jshargo/medical-interview-conversations huggingface dataset:
Patient: No, no swell leg swelling. 

Doctor: No leg swelling? OK, um how about do you feeling like your heart's racing? 

Patient: No. 

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

Doctor: How about changes in your bowel movements?
Patient: No. 

Doctor: OK, how about changes in urinating?
Patient: No, it's been fine. 

Doctor: Alright any headaches? 

Patient: No headaches. 

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

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

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

Patient: Um I think when I was back in India a couple years ago, they did give me some antibiotics for like a chest infection, but I couldn't really afford the medications and didn't take them. I didn't finish the course, but other than that, nothing else. 

Doctor: OK, did they mention what type of chest infection it could've been?
Patient: No, I don't really remember. I think it was some kind of pneumonia. 

Doctor: OK, OK. Are you on any medications?
Patient: Just uh I take Tylenol sometimes, like it hasn't really been helping. 

Doctor: OK. And, are you allergic to anything?
Patient: No, not that I know. 

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

Patient: Yeah, as far as I know. 

Doctor: OK. And and is there any family history of lung conditions or heart conditions?
Patient: Nope. 

Doctor: No OK, how about cancers?
Patient: No cancers that run in the family, no. 

Doctor: OK OK, so you mentioned you moved to Canada from India about a year back. Where do you live now?
Patient: So I live in it's, we have like a student house with some of the students who came from India as well, and there's six of us living together in in a house. 

Doctor: OK, OK, and are they sick as well or no? 

Patient: Yeah, so three of them actually have like, two of them have a cough and one of them has some shortness of breath as well. 

Doctor: OK. And have they been to a doctor? Have they been investigated? Were they ever given a diagnosis?
Patient: No, not that I know of. I think I might be the first one who actually went to a doctor. 

Doctor: OK, OK. Um, do you smoke? 

Patient: I smoke like I would say like 5 cigarettes a day. 

Doctor: OK, how long have you been smoking for?
Patient: Around 10 years. 

Doctor: OK, that's, it's been a while then. Um, and do you do you drink alcohol?
Patient: No, I I don't drink and I don't do any drugs either. 

Doctor: OK, OK. Are you sexually active? 

Patient: Not currently, no. 

Doctor: No, OK. Have you ever had unprotected sex?
Patient: No. 

Doctor: No?, OK. OK, um, did you have any questions or concerns? Anything you wanted to discuss that I hadn't asked you about?
Patient: Um, so yeah, this is just like my first time visiting a DOCTOR: in this country and like I was just very scared that it might be something serious, so just wanted to know what it can be. 

Doctor: Yeah, for sure. So the first thing we want to rule out is TB. Because you have recently moved to Canada from a country where it is, I believe it is endemic, so and some of your most of your symptoms fit with TB and how it presents so we just want to make sure it's not that because it is highly infectious and and we don't want it to spread. So, we can do like a AFB smear or I think they have other diagnostic work up for that too. So we'll do that first. If not, we can check to see if it's like another, another typical pneumonia, we can do a chest X Ray for that as well. If both of those turn out to be negatives, then we'll have to work you up further for other things, like COPD, or lung cancer. How does that sound?
Patient: Sure, um, I have been coughing a lot. I've been feeling short of breath and I just feel really wheezy, so I thought I should come check it out. 

Doctor: OK, when did the cough start?
Patient: I've always had a cough. Well, I guess I've had a cough for the past five years, but over the past three days it's gotten a lot worse. 

Doctor: OK, did anything happen 3 days ago that has brought the cough on?
Patient: Uhm, no, I was, I did groceries, I came home and then I started coughing a little bit more and I haven't been able to stop since. 

Doctor: OK, is there any particular time of day that the cough is worse, like morning, night? 

Patient: Uhm, it seems to be worse in the morning. 

Doctor: OK, and are you bringing up any sputum?
Patient: I am. Umm, and it looks yellow and sometimes even green. 

Doctor: OK. With your cough prior to three days ago were you bringing up sputum with that? 

Patient: I guess some, but it was clear. 

Doctor: OK, and are you bringing up more sputum now, the same or less?
Patient: Um, more sputum, and sputum just looks different. 

Doctor: OK, have you noticed any blood? 

Patient: No blood. 

Doctor: OK, and you mentioned you've been you've had a wheeze, when you do you notice that?
Patient: Uhm, I also, I guess I notice that mostly last night, yeah. 

Doctor: OK, um and what types of activities have you had shortness of breath? 

Patient: Uhm, I guess walking, doing day to day things has made me feel a little bit more short of breath than I used to feel. 

Doctor: OK. And have you been experiencing any other symptoms besides the cough, wheeze and shortness of breath?
Patient: Um, I feel a little bit more tired, but other than that, no. 

Doctor: OK. So a bit more tired. How has your sleep been? 

Patient: My sleep has been, um, pretty normal. It's been, yeah, it's been the same. I guess it's the coughing that's making me tired. 

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

Doctor: Any discharge from either, either your ears or eyes?
Patient: No. 

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

Doctor: Or felt congested?
Patient: No. 

Doctor: OK, have you had a sore throat?
Patient: Uh, no. 

Doctor: Or any difficulty swallowing? 

Patient: Uhm, no. 

Doctor: Changes to your sense of smell or taste?
Patient: No. 

Doctor: OK, have you had any changes in appetite? 

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

Doctor: Alright, and have you had any weight loss over the last several months?
Patient: Weight loss, no. 

Doctor: OK. How about have you had any fevers or chills?
Patient: Fevers or chills ah, no. No, nothing like that. 

Doctor: Nights, how about night sweats?
Patient: No. 

Doctor: Have you had any chest pain? 

Patient: Ah no, no chest. Well my chest feels, I guess sometimes I, it feels painful because I'm coughing so much, but nothing more than that. 

Doctor: OK, do you get chest pain when you exert yourself physically?
Patient: Uhm, no. 

Doctor: OK, so it's just after the coughing?
Patient: Yeah. 

Doctor: OK and how would you describe the character of the chest pain? Some people will say sharp, dull, achy. 

Patient: Um, I would say dull. 

Doctor: OK, and have you had any like heart palpitations, feeling like your heart's racing?
Patient: No. 

Doctor: And how about any episodes where you felt like you were going to faint or, yeah, pass out? 

Patient: No. 

Doctor: OK. Uhm and have you had any swelling in your feet, ankles, hands?
Patient: No, nothing like that. 

Doctor: OK. And then have you had any urinary problems? 

Patient: Um, no. 

Doctor: Any bowel problems?
Patient: No. 

Doctor: OK, and then any joint pains or muscle aches? 

Patient: No, nothing like that. 

Doctor: And how about any rashes anywhere?
Patient: No. 

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

Doctor: OK. In terms of your past medical history, have you been diagnosed with any conditions before?
Patient: Uhm, I have high blood pressure and diabetes. 

Doctor: I see. Are you on any medications for those?
Patient: Um, for the blood pressure, the high blood pressure, I'm on a beta blocker and then for my diabetes I'm on metformin. 

Doctor: OK, uh, do you, are you taking any other medications? 

Patient: Um, just some calcium and vitamin D. 

Doctor: Any surgeries in the past?
Patient: Nope. 

Doctor: Any allergies to medications? 

Patient: No. 

Doctor: OK. Are your immunizations up to date?
Patient: I believe so, but I recently learned that I should get something called the pneumococcal vaccine. I haven't gotten that yet. 

Doctor: Yeah, you're you're right. So for um, in Canada or anybody or in Ontario, at least, anybody who's older than 65, it's recommended to get this vaccine to protect against certain types of bacterial infections type which can cause pneumonia. So it would be good something that you can set up with your family doctor. 

Patient: OK. 

Doctor: Yeah, and so are you, so do you smoke cigarettes?
Patient: I used to. 

Doctor: OK, and how much do you smoke or how much did you use to smoke?
Patient: Um, I smoked a pack a day and I smoked for 45 years, but I stopped two years ago. 

Doctor: OK, that's great that you were able to stop. Do you drink alcohol? 

Patient: Uhm, occasionally like once every two weeks. 

Doctor: OK, and any triggers that you can think of you were exposed to either at work or home like chemicals or things that you were exposed to that you had to breathe, that you breathe in?
Patient: No, nothing like that. 

Doctor: OK, have you traveled anywhere?
Patient: No. 

Doctor: Alright, and have you been near anybody who's been sick or has similar symptoms? 

Patient: Uhm, no. 

Doctor: Alright, and anybody in the family have a heart or lung condition?
Patient: Um, no. 

Doctor: Any cancers in the family?
Patient: Um, there was a liver cancer. 

Doctor: OK, and, I think that.. OK, and that was all I wanted to ask on history. Was there anything else that you wanted to tell me today? 

Patient: Um, no, just um, what do you think the problem is? I've never felt this bad with my shortness of breath before. 

Doctor: Yeah, certainly so umm, it, it sounds like it could be maybe a viral infection that I brought on this cough and worsen the sputum. This could be a bacterial infection, it could be a COPD exacerbation and also one of the other things that we would have to consider right now is Covid as well and so we will do a PCR nasal swab for Covid and a chest Xx-ray and some other investigations as well and uhm, we will try to get to the bottom of what's causing your your shortness of breath.
Patient: Yeah, so over the last week I've just been feeling some symptoms. It kind of first started with, like a runny nose. That was around like 5 days ago and then it turned into just a lot of congestion, like around my nose and like my throat. And now over the last two days I've been just feeling so much pressure around my nose and around my jaw so I've been getting a lot of pain there as well. 

Doctor: OK, is your nose still running?
Patient: Yeah, I'm still getting some discharge and I also feel like I'm getting some dripping at the back of my throat too, especially when I wake up. 

Doctor: OK, and could you describe the discharge? Is it clear, yellow, greenish?
Patient: Uh, it's fairly clear and sometimes, like a bit white, but like, it's not like green or yellow. 

Doctor: OK, uh, and have you felt that it's difficult to breathe in through either of your nostrils, like it's obstructed?
Patient: Yeah, so at night sometimes I have to like turn because one side of my nose gets difficult to breathe from and then it kind of balances out on the other side. So yeah, I do have some obstruction. 

Doctor: OK, and have you had any changes to your sense of smell? 

Patient: Yeah, so just in the last three days when the congestion got really bad I started losing the ability to smell. 

Doctor: OK, have you had any changes to your sense of taste?
Patient: No, taste is fine. 

Doctor: OK, and have you had any cough or sore throat?
Patient: Uh, no. No cough or sore throat. 

Doctor: OK, and the symptoms have gone on for five days. Have you had a period of time where you got better and then got sick again? 

Patient: I did kind of have a runny nose last week as well, so probably like 8 days ago but then the runny nose discontinued a little bit but really got worse 5 days ago, but all these other symptoms just happened in the last few days. 

Doctor: OK, and you have pain. Do you feel it in your jaw or do you feel it in the in the front of your nose?
Patient: Yes, I would say mainly over the cheeks. It can kind of go near the front of my teeth as well, so like I would say like mostly around the cheeks, jaws and up to the front of my teeth. 

Doctor: OK, And do you grind your teeth at all at night? or have you had, TMJ issues before? 

Patient: No nothing like that. I think it's not so much on and around my teeth, it's more so just to right below my nose, above my teeth and just around my cheeks. 

Doctor: OK, so no pain in your mouth or anything like that?
Patient: No, not inside my mouth. 

Doctor: OK, have you had any fevers or chills?
Patient: Uhm, I Don't think I've had a fever. I did feel some chills over the last few days, but just very brief episodes. 

Doctor: OK, and over the last few weeks have you had any weight loss?
Patient: No. 

Doctor: OK, and you said you didn't have a cough or a sore throat, but have you had any wheezing? 

Patient: No wheezing. 

Doctor: How about any shortness of breath?
Patient: Uh, not shortness of breath. Just sometimes when my nose gets like really congested, I just turn into like a mouth breather, but that's about it. 

Doctor: I see, OK, and have you had any chest pain?
Patient: No, no chest pain. 

Doctor: Alright, and any lightheadedness or feeling dizzy?
Patient: No. 

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

Doctor: Any abdominal pain?
Patient: No. 

Doctor: Have you had any diarrhea?
Patient: Sorry, what was that? 

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

Doctor: OK, and have you had any urinary problems? 

Patient: Uh, no. 

Doctor: And have you had any rashes or skin changes?
Patient: No, not that I know. 

Doctor: OK, then how about any muscle aches or joint aches?
Patient: Uh, no. 

Doctor: OK, and have you had any muscle weakness? 

Patient: No. 

Doctor: And how has your energy been? Any fatigue?
Patient: Uhm, it's been mainly OK, just maybe sometimes difficult to get to sleep with all the all the congestion, but I don't think my energy has been affected too much, no. 

Doctor: OK, and, uh, sorry to go back to this, I don't think I asked. Did you notice any discharge from your eyes or any eye redness? 

Patient: Not discharge, but yeah, maybe a little bit of redness. 

Doctor: OK, have your eyes been itchy?
Patient: Uhm Yeah, a little bit. I would say they have been a bit itchy. 

Doctor: OK, alright then, do you have any medical conditions that you see a physician for regularly? 

Patient: Uh, just uhm, its called dyslipidemia. 

Doctor: OK, I see, and any medications you take for that?
Patient: Just like a Statin medication. 

Doctor: OK, do you take any other medications? over the counter? prescribed?
Patient: No, other than that I take multivitamins. 

Doctor: OK, and do you have any allergies to medications or like environmental allergies that might be getting worse?
Patient: Uh, no, not that I know. 

Doctor: OK, so you don't experience any symptoms like this when the seasons change? 

Patient: I don't think so. I have had this happen to me, Uh, I would say like once before. It happened like two years ago. It was pretty similar. 

Doctor: OK, uhm, and what was done at that time?
Patient: At that time it kind of just went away on it's own. It got better. I feel it's definitely worse this time. But at that time I didn't even go to the doctor, it kind of just went away. 

Doctor: OK, I see. Any recent hospitalizations?
Patient: No hospitalizations. 

Doctor: Any surgeries? 

Patient: Nope. 

Doctor: Alright, and could you tell me where abouts you're living currently and who you're living with?
Patient: Yeah, so I'm currently living in an apartment by myself, just outside of London. 

Doctor: OK, and anybody that you've been around who's had any symptoms? 

Patient: Uh, no, not that I know of. 

Doctor: OK, so no sick Contacts. And have you traveled anywhere out of the city or province?
Patient: No, I've tried to stay home, besides going to work. I just work at the grocery store. Besides that, no, nowhere else. 

Doctor: OK, and any of your coworkers have any symptoms? Or any coworkers being off sick? 

Patient: No, we're pretty careful right now with the pandemic. 

Doctor: I see, yeah, that's great. OK, and do you smoke cigarettes?
Patient: No, I quit just a couple of years ago. 

Doctor: Oh, that's great. It's not easy to quit, so that's awesome. And do you drink alcohol? 

Patient: Just maybe like red wine a couple of times a week. 

Doctor: I see, OK, and do you use any recreational drugs?
Patient: Uh, just, in a month, maybe once or twice, I smoke a joint. 

Doctor: OK, uh, and anybody in the family have any lung or heart conditions?
Patient: No, not that I know of. 

Doctor: Alright, and how about any cancer in the family?
Patient: Uh, no, no cancers. 

Doctor: OK, I think I that was everything I wanted to ask about today. Was there any other symptoms or anything else that you wanted to make sure I knew about today?
Patient: No,  I think that's all. I just didn't know if I needed any, like, medications or if I needed to get tested. I just wanted to make sure. 

Doctor: Yeah, so well, certainly check your temperature to see if you have a fever. And if you do and it's high enough, that will increase the chance that you have a bacterial sinusitis,  and if so, with some of your symptoms, including the discharge, obstruction, loss of smell, and facial pain, that all fits the picture for it and also you had a period where you felt a little bit better and then worse again. So that might require antibiotics, but we will check your temperature and go from there.
Patient: Yes I did, it was uh it was behind my left uh knee kind of in like the joint behind where it bends. Um it was stuck pretty good, it's still kind of red and tender there. I noticed it because the back of my knee was starting to just feel a bit sore, um not the joint itself, but just kind of the skin, the whole area back there. Um and I found this tick, I brought I brought it in with me if you wanted to have a look at it, um it's in like this little plastic container, uh and I don't really know when I got it. I was hiking on Friday um and then Saturday I was out in my garden, I hope they're not around my house, I hope that it was from hiking um and not gardening, but uh I did spend a lot of time outside on Saturday as well. 

Doctor: OK, so sounds like it's been a little bit of time since you were last outdoors to when you first noticed it?
Patient: Yeah. 

Doctor: OK, so when you picked it off the tick, obviously you have it for me, is it quite swollen or engorged? 

Patient: It's not too bad, um I I have actually had a tick in the past and this is a long time ago and um maybe like 10 years and I actually had that kind of target rash thing that they talk about. And, uh at that time I remember I had to take antibiotics for a bit. Um this um didn't look like that, it was more, it was just kind of sore in one spot, I don't think it um it was as bad as that time and the tick that time, sorry I've kind of gotten off track, that time it was quite swollen, this one was maybe a little bit, but not as much. 

Doctor: OK, so just in terms of the tick's size, it doesn't look like it's been feeding for too long, so when ticks uh are feeding they tend to engorge, they tend to swell up, so this looks more like a tiny little bug or does it kind of look like a little grape, almost like it's been swollen up with blood?
Patient: No, this one, this one's pretty small. 

Doctor: This one's pretty small, OK. And I should mention that, well obviously you've had a tick bite in the past, the big concern for us is a disease called Lyme disease, which is spread by bacteria, but in fact only one type of tick predominantly is a transmission transmitory agent for it. It's called a deer tick, and its coloration, it's got a little bit of a brown butt and there's some black legs. Does it look like that at all?
Patient: I don't think so, uhm, I uh I was looking at the pictures online, I think it looks like the other kind of tick, um but I heard that, yeah, but I heard that lately now they've been considering all ticks in this area as possibly carriers of Lyme um because I think it's kind of become more more of a problem sm so that was making me a bit nervous. 

Doctor: OK, absolutely, what we can do is we can send this tick off to the lab and they'll be able to identify the species for it, but for tick bites in general, one of the key considerations is for how long it's been on your body for. So unfortunately, if you're out on Friday and Saturday, that'd mean that this tick has been on you for longer than at least 72 hours. So I think one way or another, we're likely going to have to put you on antibiotics just as kind of a prophylactic at the very least, just want to make sure that um you're not at risk of developing Lyme disease. I'm sure you've heard from the news that Lyme disease can present in a variety of ways, but it's a disease that we try our best to avoid. And just in terms of your symptoms, so you say you've had a bite in the past and you you've got that rash before, that kind of bullseye rash, do you have that rash now?
Patient: No, I don't uh as far as I know, I mean, you can have a look too. It's behind my knee, so it's not the easiest place to see, but it's uh it looks a little red, it's like tender where the tick was, but I don't see that like larger circle rash. 

Doctor: OK, that's reassuring. Now any, it'd be pretty unlikely for you to have other symptoms, but just in case, do you have any other joint pain?
Patient: No. 

Doctor: Have you been feeling ill or have been feverish in the last little while?
Patient: No, no, I've been fine. 

Doctor: OK, and you removed that twit tick once you found it, you presented to me, have you checked your body for any other possible bites? 

Patient: Oh yeah, I looked around and I looked at my husband too 'cause we we were just a little bit, you know, gave us a little bit of a scare, but no, there's been nothing else. 

Doctor: That's good. And did you bring a pet with you at all when you were hiking and gardening?
Patient: Uh no, I didn't, no. 

Doctor: OK, good. Any other family members you think might have been exposed?
Patient: Uh no it was just uh me and my husband. 

Doctor: OK, and what geographic area were you in um when you were hiking? 

Patient: We were uh in Strathroy along the creek. 

Doctor: OK. I can do, if I remember there's a Lyme disease distribution map for Ontario and we can see exactly how that lines up to see if we should be a little bit concerned or not. Looks like Strathroy is close enough to be considered a little bit of a concerning point, so I think that we will be moving forward with antibiotics, but of course we'll be talking to the physician who'll be having a look at you as well. So it sounds like you haven't been having too much symptoms aside from you've noticed this tick, the skin around it is fairly sore and you've had this in the past, but you were treated with antibiotics in the past and since then you haven't had too many health problems after that?
Patient: No, no. I've been pretty healthy. 

Doctor: OK, and just about your health right now, is there anything that you see the family physician or  for in general and regarding your health?
Patient: Uh just for my cholesterol. 

Doctor: OK, are you taking and medications for that? 

Patient: Uh Yeah, I take a uh statin, can't remember which one. 

Doctor: OK, got it. And do you have any allergies?
Patient: Uh no. 

Doctor: So no drug allergies? 

Patient: No. 

Doctor: OK, now we've already talked about other exposures, so it doesn't sound like anyone else in your family or any pets are around, so it's unlikely that you have ticks coming in and you said you might have gotten this from gardening, but um you're hoping that your area doesn't have ticks. Maybe just take a look, ticks like to live in long grass, kind of on the intersection between woods and fields to see if there's any hovering around that kind of make a waving motion with their legs and they're sometimes easy to spot, you might wanna get some insecticide out there. But it sounds like this is fairly recent, unfortunately just for the length of time this tick might be on you for, it's probably safer than not to start you on some medications, but I'm going to go talk to the  after we do a quick physical exam, and we might also send the tick off to a local laboratory so they can identify the species for it definitively, as well as might just send some blood work just to see if there's any titres or any serology that would make us a little bit more concerned for Lyme disease. But aside from that you've been feeling well otherwise?
Patient: Yeah, totally fine. It was just a little tender there and that's the only reason I looked. 

Doctor: OK. So no headaches? 

Patient: No. 

Doctor: Nothing like that?
Patient: Nothing like that. 

Doctor: OK, excellent, alright. I'm fairly happy with what we talked about today. Do you have any questions for me Jean?
Patient: No, this is pretty well what I expected today, so thanks for helping me out. 

Doctor: No problem. OK, I'll go talk to the doctor, we'll come back and talk to you, OK?
Patient: Yeah, so uh I'm just bringing my son uh here to the clinic. He's been having um just I think he's been complaining of uh ear ache in his uh I think it's mainly in his left ear for the last, I'd say at least a week. Um he's been kind of just having discomfort um and over the last few days uh he also started crying because of how much pain he is having, and then um we also noticed that he had like was just feeling warm, so we took his temperature and he actually had a fever just yesterday of like 39 degrees Celsius. 

Doctor: OK, uhm, alright. So let's back up just a little bit. The ear pain, when did that start? You said a couple of days ago, so was that two, three, four days?
Patient: Uh I think the discomfort like uh, we saw him scratching his ear for the whole last week, but uh the crying actually started just I would say four days ago, um. 

Doctor: OK. 

Patient: So I think the last few days have been really tough for him. 

Doctor: Yeah, so three, four days. OK, have you taken a look into his ear? Like does does it seem red? Is there discharge?
Patient: Uh I think we did see some uh, just like it wasn't red or anything, but I think we did uh see some um just kind of clear to almost uh clear to yellowish fluid from his affected ear. 

Doctor: OK, clear to, you said white-ish?
Patient: Uh like it was a bit of a yellow tinge to to it as well. 

Doctor: Yellow, OK, OK. And which ear was it, sorry, the right or left?
Patient: Left ear. 

Doctor: Left ear, OK. And the right ear looks normal? 

Patient: Yeah, right ear, he hasn't been complaining uh at all. I haven't even looked at the right ear yet. 

Doctor: OK, is he itching his ears at all?
Patient: Uh he was he was itching like pretty much this whole week, but I think right now he's hesitant to even touch his ears. 

Doctor: OK, and does it look like it's angry on the outside or on the inside of his ears? 

Patient: I can't really see anything on the outside. 

Doctor: OK, OK, and have you noticed that his hearing has changed at all?
Patient: Um he still like answers to us and like I don't think his ear, hearing is affected. 

Doctor: OK. Has he had any past issues with his ears, like ear infections or like hearing issues in the past? 

Patient: Uh no hearing issues, but he did have uh like he used to, probably when he was uh like 2 years old, he did have a couple ear infections. 

Doctor: OK, OK. Were they were they treated with antibiotics?
Patient: Uh I think one time they were, but I I'm pretty sure that was on, in his right ear. 

Doctor: OK, OK. He's never had to get like tubes inserted or anything like that?
Patient: No, no, nothing like that. 

Doctor: No, OK. Um, alright. Um has he had a stuffy nose or runny nose? 

Patient: Uh not this week, but he he was a bit like stuffy like last week I would say. 

Doctor: OK, he was a bit stuffy, you said?
Patient: Yeah, maybe even, maybe two weeks ago. 

Doctor: OK. And that stopped. Did he have anything else along with his stuffy nose at that point?
Patient: No, nothing else. 

Doctor: Um right now, have you noticed any changes in his vision, in his smell or taste? 

Patient: Uh mo, not that I know of. 

Doctor: OK, how about weight loss?
Patient: No, he's been um growing pretty well. 

Doctor: OK, and you said um you had taken his temperature. When did you take his temperature? 

Patient: I just took it yesterday but uh he was feeling a bit warm yesterday so we just took it and it was like um 39 degrees Celsius. 

Doctor: OK, OK sweet. Um so 39 degrees, so he does have a fever uh for sure. We'll take his temperature again today just to make sure. Have you been giving him anything for his high temperature, like Tylenol?
Patient: No, we haven't given him anything. 

Doctor: OK. Have you noticed any rashes on him? 

Patient: No. 

Doctor: No, um how about coughing?
Patient: Uh no, he hasn't been really coughing. 

Doctor: No coughing, how about wheezing or shortness of breath?
Patient: No. 

Doctor: Like anything that would indicate he has chest pain or palpitations of his heart? 

Patient: No, I don't think so. 

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

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

Doctor: Headaches?
Patient: Uh not that I know of. 

Doctor: OK, and how how have his bowel movements been? 

Patient: His bowel movements have been pretty much the same, um he's uh, yeah, there's been no real changes. 

Doctor: No, OK. Um alright, and how about uh nausea or vomiting?
Patient: Uh no, no, no nausea or vomiting. 

Doctor: Any appetite change?
Patient: Uh no, uh, maybe a little bit more fussy just, but I don't know if that's probably due to the pain. 

Doctor: OK. Um and how about his urine?
Patient: Uh his urine has been the same, like no changes. 

Doctor: No changes, OK good. Is he an otherwise healthy kid or does he have any longstanding conditions?
Patient: Yeah, he's pretty healthy. There have been no concerns at all that we've had for the doctor. Uh he's been growing well, um meeting all of his milestones. Um yeah, no, nothing that's concerning. 

Doctor: OK, um do you know if his mother's pregnancy with him was normal? Did she have any complications?
Patient: Um she didn't have any like complications during the pregnancy. Uh they did have to, um I forgot what it's called, but uh he was like a difficult baby coming out. Um and he was at term though, he wasn't premature, but they had to use just um some tools to get him out. 

Doctor: OK, OK. Um so it was a vaginal delivery, but they used some tools like forceps maybe or vacuum?
Patient: Yeah, yeah it was forceps, yeah. 

Doctor: OK, OK. Um and he's, you mentioned he was full term? 

Patient: Yeah, he was born at uh 40 weeks. 

Doctor: OK, perfect. Did he need to be hospitalized for any reason after that?
Patient: No, he wasn't hospitalized. Uh we stayed there maybe one day extra just because um there was some just kind of misshaping of his head. 

Doctor: OK. 

Patient: That kind of went away. 

Doctor: OK, OK, good. And is he on any medications?
Patient: Uh no, no medications. 

Doctor: No medications, up to date with his immunizations? 

Patient: Yeah, he's all up to date. 

Doctor: OK, any allergies?
Patient: Um not that we know of. 

Doctor: OK, how about family history of lung conditions, heart conditions?
Patient: Um no, we've been pretty healthy as parents. Um and I think my my father has like high blood pressure, diabetes, and all those types of things. 

Doctor: OK, OK, any um ear issues like congenital ear, sorry um, genetic hearing issues or ear issues? 

Patient: No, nothing like that. 

Doctor: OK, um does anyone at home smoke?
Patient: No, no one smokes. 

Doctor: OK. Um and who does he live with?
Patient: So he lives with um me, his father, and his mother as well. 

Doctor: OK. Uhm, any siblings?
Patient: No siblings, he's an only child. 

Doctor: OK, and how are things at home, um is like, are things financially stable? Any relationship issues? 

Patient: No, we've been pretty uh fortunate like it it's, no financial issues uh and we have a lot of support from our parents as well. Uh the relationship is great, so no, no issues. 

Doctor: OK, good good. Um has he had any sick contacts recently?
Patient: Um I don't think so. He's, we've been at home so I don't know. We we did have like, with our with my brother's uh kids like uh they came to see us once um but that was like, that was, I think at like three weeks ago. 

Doctor: OK, OK, three weeks ago. Alright, um travel to anywhere recently?
Patient: No. 

Doctor: No, OK. Alright, those were all the questions I had for you today. Do you have any questions that you wanted to ask me today before we end the interview? 

Patient: Uh no, not really. Just wanted to know if, like I remember he did need antibiotics before so I was just wondering if he needs them now. 

Doctor: Yeah, um so, well first, because some of his symptoms overlap with Covid, like the fever especially, we'll do a swab on him anyways um and you should hear those results in about 24 to 48 hours. Um and then it, this picture sounds like acute otitis media, so like an ear infection. And um it's especially likely because he's had them in the past, so I'm gonna have to take a look into his ears first before like um coming up with a management plan. But I'll kind of walk you through what we look at. So if I take a look and I see like a perforated tympanic membrane with like pus, we'd prescribe like 10 days of um antibiotics. If he has some like middle ear effusion, so like some fluids with like a bulging tympanic membrane and he appears to be really ill, uh which from the sounds of it, he sounds ill, he's had this fever for more than two days, we'll also prescribe antibiotics for 10 days. And then, if it's just some middle ear effusion, so just that clear fluid um or just the bulging tympanic membrane, we can just um reassess him in 24 to 48 hours to see how he's doing. And if he's worse, again, we'll prescribing prescribe him some antibiotics. Um the antibiotics that we usually prescribe are amoxicillin, and because he doesn't have a penicillin allergy, that should work.
Patient: I've um I've been having this numbness and tingling and I guess kind of burning sensation that well uh it's been happening more often in my uh left hand. 

Doctor: On your left hand, OK. And sorry when did you say this started? 

Patient: Uh it's been going on for probably four or five months um. 

Doctor: OK.
Patient: Yeah, it first uh it would only bug me for a couple of minutes at a time and I could kind of shake my hand out, like flick like flick my wrist and um and it would go away after a few minutes. But now I'm starting to get uh like symptoms at night sometimes as well. 

Doctor: OK, so um it's gotten worse then, you said over the past few weeks? 

Patient: Yeah it has. 

Doctor: OK um and is it always there? Is it persistent or does it come and go?
Patient: It comes and goes. 

Doctor: OK and what makes it better or worse? 

Patient: Uh better uh I've tried some um Advil um and Tylenol and it's kind of the, hasn't done much um for the pain really, uh I think only the thing that kind of helps it is just not using it as much, um yeah. 

Doctor: Yeah, alright, um have you tried any like cold compresses, um topical creams? Anything like that?
Patient: No. 

Doctor: No, OK. And uhm if you were to describe the quality of how it feels like, does it does it, is it painful, is it tender, or is it just numb and tingling, kind of like when your foot goes to sleep? 

Patient: Uh I guess I have, it is a bit painful as well, yeah. I have um like a burning kind of pain. 

Doctor: OK and 1 to 10, 10 being the worst pain ever, how bad is this pain?
Patient: Uh when it gets to its worst, I would say about a 6. 

Doctor: OK, OK. Um and have you ever experienced this before or is this kind of like the first time you're experiencing this?
Patient: Yeah, this is the first uh really like over these last three months, the first time I've been experiencing it, I think uh the first time that it started it started to wake me up at night though has been like about a couple of weeks ago. 

Doctor: Oh I see, OK. Um alright and do you feel like your symptoms are getting worse over the past few weeks or is it kind of the same?
Patient: Uh over these past couple of weeks, about the same. It's woken me up uh like two or three times at night. 

Doctor: OK, alright and do you have any numbness or tingling elsewhere on your body?
Patient: No, it's just um just kind of the the outside of my hand here, it's really only the first like 3 fingers. 

Doctor: OK, first three fingers so your um thumb, index finger and uh middle finger? Or your pinky to middle finger? 

Patient: Yeah, it's just the uh my thumb index finger and ring finger. 

Doctor: And ring finger, OK.
Patient: And maybe just like a little bit of the um like of the ring finger too, but not all of it. 

Doctor: OK, um alright, so um any weakness in your arms or do you feel like you can still use your arms OK?
Patient: Uh yeah I haven't had any, uh, any muscle um weakness, I guess I may be a bit more clumsy um with uh with my left hand like I've dropped a few things, I've had it, a little bit more difficult time like opening jars or like car doors and stuff like that. 

Doctor: OK, OK, and any confusion or memory loss? 

Patient: No. 

Doctor: Headaches?
Patient: No. 

Doctor: OK, um how about weight loss? 

Patient: No, I haven't had any weight loss. 

Doctor: Uh fevers or chills?
Patient: No. 

Doctor: Uh rashes? 

Patient: No rashes. 

Doctor: Changes in your vision, hearing, smell or taste?
Patient: No, that's been normal. 

Doctor: OK, how about um a cough?
Patient: Uh no, I haven't had a cough. 

Doctor: OK, um wheezing or shortness of breath?
Patient: Nope, neither of those. 

Doctor: OK. Chest pain or heart palpitations?
Patient: Um nope, I haven't had that. 

Doctor: OK, how about um changes in your bowel movements?
Patient: Uh nope, I haven't had any diarrhea and no no constipation and no blood either. 

Doctor: OK, good. Any nausea or vomiting? 

Patient: No I haven't had any of that. 

Doctor: OK, any changes in your voiding?
Patient: Uh, no I I um haven't had any problems with urination. 

Doctor: OK, um are you otherwise healthy? Do you have any longstanding medical conditions?
Patient: Um I have hypothyroidism, so I take um like uh thyroxine for that and um I am overweight as well, or in obesity class one I think. 

Doctor: OK, and um do you take any medications for the hypothyroid?
Patient: Yeah I do, I take um I take uh Synthroid, I think. 

Doctor: OK, alright, and are you on any weight loss medications?
Patient: No, I've just been trying to uh change diet around when I can and um and trying to um exercise a bit more, but uh it's been it's been tough, especially now with my wrist or my hand bugging me. 

Doctor: Yeah, for sure. Um alright, and then are you up to date with your immunizations? 

Patient: I am, yeah and I get the flu shot every year. 

Doctor: OK, that's good. Um and have you had any hospitalizations or surgeries in the past?
Patient: Um I, I, no, I haven't had anything like that. 

Doctor: No, OK. Um any allergies?
Patient: Uh no allergies. 

Doctor: OK, family history of lung or heart conditions?
Patient: Um my grandfather had a stroke when he was in his uh 70s, um and my dad has high cholesterol. 

Doctor: Have you been worked up for all of that? Like high blood pressure, diabetes, cholesterol?
Patient: Uh yeah, I think my family DOCTOR: checked a few years ago, but I've been healthy besides this um uh this this pain um so maybe that, yeah maybe that could be investigated as well. 

Doctor: OK, um any neural, neurological, or musculoskeletal issues in the family? 

Patient: Um I think osteoarthritis, a few few people have that. 

Doctor: OK, um how about autoimmune conditions?
Patient: Uh no, I think I'm the only one with the thyroid. 

Doctor: OK, um how about cancers?
Patient: Uh no cancer. 

Doctor: No cancers, OK. Um alright and then, do you smoke?
Patient: I do, yeah, I smoke about um 5 to 10 cigarettes per day. 

Doctor: OK, and um for how long have you been doing that?
Patient: Uh probably yeah about the last 10 years, it was kind of around when I started working um in the warehouse here, um yeah. 

Doctor: OK, and have you ever thought about quitting?
Patient: I have, yeah I've tried, it's just such uh I mean people just go out and I mean have their coffee and cigarettes and it's sort of a social thing while at work, it it's kind of what people do so, I have been trying to cut down though. 

Doctor: OK, OK, that's good. If you need any resources, we have some that we can refer you to. Um and do you consume marijuana in any form?
Patient: Um no, I don't. 

Doctor: No, OK. Any recreational drugs. 

Patient: Um nope, I don't use anything like that. 

Doctor: OK, how about alcohol? Do you drink?
Patient: Um I'll have wine every once in awhile on the weekends, maybe maybe a drink per week, something like that. 

Doctor: OK, um and have you been in contact with anyone sick recently? 

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

Doctor: OK, how about travel?
Patient: No, I've been I've been at home and and just going to work. 

Doctor: OK. Um and and where do you live and who do you live with?
Patient: So I live with my husband and our two daughters and we live and we live in a house. 

Doctor: OK, um any concerns for STI's? 

Patient: No, I'm just um, I've been monogamous with my partner now for uh over 10 years and um no concerns for uh an STI at this time. 

Doctor: OK, alright good, um so now we're just going to move on to the physical exam part um of this interview. Um so I'm going to get you to look at both your arms, hands, and wrists, um side by side. Does your left one seem at all more red, swollen, uh or hot.
Patient: No, no symptoms like that. 

Doctor: No, OK. And um do you, does that one seem to be more atrophied or are there any deformities or skin changes on that one?
Patient: Um maybe uh a little less muscle bulk on the, like where my thumb is. 

Doctor: OK, OK. Um and then I'm gonna get you to palpate certain areas of that arm. So let's start um at the top, when you when you press down on your shoulder blades or just at the very top of your um arm where your, or at the very top where your arm connects to your shoulder, does it hurt over there? 

Patient: No, no pain there. 

Doctor: OK. So no pain on the acromion process or the scapula. Um any pain where your biceps are?
Patient: No. 

Doctor: No, OK. How about at your elbows? 

Patient: Uh no pain at the elbows and full, I can move my elbows and shoulders, uh no problem either. And my neck doesn't hurt at all either, I can move my neck around. 

Doctor: How about when you um palpate your wrists, both sides, medial and lateral?
Patient: Uh, yeah no, no pain if I'm just pressing or palpating the wrist. 

Doctor: OK. Um and I'm going to get you to um straighten out your arm and flex at your shoulder and extend at your shoulder, does that hurt?
Patient: No. 

Doctor: How about when you flex your elbow and extend your elbow? 

Patient: No. 

Doctor: Um how about when you flex your wrist and extend your wrist?
Patient: No. 

Doctor: OK, so I'm going to do a special test for something called carpal tunnel syndrome. Um so um I'm gonna get you to straighten out your left arm again um and right where um alright, how do we do this? OK, so with your right hand or with your yeah, with your right index finger and middle finger, you're going to tap um just below uh where the bulk of your thumb muscles are um connecting to your wrist. I'm just going to get you to tap that area. Do you feel tingling like an electric shock sensation in your hand or anything like that.
Patient: I do, yeah. 

Doctor: You do, OK, so that's a positive Tinel's sign. Um and then we're going to do one more test, so I'm going to, OK so make like a prayer motion with your hands like um putting your 2 palms together and then um and then instead invert your hand so that the outer parts are touching and your fingers are pointing towards the ground. 

Patient: OK. 

Doctor: So kind of like upside down but with your outer parts of your hands touching. Um and then I'm going to get you to uh just hold your arms like that um for about 60 seconds. Do you feel any tingling, numbness, or pain in those fingers?
Patient: Yeah, I get a bit of uh numbness and tingling when when I do that. 

Doctor: OK, so that's a positive Phalen's sign test. Um alright, so that brings me to the end of um this interview, did you have any questions or concerns, anything that you wanted to bring up? 

Patient: Uh just wondering about um what this could be. 

Doctor: Oh yeah, so um it seems like you have something called carpal tunnel syndrome. Um and that is, it's pretty common um so it can be caused by um a lot of things, but basically your median nerve runs through your forearm into your wrist, and anything that squeezes or irritates that median nerve can lead to carpal tunnel syndrome, um and some things include um like repetitive movements at work, um obesity, um any nerve damaging conditions like diabetes, um inflammatory conditions, but mostly just like workplace factors can can do it, um especially if you're working with like vibrating tools or on an assembly line that requires like repetitive and prolonged flexing of the wrist. Um so uh diagnosis, we just do that through like symptoms, physical exam, um we don't really need to do any imaging at this at this point. And to treat it um basically work modification, so taking frequent breaks, uh not doing those repetitive movements um as often um and then you can do things at home, like apply cold packs. Um and then we also have some like non-surgical treatments where we can uh splint, we can put like a wrist splint um while you sleep to relieve those nighttime symptoms. Uh you can take some NSAIDs to relieve pain, um and if those don't work, we can try corticosteroids, um and if that doesn't work, then we can also discuss surgery sometime down the line. Does that sound OK?
Patient: Yeah hi, um, I have been coughing nonstop for the past three days, and today I have been feeling very short of breath. So I just wanted to get it all checked out. 

Doctor: Yeah, for sure. And, so you said the cough started uh, three days ago. Were there any triggers to the cough or anything that, uh that changed three days ago? 

Patient: No, nothing that I can think of um, I have, like the only thing that I've been doing is going to the grocery stores, uh the bank, and laundromat. Um, and once I ran all these errands, like, I just started having this coughing fit that hasn't stopped. 

Doctor: Okay, uh, has the cough gotten any better, or stayed the same, or gotten worse these past three days?
Patient: Uh, it seems like it's getting worse. 

Doctor: Okay, are you bringing up any uh, sputum or phlegm? 

Patient: Um yes, it's yellow. 

Doctor: Okay, is this um, any different from before? Like have you had a cough in the past and, and brought up phlegm, or is this entirely new for you?
Patient: Um no, this has happened to me before, um, like I don't know, like maybe a year or two years back. Uh, and it kind of feels the same, but just a little bit worse. 

Doctor: Okay. Um, and uh, have you seen any blood in the sputum?
Patient: No, no blood. 

Doctor: Okay. Um, and you mentioned you've been short of breath as well. Uh, how has that come on?
Patient: Um, it was, I, I don't know if it's because of all the coughing that I've been doing, but it just started this morning. 

Doctor: Okay, um, and have you been experiencing uh shortness of breath um, on exertion otherwise, like prior to this?
Patient: Um no, no. 

Doctor: Okay. And have you had any shortness of breath after, like if you lie down flat? 

Patient: Um, no, not that I've noticed 

Doctor: All right, and have you had a wheeze?
Patient: A little bit, yeah. 

Doctor: Okay um, uh, and have you had any um, infectious-like symptoms such as like red eyes, runny nose, or, or a sore throat?
Patient: No, nothing like that. 

Doctor: Okay, um, have you had any, any chest pain? 

Patient: Nope, nothing like that. 

Doctor: Have you had any lightheadedness or, or feeling dizzy?