jshargo/medical-interview-conversations huggingface dataset:
Patient: No, I can't think of anything uh like specific that happened, but there was one night where um like after work, I was sitting down after dinner and um I got pretty stiff that night. It was pretty sore and kind of ever since then, it's been been sore. 

Doctor: OK, OK, um and is this a persistent kind of back pain or does it come and go?
Patient: It's um, I can kind of always feel it, but it certainly gets worse if I am moving. So if I'm just kind of sitting at rest, I don't really, yeah, I don't really feel it that much. 

Doctor: OK, OK, and if you were to describe the quality of this pain, um would you say it's sharp, throbbing, achy, crampy? 

Patient: I'd say I get kind of uh, it's a sharp pain. 

Doctor: Sharp pain, OK. Um does anything make it better or worse?
Patient: Um better would just be uh resting. 

Doctor: OK. 

Patient: Um kind of just lying down, or um yeah, just just trying to uh rest. But um making it worse, yeah, if I'm uh like really any movement um if I'm like bending forward or um kind of like leaning to the side, I start to get um get some pain in the lower back. 

Doctor: OK, OK. And then 1 to 10, 10 being the worst pain you've ever felt, how bad or uh how severe would you rate it?
Patient: I would say 7. 

Doctor: A 7, OK. And have you ever had pain like this in the past? 

Patient: Uh yeah, I've I've hurt my lower back before like many years ago. Um but it's been OK since then. 

Doctor: OK. Uh did you get any sort of treatment or management for that pain um back in the day?
Patient: At that time it was just rest and like did some stretching and I took some um anti inflammatories and it went away after a couple of months. 

Doctor: OK, OK. Um and are you having any sort of like numbness or tingling, anywhere on your body? 

Patient: No, nothing like that. 

Doctor: Alright, how about any muscle weakness?
Patient: Uh no muscle weakness. 

Doctor: No, OK. Are you still able to walk and do things that you normally would do in a day? 

Patient: Uh yeah, I'm able to walk still. 

Doctor: OK. Um any dizziness or fainting spells?
Patient: Nope, nothing like that. 

Doctor: OK. Any pain elsewhere on your body? 

Patient: No, just just the lower back, yeah. 

Doctor: OK. Headaches?
Patient: Uh nope. 

Doctor: OK, weight loss? 

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

Doctor: OK. Fevers or chills?
Patient: Nope, no fevers or chills. 

Doctor: Um rashes? 

Patient: Uh no rashes. 

Doctor: Changes in your vision, hearing, taste or smell?
Patient: No changes like that. 

Doctor: OK. Any coughing, shortness of breath or wheeziness? 

Patient: Um nope, nothing like that. 

Doctor: Um chest pain or heart palpitations?
Patient: Nope, nothing like that. 

Doctor: OK. Issues or changes in your bowel movements? 

Patient: Uh no changes to bowel movements, no diarrhea and no incontinence or anything like that. 

Doctor: OK, um and then uh nausea or vomiting?
Patient: Nope, nothing like that. 

Doctor: OK, how about um changes to your appetite?
Patient: Um nope, I've been eating uh, I've been eating well. 

Doctor: Changes in your voiding? 

Patient: Uh nope, I haven't had any changes to urination. 

Doctor: OK. Um and then are you otherwise healthy or do you have any longstanding medical conditions?
Patient: Uh I I've had a few sports injuries when I was younger, uh like to my my knee, but that's it, I've been healthy otherwise. 

Doctor: OK and um those injuries, are they all healed?
Patient: Uh sometimes I'll get um like a little achiness in my knee from from doing like too much activity, but I know when those, when that happens. 

Doctor: OK. Are you on any medications? 

Patient: No, I I don't uh take any medications. 

Doctor: OK. Are you up to date with all your immunizations?
Patient: I am, yep. 

Doctor: OK. Um do you have any allergies? 

Patient: Uh, no allergies. 

Doctor: OK, any family history of um muscular or skeletal issues?
Patient: Um no, nothing like that. 

Doctor: OK, how about um heart or lung diseases?
Patient: Uh, no, no heart or lung diseases. 

Doctor: OK, uhm how about autoimmune conditions? 

Patient: Um nope, nothing like that. 

Doctor: OK. Cancers?
Patient: Uh no cancers. 

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

Doctor: OK and do you consume marijuana?
Patient: Uh sometimes, I'll have like uh edibles, little candy, sometimes at nighttime they they help me uh relax and sleep, but I don't use that very often. 

Doctor: OK, how often do you use them?
Patient: I would say maybe uh once a week. 

Doctor: Once a week, OK. Alright um and then, what else did I wanna ask you? Um do you, do you take any recreational drugs? 

Patient: No, and I haven't used any before. 

Doctor: OK, and how about alcohol, do you consume alcohol?
Patient: Yeah I'll have a couple of beers on the weekend, so maybe like two or three. 

Doctor: OK, uhm and who and where do you live right, who with and where do you live right now?
Patient: Yeah, I live with my wife and our um and our son who's in high school. We live in a in a house. 

Doctor: OK, OK. Um alright, and any concerns for STI's at all? 

Patient: Oh no, I've been with my wife now for a long time and we've been monogamous so no concerns for uh sexually transmitted infection right now. 

Doctor: OK, how about um sick contacts, have you been in contact with anyone sick recently?
Patient: No, I don't think so. 

Doctor: OK, any travel recently?
Patient: Uh no, I haven't traveled anywhere. 

Doctor: OK um and well, let's move on to the physical exam part of this interview. Um so I'm going to get you to stand up from a sitting position. Does that hurt your back? 

Patient: Um yeah it does. I I do feel a little bit of a a twinge there. 

Doctor: OK, and where about specifically?
Patient: Kind of just, yeah, on the lower uh lower right side like more on the, more on the right side. 

Doctor: More on the right side, OK. Now, if you have a mirror with you, or if you have someone there with you who can um speak to this, does your right side appear more red, swollen, or hot compared to your left side of the lower back? 

Patient: Uh no, nothing like that. 

Doctor: No, OK, and does it seem like it's more atrophied or do you see any deformities or skin changes in that area?
Patient: Uh nope, no deformities or skin changes. 

Doctor: OK, um alright and I'm gonna get you to um bend down all the way and touch your toes if you can. 

Patient: Um yeah I I can get part part way down. 

Doctor: You can get partway down, does it hurt?
Patient: Um a little bit, I can feel it pulling and stretching, yeah. 

Doctor: OK. Um alright, and then I'm gonna get you to uh like laterally flex to your right side. So kind of like you're doing an exercise um and you're just like bending towards that side. 

Patient: Yeah, that hurts. 

Doctor: That hurts, OK, how about the other side, the left side?
Patient: Yeah that hurts too. 

Doctor: OK. Um and now I wanna get you to uh bring your knees up towards the ceiling. Does that hurt? One at a time, like your right right knee and your left knee.
Patient: Uh, not really. 

Doctor: No, OK, how about when you um flex your knees backwards? 

Patient: Nope. 

Doctor: And kind of point your knees towards the ground.
Patient: No, no pain there. 

Doctor: OK, so no pain on knee extension or flexion. Um how about when you point your toes to the ceiling? 

Patient: Uh no pain there. 

Doctor: OK so no pain on plantar flexion, how about when you point your uh toes to the ground?
Patient: No pain there. 

Doctor: OK, so no pain on dorsiflexion, and then sorry I forgot to ask you earlier, do you have any sort of numbness in the groin area? 

Patient: No, no numbness in the groin area. 

Doctor: OK, so no numbness in the groin area, no weakness, no um changes in your bowel or bladder habits, including no incontinence, so uh no red flags?
Patient: Yeah, nothing like that. 

Doctor: OK, OK, good um and, OK so those are all the questions that I had for you. Did you have any questions for myself? 

Patient: Uh, no I was just uh yeah, kind of wondering do I do I need any X Rays or like what what what's going on? 

Doctor: Yeah, so um what it sounds like right now is that you have something called mechanical back pain. It's pretty common and um it can be anything from your spinal joints to the discs to the vertebrate or soft tissue or muscle. Um and a lot of these can be caused by um hard activity at work, um like carrying heavy things um and then carrying them in like an improper position or something like that. Um and we diagnose that on history and physical exam, um but if after we try some management and treatment plans, it doesn't go away and it persists for more than eight weeks, we do recommend imaging, including an MRI. So uh in terms of management for right now, um modified activity at work, um some short term bed rest, uh very short term though um and bed rest is only really recommended if you have severe back pain and muscle spasms, um and you definitely shouldn't be doing that for more than like 24 to 48 hours, and physical activity can help, um so referral to physical therapy or physiotherapy um can help in rehab and they'll give you some exercises that you can try at home to kind of um strengthen those muscles. And then ice and heating packs um temporarily can help, uh medications like NSAIDs can help as well with the inflammation. Um so we'll try these things out and then we'll continue to follow up. Um yeah, did you have any questions or does that sound like an OK plan?
Patient: I've been having this cough for around, I would say half a year now and I just can't seem to get rid of it. 

Doctor: OK. And does this cough have any phlegm that you bring up? 

Patient: No, it's completely dry. I can't bring anything up. 

Doctor: OK, and since the cough started, has it been getting getting worse, staying the same, getting any better?
Patient: It was pretty much the same for I would say like three or four months, but then I've noticed it getting more frequent over the last couple of months. 

Doctor: OK, and six months ago, can you think of anything that that changed? Including like, traveling anywhere or changing in in your work or or living environment? 

Patient: Uh, not really, uh, I'm like almost 75 years old now, so I just thought it was probably just due to my age. 

Doctor: OK. Uh, have you been have you brought up any blood with the cough?
Patient: No, I've never brought up any blood. 

Doctor: OK, and have you have had any shortness of breath? 

Patient: Not that I've noticed, but I do find that I get a little bit more tired with exercise than I used to, but not really any shortness of breath. 

Doctor: OK. Um, and have you been experiencing any other symptoms?
Patient: I don't know if this is just due to old age, but like I've noticed some joint pain as well, like in my hands and feet. I just assumed that was 'cause I'm getting old. 

Doctor: OK um, and has there been anything that's made the cough worse?
Patient: Sometimes when, I'm exercising a lot more but not not too much, it's kind of just always been there, hasn't really changed too much, but it's gotten more frequent over the last couple of months. 

Doctor: OK, and anything that's made the cough better that you've tried? 

Patient: No, nothing I've tried like everything. I've tried Tylenol cold, I've tried other home remedies but like like steaming and everything like that but nothing has really helped. 

Doctor: OK, and is the cough worse in the morning, throughout the day or or at night?
Patient: It's pretty much always there. It doesn't really change with any time of the day. 

Doctor: OK, and is the cough interfering with sleep?
Patient: Yeah, I sometimes I I do have coughing fits at night that wake me up. I do have disrupted sleep over the last few months. 

Doctor: OK. Um and, you mentioned some joint pains as well and then when did that those start?
Patient: I would say over the last year is when I started noticing it a lot more than before. 

Doctor: OK, have you been having joint stiffness or or muscle stiffness early in the morning?
Patient: It does get a little bit more stiff in the morning, but it's kind of just there throughout the day. 

Doctor: OK, have you noticed any red hot or or kind of swollen joints? 

Patient: No, nothing like that. 

Doctor: OK, any injuries to any of your limbs or or joints that could explain some of the pains
Patient: No, not that I know of, nope. 

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

Patient: Yeah, I definitely have been more tired. I can't really even go outside for a walk sometimes or I get really tired working in the garden. So it's been tough. 

Doctor: OK, and when did that when did you notice that change and and how were you different before?
Patient: Like before, like before six months ago, I remember I used to be able to go for long walks around the block, then when I was gardening I can go on for hours, but now I'm pretty it's pretty limited to like maybe 15-20 minutes and then I have to go back into the house. 

Doctor: I see OK, so pretty big difference over the last six months to a year for you.
Patient: Yeah. 

Doctor: Have you been experiencing any fevers or chills?
Patient: Not really. Not that I know of. 

Doctor: OK, how about, uh, excessive sweating at night? 

Patient: Nope. 

Doctor: Alright and, how has your appetite been?
Patient: My appetite has been around the same, no changes there. 

Doctor: OK, have you experienced any weight loss? 

Patient: I've actually, I think, lost a couple pounds but not not too much. 

Doctor: OK, would that be over the last six months or so?
Patient: Yeah, around the last I would say three to four months. 

Doctor: OK, uh, have you noticed any swollen glands anywhere like in your neck or anything like that you might feel like a lump? 

Patient: No, not really. 

Doctor: OK, have you had a sore throat or or runny nose?
Patient: No, I haven't had a cold for more than two or three years I think. 

Doctor: OK, about a loss of smell?
Patient: No. 

Doctor: Loss of taste? 

Patient: No. 

Doctor: Alright, have you been experiencing any chest pains?
Patient: When the coughing gets pretty bad like I get some strain in my chest but nothing other than that. 

Doctor: Alright, and any heart racing? 

Patient: Nope. 

Doctor: Alright, and how about wheezing?
Patient: No, not really. 

Doctor: OK, and have you noticed any swelling in your limbs, like in your hands and your feet or ankles? 

Patient: No, not really. 

Doctor: Alright at night, have you had any periods where you woke up extremely short of breath and you had to sit on the edge of the bed with your feet over?
Patient: No, not that I remember. 

Doctor: OK, and how many pillows do you sleep with?
Patient: Just one, same as before. 

Doctor: OK, um and any abdominal pain? 

Patient: No, no pain is just in my joints and sometimes in my muscles, but other than that, no. 

Doctor: OK, any urinary problems like pain or or going really often?
Patient: Nope. 

Doctor: Alright and then any changes to bowel habits like diarrhea or constipation? 

Patient: No, not that I know of. 

Doctor: OK, and have you noticed any skin rashes?
Patient: Uh, nope. 

Doctor: OK, and, uh, are there any joints in particular that are most affected? 

Patient: I would say like my legs and arms. It's it's pretty much  lot of the joints, not really affecting my hip, but like everything else seems a bit sore. 

Doctor: OK, and, have you been diagnosed with any medical conditions in the past?
Patient: No, never. I've been pretty fortunate. 

Doctor: OK, so do you take any medications either prescription or over the counter? 

Patient: No, just vitamins but nothing else. 

Doctor: Alright, do you have any allergies?
Patient: No, not that I know of. 

Doctor: Have you been so you said you've been pretty healthy, but have you been in the hospital for any reason recently?
Patient: No. 

Doctor: OK. Um and are your immunizations up to date?
Patient: Yeah, I I got a shingles vaccine, the one for pneumonia as well. 

Doctor: OK, and have you traveled anywhere recently? 

Patient: No I've been at home. 

Doctor: OK um and in the family, have you heard of anything like this happening in the family sort of way, onset of this kind of shortness of breath and cough that you've been experiencing?
Patient: Not really, I I don't really have shortness of breath like it's it's like a dry cough. Sometimes I do find myself breathing more shallow. Yeah, mostly it's just a dry cough that's been going on. 

Doctor: OK, and more of the fatigue. 

Patient: Yeah. 

Doctor: OK. And anybody in the family have like autoimmune diseases like rheumatoid arthritis or or lupus?
Patient: Uh I don't really, I can't really think of nothing my mom and dad were completely healthy. So I know and I don't have any siblings, so yeah, not nothing that I know of. 

Doctor: OK, uh, any cancers in the family like colon cancer or anything like that?
Patient: No, no cancers. 

Doctor: OK. Um, and could you tell me a little bit about your living situation? 

Patient: Yeah, so right now I live alone in a small townhouse and yeah, that's I have a pet dog, but that's that's about it. 

Doctor: OK, um, and how do you support yourself financially?
Patient: So, I'm retired, but getting a pretty good pension as well as for my a husband's pension as well, but he unfortunately passed away a couple years ago. 

Doctor: I'm sorry to hear that. What did you say you retired, what did you do for work previously? Did you have any exposures to chemicals or asbestos products while while at work?
Patient: Not that I remember, no it was it was a pretty, pretty much like a desk job I would say. 

Doctor: OK um, so no reasons that you were visiting farms and like being around birds or anything like that?
Patient: Um, not really, but I I do think like the old building that we lived in might have had asbestos. Does that does that like count at all? 

Doctor: Like a it could be important, uh, because, uh, well how long, how long did you live there for? 

Patient: I would say almost 20 years. 

Doctor: OK, so um, yes, that definitely would be is is important for the history today because, unfortunately, long term exposure to asbestos when breathing it in can cause some of the symptoms that you've been describing along with cough and uh, respiratory symptoms. So it'll be something that we'll be sure to investigate today, OK? But I just had a couple more questions. First, do you smoke cigarettes?
Patient: I quit long time ago, more than like 10 years ago, but I used to smoke like 5 to 10 cigarettes for around 20 years. 

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

Doctor: Alright, do you drink alcohol? 

Patient: No, not anymore. 

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

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

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

Doctor: OK, so those are the questions that I wanted to go over to make sure I asked on history. Was there anything that else you wanted to tell me?
Patient: Sure, my 5 year old daughter, I noticed that she's been coughing a lot over the past two days. She sounds like she has a stuffy nose and now she's got this pink eye so I just wanted to get it checked out by you. 

Doctor: Yeah, for sure. So the cough started 5 days ago?
Patient: Two days ago. 

Doctor: OK and is the cough barky or harsh sounding? 

Patient: Yes, it sounds harsh. 

Doctor: OK, alright was there anything that changed two days ago that might have triggered the cough?
Patient: I don't think so, although she does go to daycare. 

Doctor: OK, uh and so has she been bringing up any sputum with the cough?
Patient: No, no sputum that I've noticed. 

Doctor: OK, notice any blood? 

Patient: No. 

Doctor: Alright, and is the cough worse at any particular time of day?
Patient: No. 

Doctor: OK, and has there been any wheezing? 

Patient: No, not that I noticed. 

Doctor: OK. And you mentioned the red eyes. When did you notice that?
Patient: That was just yesterday. 

Doctor: OK, any discharge from the eyes? 

Patient: No. 

Doctor: OK, nothing like that? No tearing or anything like that?
Patient: No. 

Doctor: OK. Umm and has she complained about any like changes to vision?
Patient: She's been rubbing it and so it's possibly itchy. 

Doctor: OK. And have you noticed any mucus coming out?
Patient: Umm, no, it's actually stuffy. 

Doctor: OK 

Patient: Yeah, not so much mucous. 

Doctor: OK, has she mentioned anything about losing smell?
Patient: No. 

Doctor: OK, umm and has she mentioned anything about being congested? 

Patient: She just sounds like she's congested. 

Doctor: OK. Umm any sore throat?
Patient: Umm, possibly. 

Doctor: OK, how has she been eating?
Patient: Um, she's been eating OK. I guess she's been eating alittle less than usual. 

Doctor: OK umm, would you say that she's been going to the bathroom as often as normal? 

Patient: Yep, I would say so. 

Doctor: No changes there, OK. Um and has she had any loss of taste?
Patient: Umm, possibly since she's not eating as much. 

Doctor: OK. Any fevers or chills? 

Patient: Um, she did feel a little bit hot, but I didn't take her temperature. 

Doctor: OK, so hot. We will definitely check for fever today. Any night sweats?
Patient: Umm, no. 

Doctor: OK. And has she been gaining weight OK?
Patient: Yep, Yep, no change, nothing abnormal there. 

Doctor: OK, and has she been complaining about having any stomach pains?
Patient: Umm, no. 

Doctor: OK, has she had any nausea or vomiting? 

Patient: Um no no. 

Doctor: OK, and how about any painful urination?
Patient: No. 

Doctor: OK, and any diarrhea?\
Patient: Umm, no. 

Doctor: OK, and has she mentioned anything about headaches? 

Patient: No. 

Doctor: OK. And how about any aches or pains anywhere?
Patient: Uh, no, I don't think so. 

Doctor: Have you noticed any rashes? 

Patient: No. 

Doctor: OK, and has she been diagnosed with any conditions before?
Patient: No. 

Doctor: OK. And any reason for her to be hospitalized? 

Patient: Uh, no. 

Doctor: OK, um does she take any medications regularly?
Patient: Um, no. 

Doctor: OK, does she have any allergies to medications? 

Patient: Umm, no. 

Doctor: Alright, any surgeries before?
Patient: Umm, no. 

Doctor: Any concerns with her growth or development? 

Patient: Umm, no, everything's been pretty normal. 

Doctor: OK, and any concerns about her vision or hearing?
Patient: No. 

Doctor: OK. And can tell you tell me a little bit about the living situation currently? Are you the primary caregiver?
Patient: I am. 

Doctor: OK, and who else is in the home?
Patient: Her father. 

Doctor: OK, are there any pets around? 

Patient: No. 

Doctor: Alright. And does anybody in the house smoke?
Patient: No, no one smokes. 

Doctor: OK, any exposures in the house to like carpets or dust or inhalants that might bring on a cough?
Patient: No. 

Doctor: OK. Ummm and uhh anybody in the family been sick?
Patient: No. 

Doctor: OK, and how about anybody you mentioned at the daycare? Was anybody been sick there? 

Patient: No, I don't think so. I contacted them and checked, but it seems like no one's been sick. 

Doctor: OK, and you say you haven't traveled anywhere?
Patient: Oh no, no, not recently. 

Doctor: OK. And any lung conditions or heart conditions that run in the family?
Patient: No. 

Doctor: OK, and how about any genetic conditions or congenital conditions in the family?
Patient: No, none, none that I know of. 

Doctor: OK, so the main symptoms are the cough that started two days ago and also you've noticed she's been congested. And sorry, what was the last symptom?
Patient: Hi, I'm here because I've had this numbness and tingling in my feet for awhile now and I started to notice these open wounds on my feet as well and I'm not feeling it, but it's there. 

Doctor: OK, and when did you first notice the numbness and tingling? 

Patient: It's been on going for the past like 2 years, but recently I've seen the past like 3 months it's gotten worse. 

Doctor: OK, and do you feel it in in both feet?
Patient: Yes. 

Doctor: OK and, where about do you feel the numbness and tingling tingling. Do you feel like all the way up your up your leg, or is it only part way? 

Patient: It it goes right up until my ankles. 

Doctor: OK. And do you have wounds on your feet that like you, you don't notice them because you can't feel it?
Patient: Yeah, I don't notice it because I can't feel it, but then I'll see them and they look bad. 

Doctor: OK, do you recall hitting your foot or off of anything or stepping on any objects that could have caused trauma to your feet? 

Patient: Um I mean it's possible um, but I didn't feel anything, so I'm not too sure about that. It is the summer, so I've been like going to the beach and when I'm at the park like I'll take off my flip flops. 

Doctor: OK, have you had any like muscle weakness, to your legs or feet?
Patient: Hum, maybe a little bit of muscle weakness in my legs. 

Doctor: OK, have you had any problems with balance or have it you had any falls? 

Patient: No. 

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

Doctor: Have you had any night sweats?
Patient: No. 

Doctor: And have you had any unexpected weight loss? 

Patient: No. 

Doctor: OK, have you had any headaches?
Patient: No. 

Doctor: Alright, have you had any sensory changes like changes to your vision, hearing or sense of smell or taste? 

Patient: No. 

Doctor: Have you had any any sore throat or cough?
Patient: Nope. 

Doctor: How about um any shortness of breath?
Patient: No. 

Doctor: OK, have you had any wheezing? 

Patient: No. 

Doctor: Have you had any chest pain?
Patient: No. 

Doctor: Any have you had any dizziness or lightheadedness?
Patient: Nope. 

Doctor: Have you had any heart palpitations or feeling like your heart's racing? 

Patient: No. 

Doctor: Have you had any nausea or vomiting?
Patient: No. 

Doctor: How about any abdominal pain? 

Patient: No. 

Doctor: Have you had any changes to bowel movements like diarrhea or constipation?
Patient: Nope. 

Doctor: OK. And have you had any urinary problems like frequency or painful urination?
Patient: No. 

Doctor: OK, and have you had any rashes on your skin?
Patient: No. 

Doctor: OK, and any muscle aches or joint pains?
Patient: No, nothing like that. 

Doctor: OK, and do you have any numbness or tingling to any other parts of your body? 

Patient: Maybe a little bit in my fingertips as well. 

Doctor: OK, and when did you first start noticing that?
Patient: Um in the past year. 

Doctor: OK, and have you had any like like clumsiness or like dropping objects? 

Patient: Um yeah, definitely some of that like I'll find it hard to like open cans and bottles. 

Doctor: OK, any weakness in the hands?
Patient: Um only when, only sometimes when I'm trying to grip things pretty hard. 

Doctor: OK, uh. And. Have you had any memory changes or any confusion? 

Patient: No. 

Doctor: OK, and have you had any any back pain?
Patient: No. 

Doctor: OK, in the past have you been diagnosed with any? Or sorry before that and have you had any neck pain?
Patient: No, no neck pain. 

Doctor: OK. And in the past, have you been diagnosed with any medical conditions? 

Patient: Um yeah, so I've been diagnosed with diabetes. Hypertension. Hypercholesterolemia. Obesity. And and I think, yeah, I think that's that's about it. 

Doctor: OK, and are you currently on any medications? Like do you have? Do you use insulin?
Patient: I do so. I'm on insulin, short acting and long acting, I'm on Ramipril, I'm on Atorvastatin, yeah. 

Doctor: OK. an, and do you recall any like what your A1C has been in the past or, an have you had your eyes checked and kidneys checked?
Patient: A1c has been pretty high. Especially recently I think it was eight point 8.1 or something. The last time I got it checked. I haven't had my eyes checked in awhile, and in terms of my kidneys, I think I did a urinalysis recently and everything came back normal. 

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

Doctor: Alright, and have you had any prior surgeries or hospitalizations?
Patient: No, I don't believe so. 

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

Patient: Yes. 

Doctor: OK, and. and. Can you tell me a little bit about where you're living currently and who you're living with?
Patient: I live in a house downtown with my wife. 

Doctor: OK, and are you working currently? 

Patient: I am, I work from home though. 

Doctor: OK. So and, have you been around anybody who's been sick?
Patient: Oh no, I don't think so. 

Doctor: OK, and have you traveled anywhere recently?
Patient: No, not outside the province. 

Doctor: Alright, and do you drink alcohol?
Patient: Um yeah, I'll have some alcohol every day. 

Doctor: OK, OK how many drinks per day would you have for and how many drinks per week? 

Patient: I'll have about 5 beers a day. 

Doctor: OK, do you feel as though that's a lot?
Patient: Yeah, I. I'm hoping to cut down. 

Doctor: OK, that's good, and if at any point you need help or I would like to discuss that, just please let me know. OK, and do you smoke cigarettes?
Patient: I do. 

Doctor: OK, how much do you smoke? 

Patient: Talk about half a pack a day. 

Doctor: And for how long have you been smoking for?
Patient: For the past almost 20 years. 

Doctor: OK, have you thought about cutting down?
Patient: Ah yeah again, that's something that I'm hoping to quit doing in the future as well. 

Doctor: Certainly OK. And are you currently sexually active?
Patient: I am. 

Doctor: OK and. Could you tell me about your partners or partner? 

Patient: Yeah, just my wife. We've been together for the past five years. 

Doctor: OK, any concerns for a sexually transmitted infection at this time?
Patient: No. 

Doctor: OK. And any a musculoskeletal or neurological conditions that run in the family? 

Patient: No. 

Doctor: OK, and how about any cancers that run in the family?
Patient: No cancers that I know of. 

Doctor: OK, and how about heart conditions or or lung conditions?
Patient: No, nothing like that. 

Doctor: OK, so next. Just wanted to move on to their physical exam piece of the appointment today, so just looking at your um, the, at your feet and at the joints of the ankle and toes are you seeing any swelling, redness, or yeah, any swelling or redness? 

Patient: Um no no swelling or redness. 

Doctor: All right, are there is there a temperature change to your feet or any of the joints? Are they feeling hot or cold?
Patient: No. 

Doctor: OK. And is there any deformities or misalignment of any of the joints? 

Patient: No. 

Doctor: OK, and any scarring from any of the trauma?
Patient: Uhm, there are like. Yeah, there's some scarring from like ulcers. 

Doctor: From previous ones that have that have healed? 

Patient: Healed. Yeah, that's right. 

Doctor: OK, and. And is there any pain to palpation over the um ankle joint, over the ankle joint?
Patient: No. 

Doctor: OK, then how about over any of the joints of your toes?
Patient: Um no not nothing like that. No pain, just um I can't feel it. 

Doctor: OK. And how is the range of motion of your feet and toes? 

Patient: Um pretty good. I can move them all. 

Doctor: OK, and then how about your knees?
Patient: My knees are also the same. 

Doctor: OK, uh, an any ankle like instability with any special tests?
Patient: No 

Doctor: OK, and and on walking is there any limp or does it appear, how does the walk appear?
Patient: I'm pretty normal. I'm not limping. 

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

Patient: Just what do you think is going on with my feet and how do I get some sensation back? 

Doctor: So it does sound like it could be related to diabetes where what happens is you get like a peripheral neuropathy overtime and you can lose sensation to your feet in a glove and stocking distribution, which sounds like the history history you're saying today with having sensation reduced on your feet and also your fingertips as well.
Patient: Mmmm 

Doctor: Where you lose sensation and you can't feel pain. And so But other things to consider could be. Possibly like vitamin deficiencies or things like that, but I would be much much lower down on the differential. And. So to regain sensation I think. Really, the only thing that can be done now is to help prevent further damage to the nerves, and that would be to make sure that the diabetes is under good control and. Trying to monitor your feet as regularly as you can, making sure that the. There aren't any kind of open wounds or sores that are are not healing. If things are not healing, it will be important to check to see if there is an underlying infection such as osteomyelitis, which will prevent wound healing. And so if there are any, is anything like that it would be important to have that checked out. So feet hygiene is extremely important. As we're working on improving the diabetes control as well as things like cutting down alcohol could could also help as well.
Patient: Yeah, so I've had this cough now, it's been going on for about two weeks, just, just hasn't gone away. 

Doctor: Uhm, oK, can you tell me a little bit more about this cough? Is it dry or wet?
Patient: Uh, yeah it's been, uhm, mix, it's been dry sometimes and I have had a little bit of sputum production recently, uh, it's been mostly clear though. 

Doctor: Has the cough gotten worse over the past two weeks?
Patient: No, it's been about the same. 

Doctor: Uhm, and have you had any blood that came up with the sputum?
Patient: No, I haven't noticed any blood. 

Doctor: Alright, what about any other symptoms over the past two weeks? Have you had, have you had any fevers or chills? 

Patient: Not, no. 

Doctor: No. OK. And any uhm, I guess, any runny nose?
Patient: Yeah, my nose was a bit runny last week, but it's, that's better now. 

Doctor: OK. OK, uhm, it's just, OK last week, what else, what other symptoms did you have last week?
Patient: Yeah, I had a sore throat and a little bit of a headache as well, uhm, and, and some aches and fatigue. Those were uh, yeah, that was last week for about three days, and then I started to feel better. But I still have this cough, that, it's still going on. 

Doctor: So those other symptoms that you had last week that lasted about three days, are they all gone? are you still feeling fatigued or having a headache?
Patient: Those are both, yeah, they're gone. 

Doctor: Hmm, It's only the cough? 

Patient: Yeah I just have the cough. 

Doctor: Is there any time, any specific time of the day that it's worse or better? Anything that triggers it?
Patient: Uhm, maybe like, maybe when I went out into the cold or, uhm, like, when I went for a run where I really kind of exerted myself, it brought it on, but other than those things, nothing. 

Doctor: OK, but you're otherwise feeling better? 

Patient: Yeah, for the most part, yeah, feeling better, but I still have a cough. 

Doctor: OK. Uhm, have you had any chest pain?
Patient: No. 

Doctor: Any palpitations? Do you feel like your heart's racing?
Patient: Uhm, no. Nothing like that. 

Doctor: Any other symptoms such as belly pain or diarrhea or Constipation or changes in your urine, are having any urinary symptoms?
Patient: No, I haven't had anything like, like that. 

Doctor: OK. OK, and can you tell me about your past medical history, any medical conditions you have?
Patient: Yeah, I, I'm healthy. I haven't, been diagnosed with, with anything. 

Doctor: OK alright, any medications that you take including over the counter pills or any herbal pills or multi vitamins etc.
Patient: Yeah, I'm taking a birth control. 

Doctor: I see. OK, any allergies?
Patient: No allergies. 

Doctor: OK. Do you have any, you don't have any lungs related diseases right? Like asthma or COPD or anything of that sort?
Patient: Uhm, no, nothing like that. 

Doctor: Alright alright, that's good,  and who do you currently live with, and where do you live? 

Patient: Alright, so I live with a few roommates. I'm just finishing up my undergraduate degree. 

Doctor: Yeah, that's great. Have you had any contact with anyone who was sick recently?
Patient: No, not that I could think of, I mean we went out one night last week and that's kind of when I had those other symptoms for a few days after that. 

Doctor: OK, OK. Uhm and have you traveled outside the city or country?
Patient: No, I haven't. 

Doctor: No, ok. Do you drink alcohol? 

Patient: Sometimes yeah, I, I will with friends, kind of socially. 

Doctor: alright.
Patient: Just a few drinks. 

Doctor: What about smoking? 

Patient: Uh, no. 

Doctor: Marijuana?
Patient: Uh, sometimes with, like socially with friends, but that might be once a month or probably even less. 

Doctor: Any recreational drugs? 

Patient: No. 

Doctor: OK, alright and any lung conditions that run in the family?
Patient: No. 

Doctor: OK, uhm, OK alright, so that's all that I, I wanted to know. It sounds like you had a, you had a cold last week and you just have this residual cough that's still there, and it's been two weeks and you're just worried about it, but otherwise you're feeling well, you don't have any other symptoms. Often times when we get sick, or we have an infection or inflammation of the, uhm, the airway, we can get a cough that lasts a long time and it might just take you a couple more weeks for the cough to go away. But if you feel that it's getting any worse or you're, you have those symptoms come back again, or you develop a fever, we can, you can definitely, we can do something more about that. I'll also do a physical exam and, and see how you're doing and then we can go from there.
Patient: So two days ago I started to have this cough. Came out of nowhere. I haven't had a cough before and I, just today I've noticed the fever as well and and I've had a headache the last few days. 

Doctor: Can you tell me a little bit more about your cough? Has it gotten better or worse over the past two days? 

Patient: So it, it's a it's been about.. well, it got worse at first and then it's been about the same since then. 

Doctor: Okay, and is it dry cough or wet cough?
Patient: It's dry. 

Doctor: Okay. Uhm? And does it ever wake you up at night? 

Patient: No. Well, it kind of happens all throughout the day. Yeah, no, no, it hasn't woken me up at night. 

Doctor: OK, is there any, are there any triggers? Anything that makes your cough worse?
Patient: I can't think of anything really. It just kinda comes on like throughout the day on it spontaneously. 

Doctor: How do you take any medications to help with your symptoms?
Patient: Yeah, some over the counter cold medicines. I tried some to take Tylenol cold and sinus or something like that anyway and it did help me sleep a little bit with that the headache and just haven't been feeling very good, to help with that. 

Doctor: And tell me about your fever. Did you check it check it, check your temperature? 

Patient: I did yeah today I checked it and it was, like just over 38 I think like 38.1 or two. 

Doctor: OK, what about your headache? Where exactly is it?
Patient: I kind of feel it all over. It's like a band night feels like it's just around my head and squeezing. 

Doctor: And, how like if you had to give it a number from one to 10? What number would you give it? With 10 being the worst headache ever?
Patient: I would say maybe a 5. 

Doctor: OK, and you mentioned that the Tylenol helped. 

Patient: It did, yeah, probably took it down to a two or three. The headache didn't go away entirely. It was sort of still there, but did help. 

Doctor: Have you had any other symptoms?  Have you had a confusion or is it any fuzziness? Or any flu like symptoms?
Patient: Uh, I have felt just tired and, over these last couple of days. That and I have had a sore throat as well. 

Doctor: Oh, you get OK. OK, what about a runny nose or stuffy nose? 

Patient: Uh, no, nothing like that. 

Doctor: Any difficulties breathing?
Patient: No. 

Doctor: Any difficulty swallowing with a sore throat? 

Patient: Ah is a little bit painful, but I've been able to to eat and drink okay, just really takes a little longer. 

Doctor: Any dizziness or fainting in the past couple of days?
Patient: No, nothing like that. 

Doctor: OK, any rashes or changes in their nails? 

Patient: No, I haven't had anything like that. 

Doctor: Any changes in your? I guess have had any chest pain?
Patient: No, haven't had any chest pain, haven't had anything like that before. 

Doctor: Any belly pain? 

Patient: No. 

Doctor: any changes in your bowel movement, any diarrhea?
Patient: No, no, I haven't had ah, any diarrhea. 

Doctor: OK, uhm any changes in your urination, any difficulties or any pain or any increase in frequency? 

Patient: No, I've had a urinary track infections before so I know what that's like. I haven't had any of those symptoms. 

Doctor: OK, alright, good. And. Have you been diagnosed with any medical conditions in the past?
Patient: Uhm? No, I haven't. I had surgery on my knee when I was a teenager. I uh tore my ACL but it's been good since then. 

Doctor: Any hospitalizations?
Patient: No. 

Doctor: OK, any medications that you're taking, including over the counter meds? 

Patient: Yeah, I just say I'm on birth control right now. I've been taking it for the last like five years. 

Doctor: OK, any allergies?
Patient: Oh no, I don't think so. 

Doctor: OK, good. And do you have any medical conditions that run in the family? Including any heart or lung conditions or cancers. 

Patient: Yeah, my, my aunt had had breast cancer. But ah, and my dad has high blood pressure. 

Doctor: OK OK uhm. And do you currently smoke?
Patient: No, I don't. 

Doctor: Do you ever smoke in the past?
Patient: No, I I I I I've stayed away from that. 

Doctor: Good. Any marijuana or recreational drugs? 

Patient: Yeah, sometimes, well, we'll smoke with like friends at a party I guess, but I haven't had any. I haven't done that in awhile. 

Doctor: Alright. Any alcohol?
Patient: Similar like sometimes at a party, but I mean yeah, it's been awhile for something like that, so I haven't really had any alcohol on in months. 

Doctor: And are you currently working, or? 

Patient: I am yeah. So it's uh, yeah I work for this tech company so I've been able to do a lot of my stuff at at home. 

Doctor: OK, uhm. Have you had any exposures to anyone who could potentially be sick?
Patient: I will without, well, yeah I there a couple or last weekend. Actually there was a family party that we went to. It was outside, but uh, it, yeah, there's people around. There was nobody that was sick that I'm aware of. 

Doctor: OK. And and have you traveled anywhere outside the province?
Patient: No been besides that, the family party last weekend, but I mean that was just here in town so. It was close by. 

Doctor: OK, I guess I forgot to ask about a symptom. Have you felt that you've lost your sense of smell or sense of taste? Has it just been different?
Patient: Yeah, I said some actually now that you mention it right sense of smell has been different, which is kind of weird, 'cause I I don't have, everybody knows or I don't feel congested or anything. So yeah, but my taste has been OK. 

Doctor: Good. Well, that's all the questions I had for you. Given that your symptoms sort of sound like you may have a viral or bacterial infection and seeing that you were, you had some exposure to to other people even though they weren't sick, it could, it could be that they, they had some sort of an illness that they could transmit that they weren't just showing symptoms at the time. We will get a covid swab done just to make sure that that's not what's happening. It could be that. And I'll recommend that you continue to, you know, take Tylenol and rest and take care of yourself and if your symptoms worsen or stay the same for long period of time, definitely come back or call public health to get some guidance and try to stay away from others and self isolate for the next couple of days or at least clear covid swabs back or your symptoms improve. Or the next 14 days. So that's all I have for you today. Do you have any questions for me?
Patient: I am here with uh, with my daughter, who has just been having a cough for the past um, two weeks. 

Doctor: Okay, um, and can you describe the cough a little bit? Is it a dry cough or is she bringing anything up? 

Patient: Um, it is a, it is a dry cough, um, but she just keeps coughing and coughing and, and then she just, you know, once she'll start coughing she just doesn't stop. And then um, there's been times when she just turns blue, she's coughing so much. Um, and then it just gets, gets better um, on its own. But yeah, it's a dry cough. 

Doctor: Okay, and um, what does the cough sound like? Is it like a harsh cough, a barky cough?
Patient: Um, it's just, she just makes this noise when she's like breathe, trying to take a breath in. It's, it's yeah. 

Doctor: Okay, is it kind of a wheeze? 

Patient: Yeah, sure. 

Doctor: Okay. Um, and so there's episodes where she also turns blue?
Patient: When she's coughing a lot, yeah, she does. 

Doctor: Okay.
Patient: She's also vomited once or twice. 

Doctor: Oh, I see, okay. Um, any blood in the vomit? Or is she coughing up any blood?
Patient: No. 

Doctor: No, okay. Um, any, so this started two weeks ago, any kind of symptoms of runny nose or um, cold-like symptoms before then?
Patient: Yeah, yeah she did have a bit of a runny nose. It was just uh, watery, uh, since discharge. And at that time her cough, she had a cough as well. Um, but I thought it was, you know, it's nothing. It was just like another flu and it would get better, but then she just, the runny nose got better without, in a couple of days, but the cough stayed. And it got, got pretty worse, uh, it got worse. 

Doctor: Okay, um, other than the cough uh, any, any fevers or chills? 

Patient: No, I don't think she's had fevers. I haven't checked, though. 

Doctor: Okay. And the cough is pretty constant, or is it, does it come and go?
Patient: Yeah, she just has these episodes where she just coughs and coughs and coughs, and then she'll either vomit or just turn blue, or just um, get better in a couple, couple minutes. This kind of comes and goes like that. 

Doctor: Okay. And is there anything that has helped her at all? Like any over the counter medications or anything like that?
Patient: I haven't tried anything, I'm just worried about, you know she's my first child and I don't know what to give her and what not to give her at this age. So I just decided to come in and not try anything over the counter. 

Doctor: Okay. Um, and so, has this happened before at all? 

Patient: No. 

Doctor: No, this is the first time, okay. Um, any so, she, she is vomiting. Um, is the vomit like green in colour? Or is she just vomiting up what she has eaten? What's the content of the moment?
Patient: It's usually just what she's eaten. 

Doctor: Okay, um, any sick contacts recently or any travel? 

Patient: No, I don't think so. Not, nothing really. 

Doctor: Um, and how about her behaviour? Does she seem like uh, very tired or fatigued, or more irritable?
Patient: She does get tired, especially after, and then she's irritable and crying after, you know, she has these fits of coughs. 

Doctor: Okay.
Patient: Yeah. 

Doctor: Okay. Um, any symptoms of diarrhea or constipation?
Patient: No. 

Doctor: Okay. Any um, any trouble with urinating at all?
Patient: No. 

Doctor: No. How's her sleeping like?
Patient: Uh, not great. It's just the cough keeps uh, waking her up and she just doesn't, can't fall asleep. 

Doctor: Okay, any uh, exposure to dust or fumes, or animals or pets at home? 

Patient: We, we did get a cat um, about a month ago. 

Doctor: Okay. Um, and any, has she been diagnosed with any medical conditions in the past?
Patient: No. 

Doctor: Um, and any allergies that you know of? 

Patient: Um, no. 

Doctor: And um, any previous hospitalizations or surgeries?
Patient: No. 

Doctor: And how was your pregnancy, your pregnancy with her, like any complications at all? 

Patient: No, no complications. It was uh, it was very, yeah, it went well. 

Doctor: And was she at term or premature?
Patient: She was at term, she was born at term. 

Doctor: Was it a vaginal delivery or uh, a c-section?
Patient: Uh, vaginal. 

Doctor: And did she have to stay in the NICU at all, at the hospital afterwards? 

Patient: No. 

Doctor: Okay. And is she feeding well, like what does she usually eat?