jshargo/medical-interview-conversations huggingface dataset:
Patient: Um, I've been, I've been feeling really cold. 

Doctor: OK, have you had any, uh, like shakes or or rigors? 

Patient: I've been like kind of kind of shivering. 

Doctor: OK, how about any night sweats?
Patient: Um, yeah, come to think of it, like I was I was, when I was last traveling with, when I was last on it because I'm a truck driver, I I was in the States, I I had to bring something to Ohio, and I had to change my clothes in the night. They were just like so drenched in sweat. 

Doctor: OK, has that happened more than that that one time?
Patient: Maybe a couple times that it wasn't as bad, that one time was really bad, but here and there like I I've been feeling pretty sweaty at night in general. 

Doctor: OK, and have you had any, uh, like difficulties breathing or shortness of breath? 

Patient: Not really, just like kind of tired, but it's not like hard to breathe. 

Doctor: OK, um have you had a cough?
Patient: Uh, no. 

Doctor: OK, how about a runny nose?
Patient: Maybe maybe a little bit, but not like too noticeable. 

Doctor: OK, and when did the runny nose start? 

Patient: Oh, it's all like around the same time. 

Doctor: OK and have you been having any headaches?
Patient: A little. 

Doctor: OK, and then how about any chest pain?
Patient: No no. No chest pain. 

Doctor: Alright, and how about any wheezing? 

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

Doctor: Alright, then any heart palpitations?
Patient: No. 

Doctor: OK, have you felt lightheaded or or like you were going to pass out or faint? 

Patient: Uh not like I've been feeling really tired, but it's not been like I don't think it's been like fainting. 

Doctor: OK, so kind of like you are fatigued that you've been experiencing. Um, have you had any abdominal pain?
Patient: I mean, I'm not really eating a lot, so it's kind of like gurgling. 

Doctor: OK, have you had any nausea or vomiting?
Patient: Uh, no. 

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

Doctor: Any bowel problems?
Patient: No, I mean, you know I haven't been eating that much, so I haven't been going as much as normal, but it's I don't think there's problems. 

Doctor: OK, so you haven't had any diarrhea?
Patient: No. 

Doctor: OK. Um, and have you had any skin rashes? 

Patient: No, not that I've noticed. 

Doctor: OK, and um have you had any like muscle aches or or joint aches?
Patient: I mean, I feel kind of achy all over but not in like one particular spot. 

Doctor: OK. And in terms of your past health, have you been, is there any reason you you see a  regularly?
Patient: Oh Oh yeah, like I have I have high blood pressure and diabetes. Yeah, that's that's pretty well it, but yeah, those two things. Oh and I take a medication for my prostate. 

Doctor: Oh OK, um, and do you take medications for the blood pressure and diabetes?
Patient: I yeah yeah, I um, oh geez, what's it called? I take ramipril, and I take Metformin. I was on insulin but I pretty well I just have been able to eat well so I'm not taking it now. And then, uh, I can't remember the, uh, the prostate one. Like tam, tam something. 

Doctor: OK, maybe tamsulosin?
Patient: That sounds right, yeah. 

Doctor: OK, I can check on the chart as well to confirm. Um, do you have any allergies to medications? 

Patient: No. 

Doctor: Alright, and any recent hospitalizations?
Patient: No, no, I've been pretty good. 

Doctor: OK, and any surgeries?
Patient: Uh, not for a really long time, I I had my gallbladder out like 20 years ago. Yeah, that's it. 

Doctor: OK, um, and has anything like this happened to you or any of your family members before, suddenly they start started to feel fatigue like this? 

Patient: I don't think so. I mean, we've all like you know, caught colds and you know stuff like bugs and stuff but, not not quite like this, like I can barely get up. 

Doctor: OK, anybody in the family have a history of heart disease or cardiovascular disease?
Patient: My dad had high blood pressure, that's it. 

Doctor: OK, anybody in the family have cancer? 

Patient: My mom, my mom had breast cancer. 

Doctor: OK, and you told me that that you work as a trucker, so you were over in the states, it sounds like. How recently were you in the United States?
Patient: That was like about a week ago. I probably got back five or six days ago. 

Doctor: OK, do you travel there often? 

Patient: Oh yeah, yeah. I mean that's you know the route that I usually take. 

Doctor: OK, uh any anybody you interacted with that was sick, do you believe?
Patient: I don't. I don't really interact with with many people. I kind of just go there and um, and then you know I stayed in a hotel. But you know, I didn't really see anyone besides like the lady that works there. And maybe you know, the people at the McDonald's like counter. I didn't I didn't like see anyone that I know that I sat with for a long time or anything. 

Doctor: OK, but you got home about five or six days ago. Um, yeah, and who are you living with currently? 

Patient: Just me. 

Doctor: OK, and do you drink alcohol?
Patient: Oh no. No, I used to a little bit, but not not anymore. 

Doctor: OK, and how about cigarettes? Do you smoke cigarettes?
Patient: I quit um 10 years ago. 

Doctor: OK. 

Patient: I smoked I smoked probably like 1/2 a pack a day for for a while, maybe 20 years. 

Doctor: OK, but you quit over 10 years ago?
Patient: Uh, about 10 years ago, yeah. 

Doctor: OK, and do you smoke marijuana?
Patient: No no. 

Doctor: Alright, and how about any other recreational drug use, including the use of IV drugs? 

Patient: No, nothing like that. 

Doctor: OK, and are you currently sexually active?
Patient: No no. 

Doctor: OK um, and have you had a sexually transmitted infection before?
Patient: No no. 

Doctor: OK uh, and are you currently in a in a relationship?
Patient: Uh, no, uh, like I have I have a friend that I see and we both, um, we both lost our spouses, um, several years ago, and I mean, we, we see each other and like we live in the same apartment building and often have meals together. But we're just like friends. 

Doctor: OK.
Patient: But that's the person that would check on me if I needed it. 

Doctor: OK, that's great. It sounds like you have some good support nearby. I'm sorry to hear about your wife. But I think that was all of the questions that I wanted to ask on the the history today. So next I we're gonna order some some lab work for sure to start with then and maybe we'll go from there. So we'll give you some fluids, and maybe some Tylenol and we will see what the lab work shows.
Patient: Hi, so I feel like I might have a bladder infection. I see a urologist because I've had some issues with like an overactive bladder for awhile. I've had a few bladder infections in the past and this is usually how how they feel. I feel like a little bit of burning when I go to the bathroom and I have to go like a lot right now. But then also sometimes it means that like it gets like this when I have my period and I don't have my period right now, but I you know I I could be getting it, but I also just don't wanna let it go keep going if I do have an infection. I just like rather get it like treated if I do. 

Doctor: OK understood. When was your last period?
Patient: Um, like 2 weeks ago. 

Doctor: About two weeks ago, are you fairly regular? 

Patient: Like yes and no, it's. I'm I'm not super irregular, but I I sometimes have like basically it's like I alternate sometimes. I my cycles like 4 weeks and sometimes it's more like 5. 

Doctor: Sorry, just clarify again, you're 30 years old?
Patient: Yeah I'm 30. 

Doctor: Ok are you on any contraception right now? 

Patient: Uh, no, I'm not. 

Doctor: Ok. Are you sexually active at all?
Patient: No. 

Doctor: No? Ok. So just in terms of your urinary tract infections, when was your last one? 

Patient: I had one like 3 months ago maybe. 

Doctor: 3 months ago ok, and they prescribed you antibiotics and it went away fairly quickly?
Patient: Yeah yeah it went away like I always I always have an overactive bladder and I always have to go pretty frequently, like every hour, sometimes half hour. But so that's still there, but like it hasn't ever since then, I haven't had any like pain with it. 

Doctor: Ok, so you still have quite a, you have a, quite a bit of urgency to go? 

Patient: Yeah. 

Doctor: Kind of going more frequently, but I suppose the new thing you're a little bit concerned about is that it, it burns a little bit, it stings a little bit when you do urinate. Am I understanding correctly?
Patient: Exactly like for the past couple days, it's felt like that. 

Doctor: Ok, has it been getting progressively worse at all? 

Patient: Um, maybe a little bit I I feel like now I can recognize it pretty early when it's not too bad to kind of get ahead of it. 

Doctor: OK understood. And do you have any pain kind of behind your ribs at all? On your back?
Patient: Sorry, can you repeat that? 

Doctor: You haven't had any pain on your back, middle back kind of close to your ribs, have you?
Patient: Not that I can think of. 

Doctor: Ok, and have you noticed any changes to the quality of the urine? For example has it looked frothy or smelled bad?
Patient: It maybe looked like a little cloudy. But nothing, nothing else out of the ordinary like I've never had blood in it or anything. 

Doctor: Understood. Have you noticed any visual changes in the area near the vagina? 

Patient: No, not that I can think of. 

Doctor: Like any lesions, anything like that? Anything concerned for an STI that you're worried about?
Patient: No, and like I haven't had like had a sexual partner in a few years. 

Doctor: Understood, understood. These are kind of questions that we ask when someone's having a little bit of maybe an issue holding in their urine. Have you ever felt any numbness or inability to feel kind of around your buttocks region? For example, when you wipe with tissue paper, can you feel that well?
Patient: Oh yeah, I can feel everything. 

Doctor: Ok and no changes to your poops, to your bowel movements? 

Patient: No, nothing, pretty normal. 

Doctor: Ok, and how do you feel otherwise?
Patient: I, I mean, I feel I feel a little tired, felt like a little hot yesterday. I don't have a thermometer so like I didn't take my temperature but, you know, sometimes I feel a little hot like when I've had the infections before. 

Doctor: OK, you don't have any swelling on your anywhere in your body on your ankles, do you? 

Patient: No. 

Doctor: No? Ok, and then, so no puffiness around your eyes that you've noticed?
Patient: No, nothing like that. 

Doctor: Any rashes or any changes on your face?
Patient: Like my mom said, I, I I saw my mom earlier and she said I looked like a little flushed but it's not not like a rash or anything. 

Doctor: No? No markings across the bridge of your nose and your cheeks? 

Patient: No. 

Doctor: Ok, and then in regards otherwise you feel a little flushed, a little tired? Any other medical issues that you have?
Patient: No, just this like overactive bladder thing. 

Doctor: OK, and have they given you any medications for it?
Patient: We tried a few different ones before, now I get I get Botox injections into the bladder like maybe twice a year. 

Doctor: Anything else they've used recently? Like any medications you're on right now, I suppose? 

Patient: No, nothing no nothing else. Yeah, I guess I have like I have an inhaler but I don't use it all the time like I haven't had to. 

Doctor: Oh, so you have asthma?
Patient: Yeah, like I honestly don't feel like I have it very much now, but I still have like I still have the inhaler. 

Doctor: Understood, understood. Anything else, you've taken medications for in the past?
Patient: Oh, I used to take birth control, like the the pill but like I just I don't have a boyfriend right now and I just didn't really feel like I needed it otherwise. 

Doctor: Understood, understood. And have you had any past surgeries?
Patient: Um, I had my appendix out when I was 24. That's it though. 

Doctor: Ok got it. And then just in terms of you yourself, do you live in London? 

Patient: Yeah yeah I do. 

Doctor: Ok. What do you do for work?
Patient: I work at a bank. 

Doctor: Ok, do you have any children?
Patient: No. 

Doctor: Ok, and in regards to anything so any sick contacts? 

Patient: Uh no. 

Doctor: Any recent travel?
Patient: No. 

Doctor: Any allergies?
Patient: Like sometimes in the spring I'll get like a little stuffy but... 

Doctor: Ok, sounds great.
Patient: No like, yeah... 

Doctor: Nothing to concerning? No drug allergies?
Patient: No, nothing like that. 

Doctor: Got it, got it. OK, I think what now do next, I'll move to a physical exam. I think we might just do some investigations just in order to get some more information. And then the physician will come in to see you, ok?
Patient: Hi I um I just developed uh or I guess I just started having difficulties with uh breathing starting this morning. It was just very odd, I was fine yesterday night and then just this morning, I've had a really hard time breathing um and yeah, I thought I should come in and get it checked out. I don't know what's going on. 

Doctor: Yeah, certainly, and so uh like did this shortness of breath wake you uh like did you wake up, um like just like uh to kind of sit up to catch your breath, um or when did the shortness of breath start? 

Patient: Um it was kind of after I woke up and I was sort of, um just walking around that I I noticed that I was feeling short of breath just walking around, which was so weird. You know that that doesn't really happen to me. 

Doctor: OK. Um and with this, with the shortness of breath, have you had had a cough?
Patient: No. 

Doctor: OK, and um have you had any wheeze? 

Patient: Um no. 

Doctor: OK, and have you been having any uh any chest pain?
Patient: Yeah, I kind of, I guess it just hurts a little bit when I take a, when I breathe in. 

Doctor: OK is is this pain when you take a deep breath in? 

Patient: Yeah, I guess so, yeah. 

Doctor: And where do you feel the pain?
Patient: Um it's kind of on my um right side. 

Doctor: OK, does the pain uh like radiate anywhere or do you feel it just in that one spot?
Patient: It's just uh it's just in that one spot. It's just this sudden and like like this stabbing sensation um when I'm like taking a breath in. Uhm, actually now that I think about it, it's it's kind of there even when I'm like breathing normal, but it's not as bad. When I take a deep breath it's like really, really bad or when I um yeah, when I like cough or like I'm laughing or something, it just gets really bad. 

Doctor: And when did you first notice this pain?
Patient: Kind of um late this morning. 

Doctor: OK uh have you tried anything for a for the pain? 

Patient: Uh I don't know, it's just I just try not to take deep breaths, I'm just trying to just take a normal breath and try not to talk too much. And yeah, just like not doing anything that worsens the pain. 

Doctor: OK, I see and um did you have any trauma to that to that area recently like a car accident or I don't know, getting hit in the ribs, or anything like that?
Patient: No, no I didn't. 

Doctor: OK. Um and have you had any episodes where um or actually rather like, do you have any issues with lying flat and having shortness of breath? 

Patient: No. 

Doctor: OK, and um have you had any headaches?
Patient: Uhm, no. 

Doctor: Have you had any uh fevers or chills?
Patient: No. I don't think so. 

Doctor: OK, and have you had any night sweats? 

Patient: No. 

Doctor: Have you had any changes to your weight recently? I mean, like over the last several months.
Patient: Uh no. 

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

Patient: No. 

Doctor: How about any changes to your sense of uh taste or your sense of smell?
Patient: No, those are OK. 

Doctor: Alright, and have you had uh a runny nose or a sore throat?
Patient: No. 

Doctor: Alright. Um and have you had any diarrhea?
Patient: No. 

Doctor: How about any urinary problems? 

Patient: No. 

Doctor: And have you noticed any skin changes or rashes?
Patient: No. 

Doctor: OK. Um and how about any uh muscle aches or body pains? 

Patient: Um yeah, I kind of have uh, it's just my left leg hurts a little bit. I'm not quite sure why. But yeah, nothing else. 

Doctor: OK, whereabouts, uh where does it hurt um on your left leg?
Patient: Um kind of in the calf area. 

Doctor: OK is it is it swollen or have you noticed any redness of the skin there?
Patient: Yeah it is. It is swollen actually, compared to my right leg. It's a little bit warm too. 

Doctor: OK, um have you had any uh like periods of time where you were bedridden over the last several days or or last several weeks?
Patient: No. 

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

Doctor: Alright, and have you traveled anywhere over any long distances recently?
Patient: Oh yeah, yeah, I came back um two days ago. Um I went to um I went to India to visit my family, there was a death so had to to go. I came back yeah, two days ago. 

Doctor: OK, yeah, that's quite a long flight and I'm sorry to hear about um the loss of the family. Um OK, um oh and that reminds me, have you coughed up uh any blood at all?
Patient: Uh no. 

Doctor: OK. Um and um I just wanted to switch gears a little bit and ask about your past health. Have you been diagnosed with any medical conditions?
Patient: Uhm I I've had um anxiety. And uh yeah, that's that's about it. I had asthma as a child, but nothing since then. 

Doctor: I see, and do you uh take any medications for anxiety or have you?
Patient: Uh no, I'm just trying to um, just trying to reduce my stress and and trying other other ways to sort of handle my anxiety before I, I'm just trying to avoid builds actually. 

Doctor: I see, OK. So do you take any medications like either prescribed or over the counter? 

Patient: Uh no. 

Doctor: Do you have any allergies to um to medications or or environmental?
Patient: No. 

Doctor: Alright, and um have you had any surgeries in the past or any hospitalizations? 

Patient: Uh I had my appendix removed when I was uh 30 years old. 

Doctor: OK, um and any complications with that?
Patient: No. 

Doctor: Alright, and currently uh whereabouts are you living and uh who are you living with? 

Patient: Um I'm just living with my sister. And uh yeah, we we live in an apartment together. 

Doctor: OK, and has she been sick or have you been any, around anybody who's been sick?
Patient: No. 

Doctor: OK, um and uh any potential exposures to uh TB, uh either in your on your travels or or anybody that you that you know of? 

Patient: I don't think so, no. 

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

Doctor: And do you drink alcohol? 

Patient: No. 

Doctor: Uh how about the use of any uh recreational drugs?
Patient: No. 

Doctor: OK, um and in the family is there a history of any bleeding disorders or any uh clotting disorders? 

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

Doctor: OK, um and any heart conditions, lung conditions?
Patient: Um just a heart attack. Uhm both my grandparents on my dad's side uh had a heart attack and uh diabetes as well. Um I think both my parents have diabetes. 

Doctor: OK. Have you been tested for uh diabetes as well? 

Patient: Uh yeah, yeah yeah I go to see my family DOCTOR: and my uh, he said my sugars were good. 

Doctor: OK, great. Um alright, so um you've been experiencing uh so this this chest pain when you breathe in deeply since this morning um as well as some more difficulty breathing, and some left pain uh left leg pain with with some swelling. Uh have you been, after travels as well, have you had any other symptoms?
Patient: No. I don't think so. 

Doctor: OK, so that was all I wanted to ask today on on history and before I went on to uh the physical exam, we want to check uh vital signs and have a listen to your heart and lungs and um measure the diameter of your of your shins as well. Um but um it'll be important to get uh some imaging of your of your lungs um to assess whether or not there's a pulmonary embolism um uh because that would be one of the more um life threatening, or potentially um complicating uh causes of what's going on right now.
Patient: Yeah absolutely. I have had this awful, awful headache for the past, two days I wanna say, its horrible. 

Doctor: OK, has the headache, uhm, stayed the same, gotten worse, gotten any better?
Patient: It's only gotten worse over the past two days. 

Doctor: OK, and when the headache started, was it like a thunder clap, kind of worst headache of your life when it came on?
Patient: No, no. 

Doctor: OK. Was there anything going on two days ago around the time of the headache, like did you hit your head or anything like that? 

Patient: No, I just, uhm, I just went out for dinner, the night before and I know that there are certain foods that can trigger my migraines, but this really feels different. It doesn't feel like my migraine. 

Doctor: OK. Uhm, and have you had any other associated symptoms, with the headache.
Patient: I've been feeling really tired. I took the day off yesterday and today, I'm working from home, but I still decided not to get any work done today or yesterday. 

Doctor: OK. Uhm, and the fatigue, when did that start?
Patient: I think that started yesterday morning. 

Doctor: OK. And sorry, back to the headache. Have you tried anything for it?
Patient: I took Tylenol and Advil, but, I guess it did get better for about an hour a little bit, but it was back on again. 

Doctor: OK. And could you describe like where you feel the headache?
Patient: Sure, yeah, so it's like right in the front. Just kind of feels like a band, just like this pressure in the front of my head. 

Doctor: OK, and has there been anything that's made the headache worse, like lights or, or sounds? 

Patient: No, no, like I said it's like nothing like my usual migraine headaches. 

Doctor: OK. And, I mean, the Advil or Tylenol, It helps the symptoms for a brief period, but has there been anything else that's helped your headache?
Patient: No, not really. 

Doctor: OK. And is there any particular time of the day that the headache's worse, like, is, in the morning time when you're first waking up or later in the day?
Patient: I don't think so. 

Doctor: OK. And have you had any nausea or vomiting? 

Patient: No. 

Doctor: OK. And have you had any, like visual changes?
Patient: No. 

Doctor: OK. Uhm, and have you had a runny nose or a sore throat? 

Patient: Uhm, I've had a bit of a sore throat. 

Doctor: OK, have you, have you had a cough?
Patient: Yeah, but honestly the headache's been bothering me the most. 

Doctor: OK, and when did the cough start?
Patient: About the same time. 

Doctor: OK. 

Patient: Maybe two days ago. 

Doctor: OK, and have you had any neck stiffness? Does it hurt if you, if you move your neck around?
Patient: No, nothing like that. 

Doctor: OK, uh and with the, with the cough, have you had any difficulties breathing or shortness of breath? 

Patient: Maybe a little bit. 

Doctor: OK, how about any wheezing?
Patient: No. 

Doctor: OK. Have you been bringing up any sputum with the cough? 

Patient: No. 

Doctor: OK, how about, any, any blood?
Patient: No. 

Doctor: OK. And have you had any changes to your sense of smell? 

Patient: No. 

Doctor: Any changes to your sense of taste?
Patient: No. 

Doctor: OK. Uh, and have you had any changes to your weight recently over the last several months?
Patient: I don't think so. 

Doctor: Alright, and how is your appetite been? 

Patient: Uhm, it's fine. 

Doctor: Any chest pain?
Patient: No. 

Doctor: OK. Uhm any lightheadedness or, or feeling dizzy? 

Patient: No, no. 

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

Doctor: Any diarrhea? 

Patient: No. 

Doctor: Any urinary problems?
Patient: No 

Doctor: How about , uh, have you had any muscle aches or joint pains? 

Patient: A little bit. 

Doctor: OK. And any rashes anywhere?
Patient: No, no, no. 

Doctor: OK. And have you been diagnosed with any medical conditions before?
Patient: Uhm, I have, uh, I have migraines and uh, I also have Polymyalgia rheumatica. 

Doctor: OK. Are you taking any medications currently, for either of those?
Patient: No. 

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

Doctor: OK, any surgeries?
Patient: No. 

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

Patient: no. 

Doctor: Drink alcohol?
Patient: No. 

Doctor: OK and do you use any other, use any recreational drugs?
Patient: No. 

Doctor: OK. And any family history of similar symptoms like, like, unusual headaches or anything like that? 

Patient: Well, migraines kinda run in the family. 

Doctor: Migraines, OK.
Patient: Yeah. 

Doctor: And any heart conditions or cancers or anything like that in the family? 

Patient: No no no. 

Doctor: OK. And have you been around anybody who's been sick, recently? You went out for dinner a couple days ago.
Patient: Yeah, uhm, I don't think anyone was sick. 

Doctor: OK. And you didn't feel that you had any triggers to your migraines at that time?
Patient: No, I didn't. I did yes, I, I did meet up with my friends and we went out for dinner. I know we're not supposed to, but it's been such a long time. 

Doctor: Yeah.
Patient: I don't think they were sick at the time, but I haven't really talked to them after. 

Doctor: OK. Have you traveled anywhere? 

Patient: No. 

Doctor: Alright. And so I don't think I asked, did you have a fever or chills?
Patient: No, not really. 

Doctor: Oh OK. Uhm, so the symptoms you've been experiencing, you've had a headache that's been the most bothersome these, these last couple of days, which feels different than your migraines but you've also had a sore throat, a cough, shortness of breath as well as a little bit of muscle aches and fatigue over these last couple of days.
Patient: Yeah that sounds right. 

Doctor: Is there anything else?
Patient: I'm here because um I've been having some pain in my left knee for the past two months and it's not getting better. It feels stiff and um I just haven't been able to uh, you know, use it as well, as well as I was using it before um and it's just limited some of my daily activities. 

Doctor: OK, um, and where, uh so it's, the pain is in your left knee. Where are you feeling this pain specifically? Is it at the front of the knee, the sides, or or the the back? Could you point to it? 

Patient: It feels like it's mostly on the front. 

Doctor: OK.
Patient: Like deep within that um kneecap. 

Doctor: OK, and you said the pain started two months ago? 

Patient: Yes, well, it's always been a little like tender. Um but now it's more painful. 

Doctor: OK. And so, so has it been getting worse?
Patient: I would say so, slowly getting worse. 

Doctor: OK. Uh and when you get uh pain in the left knee, how long does it typically last for?
Patient: It usually hurts while I'm doing, while I'm moving it, or just after, but if I if I rest, the pain eventually goes away. Um but when I first wake up in the morning, that joint feels stiff. And then when I start using it, using it more, it's less stiff, but it becomes painful. 

Doctor: OK, so you have some stiffness in the morning?
Patient: I do. 

Doctor: OK, and how long does it last for? Like 30 minutes, 60 minutes or or longer?
Patient: The stiffness or pain? 

Doctor: Yeah, the the stiffness. 

Patient: Uh the stiffness goes away in like yeah 15 to 30 minutes. 

Doctor: OK, and how would you describe the pain, um in terms of its character?
Patient: It feels, it feels uh, I guess most of the time it's like it's like a dull kind of pain, but it can be sharp. 

Doctor: OK, and is there anything that makes the pain worse? 

Patient: Just with a lot of activity it gets worse. 

Doctor: And you feel it radiate anywhere else?
Patient: No. 

Doctor: OK, and how would you describe the severity of your pain on a scale of 10 being the worst pain you've ever felt, and 1 being kind of very minimal pain. 

Patient: Uhm, I would give it maybe uh 7. 

Doctor: OK. And have you had any injuries to your knee before?
Patient: No, not that I can think of. 

Doctor: No, OK. Um and have you been having any uh any weight loss recently?
Patient: Uh no, weight gain. 

Doctor: Weight gain, OK. How much weight have you gained over the last uh several months?
Patient: Over the past six months, I'd say I've gained about 20 pounds. 

Doctor: OK, have you had changes in your diet and or exercise?
Patient: Um I guess I've been eating a little bit more, um but no changes in exercise. 

Doctor: OK. Um have you been having any fevers or chills? 

Patient: No. 

Doctor: OK, how about any night sweats?
Patient: Uh, no night sweats. 

Doctor: OK, um have you had any changes to your vision or hearing? 

Patient: No. 

Doctor: OK. Have you had any changes to your uh sense of smell or sense of taste?
Patient: No. 

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

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

Patient: Uh no nothing like that. 

Doctor: OK, how about any uh wheezing?
Patient: No wheezing. 

Doctor: Alright, any chest pain or heart palpitations? 

Patient: No. 

Doctor: Alright have you had any lightheadedness or dizziness?
Patient: No. 

Doctor: Alright, and any confusion or memory loss?
Patient: No. 

Doctor: Alright, and have you had any changes in appetite, like a loss of appetite?
Patient: Uh no, I, if anything, had a gain in appetite. 

Doctor: Alright, uh have you had any nausea or vomiting? 

Patient: No. 

Doctor: How about any abdominal pain?
Patient: No. 

Doctor: Alright. Um and how about any urinary problems?
Patient: Uh no urinary problems. 

Doctor: Um any changes to your bowel habits, like diarrhea or blood in the stool?
Patient: No. 

Doctor: Alright, and have you had any rashes or skin changes or changes to your hair or nails?
Patient: No, nothing like that. 

Doctor: OK, and any other joint pains? Or have you or do you have any joint swelling?
Patient: Uh I have some joint um swelling. It's it's not very visible, but it's it appears slightly more swollen than my left, sorry, than my right knee. 

Doctor: OK. So just a little bit of swelling in your left knee, but no other joints?
Patient: No. 

Doctor: OK, um and have you been diagnosed with any medical conditions before?
Patient: Um I have um diabetes, high blood pressure and high cholesterol. And I'm overweight. 

Doctor: OK, do you take any medications for any of those conditions? 

Patient: I'm on insulin for diabetes. Um I'm on Ramipril for high blood pressure and I'm also on a statin for the cholesterol. 

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

Doctor: Alright, and uh, have you had any surgeries in the past? 

Patient: No. 

Doctor: Alright, and um are your immunizations up to date?
Patient: I think so. 

Doctor: Alright, uh, and could you tell me a little bit about your living situation currently, like like who you're living with and whereabouts? 

Patient: Um I live with my husband in a house downtown. 

Doctor: OK, um and are you working currently?
Patient: No, I retired early. 

Doctor: OK, um do you drink alcohol?
Patient: Um I'll have a glass of wine every night. 

Doctor: OK, so about 7 drinks per week? 

Patient: Yes. 

Doctor: OK, and um, do you smoke cigarettes?
Patient: Uh no, I don't. 

Doctor: Alright, how about the use of any recreational drugs like cannabis or uh or anything else?
Patient: No. 

Doctor: Alright. Um and is there any, uh, like musculoskeletal or like autoimmune conditions that run in the family?
Patient: Uhm no musculoskeletal issues uh that, I know diabetes runs in the family. 

Doctor: OK, um alright, so that was everything I wanted to ask on history. So next I just wanted to do a physical exam, and just looking at the left knee, are you seeing any um swelling or redness uh on the knee?
Patient: Um it appears slightly more swollen than my right knee. 

Doctor: OK, but are you seeing any redness? 

Patient: No redness. 

Doctor: OK, and are there any temperature changes? Like does the knee feel hot or or warm?
Patient: No. 

Doctor: OK, and if you um press along the uh joint line, do you feel any pain?
Patient: Uhm yeah, it feels a little tender. 

Doctor: OK. And how about pain over any of the muscles, like the thigh muscles or the hamstrings or the calf muscles? 

Patient: No, those are fine. 

Doctor: OK, and then how about any pain over the patella or kneecap?
Patient: That that's a little bit more painful. 

Doctor: OK, and are you able to bend your knee uh like like flex it, straighten it? 

Patient: Uh I can do that, it's just painful when I do that. 

Doctor: OK. Um and uh and then how about walking, are you um, do you have an antalgic gait or or or a limp?
Patient: Uhm no, no, well, I guess I'm I'm putting more weight on my right knee so it might appear to some people that I do have a slight limp. 

Doctor: OK. And any issues with moving your hip or your ankle?
Patient: Uh no. 

Doctor: OK, um so I think that was everything I wanted to ask and check today. Did did you have any questions? 

Patient: Um yeah, so um how do you, how can I treat my knee? 

Doctor: Yeah, certainly, so it it sounds like um this could be most likely osteoarthritis um of the left knee, which uh is something that would be best treated with uh trying to stay as active as you can, but but also pacing your activities as well, so that you're not um doing so much that the next day you're in significant amount of pain, but it's important to remember that um activity will help um with keeping your knee mobile, but also um actually help with reducing pain as well, and then also uh you could use Tylenol um as a medication for it. I wouldn't recommend ibuprofen or NSAIDs on a long term basis, although you could take those if you're having like an acute flare up of your pain. Um and then also like topical agents such as um like Voltaren or something like that you could put on your knee and um if it's really bad and it keeps um continuing on, we can consider something like a steroid injection as well.
Patient: Hi so I brought my 6 year old son in today because yesterday during soccer practice, he he developed this pretty severe cough and he couldn't catch his breath. 

Doctor: OK, so this happened yesterday, you mentioned?
Patient: Yeah, it happened yesterday afternoon. 

Doctor: OK, uhm so you mentioned a cough. Is it a harsh barky cough, or is it more like a muffled cough?
Patient: I would say it's more muffled. 

Doctor: OK, and is it a dry cough or is it bringing up any phlegm? 

Patient: Dry 

Doctor: Dry OK. So no blood in the with the coughing?
Patient: No blood. 

Doctor: And does he sound wheezy to you? 

Patient: He does, yeah, he's still sounding a little bit wheezy now. It's it's better than last night. He was a bit more wheezy last night. 

Doctor: OK. Uhm how about shorter breath? Does he sound short of breath at all?
Patient: No, that that's gotten a bit better, that resolved about an hour. Like after he stopped playing but he was, he was short of breath yesterday. 

Doctor: OK, and have you tried anything for his cough, for his shortness of breath or wheezing? 

Patient: No, we haven't 

Doctor: No OK. Does he have a fever at all?
Patient: No, he doesn't mention anything about feeling hot or or or having chills either. 

Doctor: No OK, and any rashes that you've noticed?
Patient: No 

Doctor: No, weight loss over the past few weeks? 

Patient: No, he's been gaining weight well. 

Doctor: OK good, has he had a stuffy nose or runny nose?
Patient: Well, sometimes he will get a runny nose. He takes like Reactin or Claritin or some sort of allergy pill for that sometimes, but that's usually like the changing of seasons that will happen more often. 

Doctor: OK OK. Does he have any allergies?
Patient: Yeah, to mostly environmental triggers. I'm not sure if the specific things are, but I just know it gets worse. Maybe in the spring, springtime? 

Doctor: OK. And does he have asthma?
Patient: He's never been diagnosed, but he has had uhm or his sister has asthma. 

Doctor: OK, OK. And has he? Have you noticed any changes in his vision or hearing? 

Patient: No. 

Doctor: No, OK. How about change in his smell or taste?
Patient: No 

Doctor: No, how about like does he seem like he has any chest pain? 

Patient: No, he hasn't mentioned anything like that. 

Doctor: Any dizziness or fainting spells?
Patient: No 

Doctor: No, confusion or memory loss?
Patient: No. 

Doctor: OK, Uhm how about confusion or sorry you said no headaches?
Patient: No headaches. 

Doctor: No, OK, any joint pains, muscle aches? 

Patient: No. 

Doctor: OK, and how about changes to his bowel movements?
Patient: No, everything's been normal there. 

Doctor: OK, how about nausea or vomiting?
Patient: Nothing like that. 

Doctor: OK, OK, so you mentioned he has asthma. He might have asthma. He was never formally diagnosed. Does is he otherwise healthy or does he have any longstanding medical conditions? 

Patient: He's been healthy. Yeah, I know he did have like he would get some itchy skin when he was a bit when he was like a baby, but he hasn't needed any creams for that for a long time. 

Doctor: OK so he might have something like eczema, you think?
Patient: Yeah, yeah I think he did. 

Doctor: OK, OK and is he on any medications right now?
Patient: No, he doesn't take anything right now. 

Doctor: OK, Uhm during his mom's pregnancy with him, were there any complications? 

Patient: No, she was uhm healthy and he was born at term with a normal weight and able to go home relatively quickly, so there weren't any concerns. 

Doctor: OK, that's good and was he healthy like after birth?
Patient: Yeah, so he's he's done well. There weren't really any concerns with development or or growth, and he's doing well in school. 

Doctor: OK, OK, good. How about uhm so was he a full term baby and was it a vaginal delivery?
Patient: Yes. Yes for both 

Doctor: OK, any complications during the delivery? 

Patient: No, 

Doctor: OK, and he didn't need any hospitalizations like right after birth as an as a newborn?
Patient: No 

Doctor: No, OK good. Uhm Is he up to date with all his immunizations? 

Patient: He is, yeah 

Doctor: OK. And you mentioned that he may have some seasonal allergies. Any other allergies that you know of?
Patient: Not that I know of. 

Doctor: No, OK. You mentioned that his sister has asthma. Any other lung conditions or heart conditions that run in the family? 

Patient: No, nothing like that. 

Doctor: No, OK. OK. Uhm and does anyone at home smoke?
Patient: No 

Doctor: No OK. Any old carpets? Does mold, asbestos, anything like that at home? 

Patient: We we took out the carpets and stuff when his sister was diagnosed with asthma, so it's good from that perspective. 

Doctor: OK, good, and who lives at home with him?
Patient: So it's myself, his mom and then his sister. 

Doctor: OK, OK, any pets at home? 

Patient: He's got a fish. 

Doctor: A fish, OK. And has he has come into contact with anyone sick recently?
Patient: No, I don't think so. I mean when at school, they've been pretty diligent with I mean covid and everything right now, so I think he's been OK. 

Doctor: Ok, uhm has he traveled anywhere recently?
Patient: No. 

Doctor: No, OK. OK, those are all the questions that I had for you today. Did you have any questions of your own for me? 

Patient: Yeah, I was just wondering if if my son had asthma as well and if like you need a prescription for inhalers. 

Doctor: Yeah, so we're gonna since he's never been diagnosed before, we're gonna do some investigations for him just to start so we can do, we can start by doing a pulmonary function test for him to see what his lung activity is like uhm so we'll start there and then we'll also, because you're saying he's short of breath, we'll take his oxygen saturation as well, and maybe even do some like some basic blood work for him, and if it turns out he has asthma, which in this case I do strongly suspect, we'll prescribe him some bronchodilators like a short acting beta agonist as well as an inhaled corticosteroid because his symptoms do seem somewhat severe this time around. And then I should also mention because some of his symptoms overlap with that of COVID, he will also get a covid swab and you should hear back about that in 24 to 48 hours. How does that sound?
Patient: That sounds good, thank you. 

Doctor: Alright great, thank you.
Patient: Hi, um so I've had this terrible fever for the past three days um and just before that I had a stuffy nose um and I had a sore throat, well I still do, um and it's just not going away, so I thought I should just come in and see if I have covid or what it is. 

Doctor: OK, so if I understand, it started with a stuffy nose?
Patient: Yes. 

Doctor: OK and that kinda progressed to a fever?
Patient: Yes, that's right. 

Doctor: OK, have you been feeling any other symptoms aside from the fever?
Patient: No. 

Doctor: Nothing really, have you had any nausea, any vomiting at all in the last little while?
Patient: No. 

Doctor: Any pain anywhere else in your body?
Patient: Uh, no. 

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

Doctor: Any headaches? 

Patient: Um no, no headaches. 

Doctor: OK, and have you been able to eat and drink during this time period?
Patient: Yes. 

Doctor: Excellent. OK, you've had a cough at all? 

Patient: No cough. 

Doctor: No cough, OK and then how about abdominal pain, any pain in your tummy?
Patient: Um no. 

Doctor: Nothing like that, what about other changes in your body? Have you noticed any fevers or any rashes, any skin changes?
Patient: Uh no, nothing like that. 

Doctor: OK. What about any pain in any of your joints and your knees, hips?
Patient: Oh, actually um not in my joints, but I've just, there there has been some muscle ache. 

Doctor: OK, how long has that been going on for? 

Patient: Uh for the past two three days. 

Doctor: So around the same time that you've had this fever?
Patient: Mhmm. 

Doctor: OK.
Patient: That's right. 

Doctor: Now have you had any contact with anyone who's been sick in the last little while? 

Patient: Um no, not that I can think of. 

Doctor: OK, have you had any recent travel anywhere else?
Patient: No, I did go hiking um last weekend, um and it was about 2 hours away, um there were some people on the hiking trail that I passed by, but um other than that, no travel outside the province. 

Doctor: OK. Does anyone around you or in your immediate circle come down with anything similar recently? 

Patient: Um my husband has also been experiencing similar symptoms for the past week. 

Doctor: OK, how's he doing?
Patient: Uh the same as me. 

Doctor: OK. And have you had any covid swabs recently?
Patient: No. 

Doctor: OK, and aside from the weekend hike, have you been mainly self isolating or? 

Patient: Uh yeah, just me and my husband at home. 

Doctor: OK, and do you leave the house for work at all?
Patient: No, I work from home. 

Doctor: OK, sounds good. So you have some muscle aches, little bit of fever, stuffy nose, sore throat, do you have any difficulty swallowing? 

Patient: Uh no, it just hurts. 

Doctor: OK, so you're still able to swallow food, swallow liquids?
Patient: Yes, that's right. 

Doctor: It doesn't feel like anything is going down the wrong way or have any coughing after you swallow?
Patient: No. 

Doctor: OK. And just in terms of coming back to this sore throat, do you feel like you have any swelling around your neck? Does it feel inflamed or swollen?
Patient: No. 

Doctor: Nothing like that?
Patient: No. 

Doctor: OK, alright, excellent. So you're eating well, doing well, any changes to your bowel movements recently? 

Patient: Uh no, no. 

Doctor: OK, alright, I'll just kind of go into other things, just in terms of anything else that you might have had in the past, uh have you ever been hospitalized for any reason in your life?
Patient: I had my gallbladder taken out five years ago. 

Doctor: OK, so that was around when you were 50 years old? 

Patient: Uh yes. 

Doctor: OK. And any other surgeries you've had in your life?
Patient: Uh no. 

Doctor: No, anything you've had to see a  for? 

Patient: Um I, in the past couple of years uh just for things like like this I guess um colds, um I'm pre diabetic, so I've been checking my glucose levels, yeah other than that nothing else. 

Doctor: So no high blood pressure?
Patient: No. 

Doctor: No cholesterol issues?
Patient: No. 

Doctor: OK, so it sounds like you've been pretty healthy otherwise.
Patient: Yeah. 

Doctor: Excellent, OK. Do you have any allergies? To medications or otherwise. 

Patient: Penicillin. 

Doctor: Penicillin, what happens when you take penicillin?
Patient: Um I get a rash. 

Doctor: OK. Any trouble breathing? 

Patient: No. 

Doctor: And what medications, if any, are you on?
Patient: Um I'm, I just take multivitamins, that's it though. 

Doctor: And you said you lived with your husband in a house, um in London? 

Patient: Um yes, that's right. 

Doctor: What do you two do for work?
Patient: So I work from home as a digital marketing agent and my husband is a computer programmer. 

Doctor: OK. And do you smoke? 

Patient: No. 

Doctor: Do you drink alcohol?
Patient: Uh I drink once once in a while. 

Doctor: OK. And when you drink, how many drinks do you have?
Patient: Um about one or two glasses of wine. 

Doctor: Got it. Any other recreational drugs, substances?
Patient: Um no, 

Doctor: So no marijuana, heroin, cocaine?
Patient: I've tried marijuana before, just like edibles, but not, not regularly. 

Doctor: Understood. And have you ever used IV drugs?
Patient: No. 

Doctor: OK, and when was your last menstrual period? 

Patient: It was um a year ago. 

Doctor: A year ago?
Patient: Mhmm. 

Doctor: OK. And then otherwise, so we talked a little bit about recent travel. It sounds like you have the hiking trip last week and you passed some people, but it sounds like your husband also has kind of similar symptoms that you do right now. 

Patient: Yeah. 

Doctor: Sounds good, now we've already talked about kind of past medical issues. Moving on, I think what we'll do next is move on to a physical exam. But before I do that, do you have any questions for me? Anything else you feel I should know?
Patient: No, do you think I have covid? 

Doctor: It's a possibility. It's always good to rule these things out, so we'll be ordering a covid swab no matter what. Obviously with any presentation where we have someone come in with a fever and sore throat, we want to rule out anything infectious. So it sounds like if your husband got it, and you have it, covid would be our first thing that we want to rule out. So just while we're trying to investigate, work this up further, I want to have you and your husband self isolate. The other question I suppose I should ask is, have you gotten your flu shot this year?
Patient: No, I haven't. 

Doctor: So it's also a possibility it might be influenza, just the seasonal flu. But until we, I suppose rule out covid, it'd be best just to keep to yourself just in case you are infectious for the meanwhile. 

Patient: OK, sure. 

Doctor: Alright, well I'm going to go talk to the  and I'll be coming back in to see you, OK?
Patient: Yeah, it's uh, for the last maybe three days, um it's not really pain, not in any specific spot, it just feels a bit tight in my chest area when I breathe in especially, and it just gets a bit harder to breathe and it feels more tight like especially when I go for my walks, which I do everyday, uh I try to walk my dog. So I was just, you know, worried that it could be something serious and I wanted to come and get checked out. 

Doctor: OK, for sure. So you said it started about 3 days ago. Have you noticed it's been getting better, worse or about staying the same?
Patient: I think it's staying the same. 

Doctor: OK, was there anything that happened 3 days ago that you can recall where you first noticed it? 

Patient: No, nothing in particular um yeah, it just kind of came on and now it's been pretty steady. 

Doctor: OK and when it came on three days ago, what were you doing?
Patient: Uh I think I first noticed it when I was gone for my walk. 

Doctor: OK, now when you're walking, you say you have some chest tightness, do you have any chest pain? 

Patient: No, there's not there's not pain, it just feels like, when I breathe in it feels tight. 

Doctor: OK, did you feel anxious or sweaty or the feeling of impending doom at all?