. 

Doctor: And what colour is it?
Patient: Just normal colour, no, it's not dark or anything like that. 

Doctor: OK, any blood that you've noticed, anything red? 

Patient: No blood. 

Doctor: And you've had this cough, but your cough is getting better. What's the cough like? Is it a dry cough or wet cough?
Patient: It's uh, it's more of a dry cough. 

Doctor: Have you coughed up anything at all, like blood or any, any mucus?
Patient: No, no I haven't coughed up anything. 

Doctor: OK. And other than the cough, have you had any other like flu like symptoms? Have you had like a runny nose or stuffy nose? Sore throat? Any of those symptoms?
Patient: No, none of those. But I, I have also been having like a little bit of a headache as well in the last few days. 

Doctor: Where is, where is your headache?
Patient: Just in the like on my forehead, on both sides. 

Doctor: What does it feel like? 

Patient: Aching sensation. 

Doctor: And how bad is your headache from 1 to 10, with 10 being the worst headache ever?
Patient: Right now, probably a 5, but it was probably like a 7 yesterday. 

Doctor: So do you feel like your headaches getting better? 

Patient: Right now, like today I took Tylenol so I don't know if it's just better because of that. 

Doctor: I see. And have you taken any other medications to help with your symptoms?
Patient: No. 

Doctor: OK, uhm, have you had a fever or chills?
Patient: Uhm, I know I haven't felt any fever, chills. 

Doctor: OK and have you had any chest pain or any difficulties breathing? 

Patient: No. 

Doctor: OK, uhm, have you had any nausea or vomiting?
Patient: Uh no, nothing like that. 

Doctor: OK, any pain in your belly?
Patient: Um just like a little discomfort with going to the washroom so much. 

Doctor: And any muscle aches in your body?
Patient: No. 

Doctor: OK, any numbness or tingling in your arms or feet? 

Patient: Uh, no, nothing like that. 

Doctor: Any change in your sense of smell?
Patient: Uhm, maybe a little bit, I haven't really.. Yeah, I would say in the last few days, maybe a little like I've been able to smell less. 

Doctor: Any change in your sense of taste?
Patient: Uh no. 

Doctor: OK. Have you have you been in contact with someone who you think could potentially be sick? 

Patient: Uh, no, not that I know of. I do I do go to work in, like in person. Unfortunately I'm I can't work from home. But I've been noticing anyone sick around me though. 

Doctor: And what do you do for work?
Patient: So I work at like a car shop. 

Doctor: OK. And do you wear a mask and maintain social distancing? 

Patient: Yeah, most of the times I would say we're pretty strict, strict with that. Uhm, sometimes when we're in our office I take off my mask, but usually when we're seeing other people or within close proximity, we keep the masks on. 

Doctor: OK. And, uh, do you, I, I guess, who do you live with at home?
Patient: I just live with my wife. 

Doctor: Do you think she might have had any exposures?
Patient: No, she's been fine and she doesn't have any symptoms. And she's, she's a school teacher. Right now that she is working from Canada. 

Doctor: OK, and do you, smoke at all? Or have you smoked in the past?
Patient: Oh yeah, I do, or I used to smoke in my 20s and 30s, but I quit smoking. 

Doctor: How much did you smoke back then? 

Patient: Probably half a pack a day. 

Doctor: And for how many years?
Patient: Only like 15, 15 years. 

Doctor: OK do you, do you smoke marijuana or have you smoked in the past? 

Patient: Uh, I've tried it a couple times. I don't really like it, so no. 

Doctor: Any recreational drugs?
Patient: No. 

Doctor: Alcohol? 

Patient: Uh, I probably have a beer every day. 

Doctor: Do you have any medical conditions that you've been diagnosed with?
Patient: Uhm I, I take uh, medications for blood pressure and high cholesterol. 

Doctor: What do you take?
Patient: Uhm, I take this medication called, I think it's it's like a Lipitor. And then I take uh, Ramipril for the blood pressure. 

Doctor: Any allergies to food, environmental allergies or any medication allergies to medications? 

Patient: Not that I know of, no. 

Doctor: Any medical conditions that run in the family?
Patient: Uhm so I think, uh, diabetes, and for my family, but I I I don't have it so and I think that's pretty much about it on my dad's side. On my mom's side and there was someone, like my aunt did have ovarian cancer. 

Doctor: OK, and have you, I guess have you, I forgot to ask earlier, have you had any surgeries or hospitalizations? 

Patient: Uhm I had a surgery to remove my appendix in my 20s and since then, no. No surgeries or hospitalizations. 

Doctor: OK.  Alright, and I guess that's all the questions I have for you. You haven't had any difficulties breathing right?
Patient: No, 

Doctor: No, OK. Do you OK? And you've had diarrhea for two days. How's your appetite and have you been eating and drinking OK? 

Patient: Uhm appetites pretty OK, like I feel like, I've been more hungry, with the carry I feel like I, need to eat more. 

Doctor: Uhm, It's also important with the diarrhea to drink lots of fluids and to make sure that you're not losing important minerals and you're not losing like sodium or potassium in diarrhea and other things like calcium that could create problems. So, continue to eat well and continue to drink lots of water. I guess so what we'll do is we'll do a COVID swab just to just to check if you have COVID or not. We'll also do a few labs to see how your electrolytes are, do your vitals to see if you have fever, measure your heart rate and do a physical exam and then go from there. And I'll off - I'll talk to my attending as well and we'll come back and discuss the management plan with you.
Patient: Hi, I'm um, I'm just, so I am here because I have this cough that I've had for the past um, week and a half, and I'm just uh, I usually don't come in with symptoms this minor, but because it's, because we're in the middle of a pandemic, I thought I should come in and get checked out. 

Doctor: Okay, yeah, so it's been going on for like more than a week. Um, can you describe to me what kind of cough you're having? Is it like a wet cough or a dry cough? 

Patient: It's a dry cough. 

Doctor: Okay, and has it been getting worse over the, over the time period you described?
Patient: Um, it's kind of the same. 

Doctor: It's the same. Um, have you noticed, although it's like dry, have you brought up any kind of sputum or phlegm at all? 

Patient: Um no, not, not, not recently. But yeah, in the first couple of days, the first two, three days. 

Doctor: Okay, um and have you noticed any kind of yellowish to greenish tinge to it?
Patient: No, it was watery. 

Doctor: Watery, okay. Have you noticed at all, any blood, have you been coughing up any blood at all?
Patient: Uh, no. 

Doctor: Okay, and is your cough like constant or does it come and go? 

Patient: Um, kind of comes and goes. There's just times when I'm coughing a lot and then it just goes away. 

Doctor: Okay, and is there a pattern to it? Like, uh, do you cough more when you're exerting yourself or any time, a certain time of the day?
Patient: Um, it's worse when I'm smoking. 

Doctor: When you're smoking, okay. And uh, how long do those episodes last? 

Patient: Couple of seconds, maybe? 

Doctor: Okay, and has this happened to you before at all?
Patient: Yeah. I think, um, yeah, I usually don't pay much attention to it. You know, I think must have happened last year or the year before. It just kind of goes away on its own. 

Doctor: Okay, and is there any anything that makes it better or worse?
Patient: Um, I um, I take this cough syrup, over the counter syrup, that helps. 

Doctor: Okay. And um, have you found that it's been helping over, like, to help improve your cough over the last few days? 

Patient: It goes away for a couple hours and then it comes back. 

Doctor: I see. Does it keep keep you up at night at all?
Patient: No, no, no. 

Doctor: No, okay. Are you having any other symptoms like shortness of breath, um sore throat, runny nose, anything like that? 

Patient: Uh, I kind of had those symptoms in those first two, three days, but then it went away, and then I only had this cough that stayed. 

Doctor: Okay, okay. And have you been in contact with anyone that's been sick around you at all?
Patient: Um, my daughter had the sniffles. 

Doctor: When was that? 

Patient: Last, two weeks ago. 

Doctor: Two weeks ago? Okay. And uh, how is she now like, did it just go away on its own, or did she have to go to the doctor?
Patient: Um, no, it kind of went away on its own. 

Doctor: Okay. Have you traveled at all recently outside of the province or the country?
Patient: No. 

Doctor: No, okay. And besides the cough, are you having any headaches at all? 

Patient: No. 

Doctor: Any nausea or vomiting?
Patient: Not anymore. 

Doctor: Not anymore, when was the last time that you had fevers or chills?
Patient: I think I had like a very, it must have been 37.4, um, in the first, two, three days. But it got better really quickly. 

Doctor: Okay, I see. Any night sweats? 

Patient: No. 

Doctor: No, okay. Any, um, do you feel tired throughout the day?
Patient: Not anymore. 

Doctor: Not anymore, okay. So any kind of chest pain, or sensation that your heart is racing? 

Patient: No. 

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

Doctor: Any changes in your bowel movements at all? 

Patient: Um, no. 

Doctor: No, so no constipation, diarrhea?
Patient: No. 

Doctor: Okay, any changes in your urination?
Patient: No. 

Doctor: No, okay. Um, have you had to miss work at all or, do you currently work?
Patient: Yeah, but I've been working from home. 

Doctor: Okay.
Patient: I didn't have to miss work, so. 

Doctor: Okay. And any changes in your sleep or appetite?
Patient: No. 

Doctor: Okay, any loss of sense of taste or smell at all? 

Patient: Um, initially, I guess the cough's first few days, my nose was a little stuffy, so yeah, I couldn't smell very well, but since then it's been fine. 

Doctor: Okay, but no loss of taste?
Patient: No loss of taste, no. 

Doctor: Okay. Uh, any recent significant changes to your weight at all over the last few months?
Patient: No. 

Doctor: Okay, um, and any exposure in your home environment to dust, fumes? Any animals in the household? 

Patient: No. 

Doctor: Okay. And otherwise, uh, do you have any medical conditions that you've been diagnosed with in the past?
Patient: Uh no, I'm pretty healthy. 

Doctor: Pretty healthy, okay. Any allergies, either to medications or environmental? 

Patient: Um, I'm allergic to penicillin. 

Doctor: To penicillin, okay. And what kind of reaction do you get to penicillin?
Patient: Um, I was told that I got a rash when I was a child. I don't really remember. 

Doctor: Okay, and do you take any medications on a regular basis? 

Patient: No. 

Doctor: No, okay. And have you been hospitalized in the past or had any surgeries?
Patient: Um, I had my appendix removed about um, five years ago. 

Doctor: Five years ago, okay. Any complications at all after that?
Patient: No. 

Doctor: Okay. Any family history of any lung conditions, heart conditions, any cancers at all? 

Patient: Um, colon cancer. 

Doctor: Colon cancer?
Patient: Yeah my dad and my grandfather had it. 

Doctor: Okay, um, and have you, have you had any scopes done recently at all? 

Patient: Oh yeah, I had mine done uh, seven years ago. 

Doctor: Seven years ago, okay. And were there any findings at all?
Patient: No. 

Doctor: No, okay. Um, currently so you work from home, so what's your home and living situation like? Who do you live with, and where, do you live in like a house, appartment? 

Patient: Uh, I live in an apartment with my wife and my daughter. 

Doctor: Okay uh, and uh, do they have any symptoms at all? Or are they, are they fine?
Patient: Well, my daughter doesn't have any symptoms anymore. She did as I mentioned, have some flu like symptoms 2 weeks ago. My wife's been healthy. 

Doctor: Okay, and uh, does your daughter go to school right now or is she doing school from home? 

Patient: Uh, school from home. 

Doctor: School from home, okay. Um, and do you at all smoke? So you mentioned your symptoms get worse with smoking.
Patient: Yeah. 

Doctor: Um, how much would you say you smoke on an average day?
Patient: Um, I don't, I try, I've been trying to cut down, so I, I smoke about 3 or 4 cigarettes a week. I used to smoke a lot more before. 

Doctor: Wow, yeah, that's really good! That's really great progress, um, it's really difficult to quit, but it's great to see that you're trying to quit. Um, so how much would you say you used to smoke? 

Patient: Well, half a pack. Um, half a pack a day, but then over the past three years I've been trying to cut it down. I started smoking when I was 20, so it's been um, 30 years now. 

Doctor: Okay, so 30 years, okay. And um, are you just, are you using anything to help you quit smoking or are you doing it without any medications, or um, like, have you used anything in the past that has worked for you?
Patient: Um, no I, I went to my doc and he said to try on my own first and if I'm struggling with it to come back, but I've been doing it very gradually so it's, it's going well. 

Doctor: Okay, and that's really good. And yeah, if you, at all, need any resources to help you quit smoking, it's great that you're doing really well, but if you need to talk more about it or need any more resources we can provide that for you. Um, other than uh, smoking cigarettes, do you use any recreational drugs like marijuana at all? 

Patient: No. 

Doctor: No. How about alcohol?
Patient: Uh, I just drink on the weekends. Maybe a glass or two of wine. 

Doctor: Okay, and uh yeah. So those were kind of all the questions I had for you today. Do you have any questions or concerns?
Patient: No. 

Doctor: No?
Patient: I was, I guess I was just worried about the cough um, it's just, I was worried that it could be COVID. 

Doctor: Yeah, so definitely right now, any of these symptoms, like COVID can have a lot of different symptoms um, so we should definitely make sure that we, to check if you have COVID or not and we'll get a COVID swab test done for you today, and the results will come back in 24 to 48 hours. Uh, and in that time, you will need to isolate even in your own home. Try to wear a mask around your family members, um, trying to eat separately and use all those methods, and, and then after the test comes back you may, you'll be contacted by public health if it's positive and kind of given more instruction on what to do. And it doesn't necessarily have to be COVID either, it can be just another virus uh, like it can be just your common cold that's been going on. So it does seem that your symptoms have gotten better. Oftentimes uh, a cough can be the last thing to go, it can take up to two weeks or more for the cough to get relieved, but it seems that you're not having any systemic symptoms like no fevers or anything else right now, so it's, it's uh, that's, that's pretty good.
Patient: Great, I'm glad. 

Doctor: Alright, yeah.
Patient: I haven't been coughing these last two weeks since I got back from Mexico. I think I got sick there. 

Doctor: OK, so just the last couple weeks you've been coughing?
Patient: Yeah, ever since I got back from Mexico it's been yeah so about about two weeks. 

Doctor: OK. And is your cough for a wet cough or dry cough? 

Patient: It's dry and I'm not bringing up any any sputum. 

Doctor: OK, and are you coughing up any blood at all?