jshargo/medical-interview-conversations huggingface dataset:
Patient: No. 

Doctor: Alright, and uh, anybody in the family have any like lung conditions, heart conditions or diseases that run in the family? 

Patient: Uh, my, my son actually just recently was diagnosed with asthma. But I think that he gets that from his mom's side. 

Doctor: OK. Uhm, you don't have any asthma or problems breathing like that?
Patient: No, nothing like that. 

Doctor: OK, and right now, so you mentioned your son and wife, is that who you're living with?
Patient: Yeah, it's just us three. 

Doctor: OK, and uh, any exposures to, to anybody who's been sick, either at home or at work or, or any other activities?
Patient: Uh, unfortunately I do have to, uh, I'm one of the unlucky ones that still has to go into work. And yeah, it's it's hard to say like at work, there are times when we, like at lunch we eat like without a mask. I don't know if, I didn't notice anyone having any symptoms, but like, I don't know if someone, you know, who knows where anyone has been. 

Doctor: Yeah, so nobody that you're aware of who's been sick though?
Patient: No. 

Doctor: And everybody at home has been OK? 

Patient: Yeah, at home everyone's good. I kind of just distance myself into like one room. 

Doctor: Mhm.
Patient: Just in case anything goes wrong. 

Doctor: OK. And have you traveled anywhere?
Patient: No, we've been, we've been at home this whole time. 

Doctor: OK. And do you smoke cigarettes? 

Patient: No, I've never smoked. 

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

Doctor: Alright and you use any other recreational drugs like cocaine, opioids, heroin? And how, have you used anything like that in the past?
Patient: No. Never. 

Doctor: OK, uhm, and do you drink alcohol? 

Patient: Yeah, well just occasionally, like I would say maybe, maybe some wine, once, uh, like once every couple days. Maybe a beer on the weekend, but that's it. 

Doctor: Alright. So I think that was all I wanted to ask on history today. Was there anything else that, that you wanted to add before we go on to the exam and?
Patient: Yeah, so I, I, I don't know if I should get a test done, like for covid. Uhm yeah, that's all, just wondering if I, if I can do that here? 

Doctor: Yeah, so that is something that that is on the differential for what could be causing your symptoms, especially with uhm, starting at having a cough and the nonspecific viral type symptoms with the cough, headache, muscle aches, so certainly could be caused by covid, but there are other reasons for, that could explain these symptoms, such as other types of viral illnesses, and so we will do a PCR swab today, as well as do, well, check your vitals to see if you have a fever now and we'll also maybe send an influenza swab as well, and and do some blood work. But in the meantime, since we're running the covid swab, it will be important to self isolate for the next 14 days and we will let you know what the test results show. But despite, even if they are negative, it will be important to still stay self isolating for the next 14 days.
Patient: Hi, yes, I just brought my son to the ER. We've noticed in the last two days he's been just making these grunting noises and just seems a little bit like just not himself, just more quiet. Not really crying. 

Doctor: OK, and when did you, you said last few days, when when exactly did you first notice the grunting? How long?
Patient: It was two days ago. 

Doctor: OK, two days ago. Was it when, did you hear this sound when your baby is trying to breathe?
Patient: Yeah, today I was trying to pay more attention. It seems like that like this really trying to breathe more. And also I like he's like the chest I see moving a lot more. 

Doctor: OK. And so you've been hearing this grunting sound, and he's been trying to breathe. And you see that his chest is moving more than usual and he's crying. Has he been sleeping well or no? 

Patient: Uh yeah, so last night it was really hard to get him to sleep. He did sleep, I would say like around like 4 hours last night, but it was really difficult. 

Doctor: And what about feeding? Does he take a formula or is he breastfed?
Patient: So he's, uh, he takes formula and today it like yesterday he was feeding. Today it's been really hard to get him to feed. Maybe he fed for like one or two times, but not much. 

Doctor: It happens when you try to feed him?
Patient: Uhm, Kind of just uh after awhile, just pushes it away, not really, uhm, yeah, uhm not really too excited about feeding. 

Doctor: OK, and what about diapers? How many wet diapers has he had over the past, or yesterday and today?
Patient: Probably around the same like usually has like five to six weight diapers and it's around the same. 

Doctor: OK. OK. Uhm and did you try anything? I know that he's six months old. Did you try feeding him anything new or anything different? 

Patient: Uh, no, it's just been the bottle feeds. 

Doctor: Nothing new right? No solid foods yet?
Patient: No. 

Doctor: OK. And uh in terms of his activities, you mentioned that he's not as he's not moving and, as active as he usually is? 

Patient: Yeah, today I also thought I felt that it was a bit warm, warmer than usual, but I didn't have a thermometer at home. 

Doctor: OK. Uhm have you noticed, has he been drooling at all?
Patient: Drooling? 

Doctor: Mhmm.
Patient: No, I haven't noticed that. 

Doctor: OK. What about coughing?
Patient: Uhm, I haven't heard any, any coughing, no. 

Doctor: OK, Sorry, is he is able to sit up on his own? 

Patient: Uhm, up against like a sofa or chair, but not really on his own. 

Doctor: Have you ever been has been left alone over the past two days at some point? Do you feel like you might have taken something in his mouth accidentally?
Patient: Uhm no I I tried checking his mouth like I was there with him like all all the time. 

Doctor: No, OK nothing like that? OK, how has his immunizations been so far? Has he as he received them?
Patient: Yeah, he's received all his immunizations, up to date. 

Doctor: Uhm, did he have, it has he was vaccinated anytime recently? Because sometimes you said he's warm and sometimes, sometimes just getting vaccinated can cause a reaction. 

Patient: Yeah, no. He was vaccinated like I think more than two or three weeks ago. 

Doctor: OK, alright. And you said no diarrhea or anything like that, right?
Patient: No. 

Doctor: OK, any, is he does he have any nausea or not nausea but is he vomiting? Is he bringing anything up?
Patient: No, not really. Like he was just pushing away the bottle. But like he didn't bring anything up. 

Doctor: OK. Has he been limp and lethargic? 

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

Doctor: OK, has you said that he hasn't had his formula much? But what about drinking? Like has he had anything to drink? Any milk or anything like that, or no?
Patient: No, I don't think so. 

Doctor: No, she hasn't had much to eat and or drink over the past or today? 

Patient: Yeah mostly. 

Doctor: So he might be a little bit dehydrated.
Patient: Yeah. 

Doctor: OK. Uhm, OK, well uhm, I, I, OK, so that's all I wanted to do know in terms of his current status, I would obviously want to examine him very carefully and see what's going on. Uhm, how has uh, how is he like just going back, how was your pregnancy? 

Patient: Pregnancy was uh, OK, no complications, but he was premature by two weeks, so I think he was born at 35 and four days. 

Doctor: OK, and were there any complications at that time, including complications related to the lung, something like respiratory distress syndrome?
Patient: Yeah, so when he was born there was they needed to do, I forgot what it was, but they told me that initially he wasn't breathing, but then right afterwards after like within 5 minutes, he was fine. 

Doctor: Hmm, uhm, OK, uhm, was he kept in the hospital in the NICU after being born?
Patient: Yeah, just because of that scare, they kept him for three more days, but like he was growing while there were no more episodes of the breathing issue, so they let him go after. 

Doctor: OK. Uhm, has, how has he been since then over the past six months? 

Patient: Since then, he's been fine. No, we didn't have to go to the hospital or anything, and during our routine visits he's been growing well, no normal issues. 

Doctor: Any issues because development?
Patient: No, he's been pretty, like he's been meeting his milestones according to like the family doctor. 

Doctor: Has he had any surgeries or any, or no hospitalizations you said, and no, uhm no diagnosis, right? He hasn't been diagnosed with any condition? 

Patient: No. 

Doctor: Alright. Can you tell me about allergies? Is he allergic to anything that you're aware of?
Patient: No, not that I know. 

Doctor: OK, is there uh, can you tell me about his family history? Anything that you might have or uhm his dad or anyone else in the family? 

Patient: Uh, no, him, his dad and I are pretty healthy, yeah. No medical conditions. 

Doctor: Anything like cystic fibrosis in the family?
Patient: No, not that I know of. 

Doctor: OK. Alright, well we'll examine the child and look at his vitals, listen to his lungs, look, look inside his mouth and that's this sounds serious, so we'll keep you, we'll keep you updated and we'll let you know what needs to be done. He might need, potentially need antibiotics. He might need potentially, to be intubated, but we will have all these discussions after the baby's been seen and we'll draw some labs and go from there. 

Patient: OK, sounds good. 

Doctor: Alright.
Patient: Hi, so yeah I I'm really worried. I started coughing up blood this morning, and for the last two days I've been having some, like on my right calf, just a lot of swelling and tenderness. Uhm, I just actually got out of the hospital just last week. I had a knee replacement surgery on my right leg. So yeah, I was just really concerned about this blood that I'm coughing up. 

Doctor: Yeah, certainly. So when, so you had a knee surgery last week, were you like immobilized afterwards for periods of time?
Patient: It's just the right calf and it's it's pretty swollen right now and I was having a lot of pain over it for the last two days. 

Doctor: OK is it, can you feel the pain at rest, or or is it with uh like with movement? Or if you press on it?
Patient: It's yeah, it's pretty tender when I press on it. I haven't really been moving around, and it's still like painful right now, but it doesn't really hurt when I'm like, like I've been trying to keep myself rested just because of the surgery, but when I press on it, it is pretty tender. 

Doctor: OK, and is the is the swelling in kind of one spot of your leg, or is it most of the of the leg?
Patient: It's just the calf, I would say more like just the lower leg area. 

Doctor: OK. Have you noticed any skin changes, like redness or or or temperature like it feels hot to touch. 

Patient: Maybe a little bit. I haven't really noticed it too much. 

Doctor: OK, and do you have a history of like varicose veins or anything like that?
Patient: No, nothing like that. 

Doctor: OK. So uhm when did the coughing up blood start?
Patient: Just this morning actually. So just uh, like I would say a couple hours ago. 

Doctor: OK, and how much blood are you coughing up?
Patient: Just some on like I just notice on the tissue like just some spots that I noticed every time that I'm, like, I would have to cough it up. Maybe like in the last couple hours, I've had three episodes of that where I've noticed blood on the tissue. 

Doctor: I see and did you ever cough prior to this? 

Patient: No, not really. 

Doctor: OK, uhm, and have you been experiencing any infectious symptoms like red or runny eyes, runny nose, sore throat?
Patient: No, nothing like that. 

Doctor: Have you been having any chest pain or or shortness of breath? 

Patient: No chest pain, but I do feel like I do have to take like a deeper breath. Like I've just been feeling it this morning a little bit. It's just kind of a bit of uneasy breathing. 

Doctor: OK, so it has been more difficult to breathe. And is that is that at rest as well, do you feel that kind of sensation?
Patient: Yeah, even right now, just a little bit, like it's it's not anything that I'm too worried about, but it is there. 

Doctor: OK, do you have any pain if you have if if you take a deep breath in.
Patient: Uh, no I don't, no I don't really have any pain. 

Doctor: OK, and do you feel like your your heart's racing or beating really fast.
Patient: I I do feel like my heart is beating like faster, especially today. But yeah, I don't know. 

Doctor: Alright, and how about your breathing? Do you feel like you're breathing faster. 

Patient: No breathing, I feel like it's around the same. 

Doctor: OK, and have you had any lightheadedness, or dizziness, or or feeling like you're going to pass out?
Patient: No. 

Doctor: OK. And have you had any any wheezing? 

Patient: No wheezing. 

Doctor: Alright, uh have you had any abdominal pain?
Patient: Uh no, no abdominal pain. 

Doctor: Any nausea or vomiting. 

Patient: Nope. 

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

Doctor: How about any urinary problems, like pain or frequency.
Patient: No. 

Doctor: Have you had any skin changes or or rashes?
Patient: Uh, no. 

Doctor: OK, and how about any other like joint pains, muscle aches? 

Patient: No, nothing like that. 

Doctor: Alright. Have you ever had a a DVT before?
Patient: No, I've never had anything like that. 

Doctor: OK, or yeah, like a deep vein thrombosis or have you had a pulmonary embolism before?
Patient: No, I've never had anything like that before. 

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

Patient: I do have uh, so with my with my knee and then I do have high blood pressure, uh I have diabetes. 

Doctor: OK, then was it a knee replacement you had done?
Patient: Yeah. 

Doctor: OK, and do you take any medications for the blood pressure and diabetes?
Patient: Yeah, so for the blood pressure I'm taking medication called Ramipril, and then for diabetes I'm taking Metformin. 

Doctor: OK, have you needed like insulin for diabetes before? 

Patient: No, I've never had to use insulin. 

Doctor: OK, and and do you take any other medications, either prescribed or over the counter?
Patient: No, nothing else. I actually I do take some multivitamins, but besides that nothing. 

Doctor: Alright, and do you have any allergies to medications?
Patient: Not that I know of. 

Doctor: OK, and any hospitalizations or surgeries in the past besides the the knee surgery last week? 

Patient: No. 

Doctor: Alright, so you've been healthy otherwise. I I'm not sure I I ask this, I'm wondering if you had any fevers or chills.
Patient: No, not really. 

Doctor: OK, and uh how about any night sweats?
Patient: No. 

Doctor: Alright and uhm has your weight been stable over the last several months or have you had any changes?
Patient: Yeah, it's been pretty stable. 

Doctor: OK, thank you, just wanted to clarify a few things there. And uhm, currently, can you tell me about where you're living and who you're living with?
Patient: Yeah, so I'm living with my wife in a house. I do have two kids, but they're off to college right now so it's just us 2. 

Doctor: OK, and and what what do you do for uh for work? 

Patient: Yes, so I actually work as a mechanic, and right now I'm kind of off of work with, I just need to recover and kind of get that physiotherapy done and then I can return, hopefully in a month or two. 

Doctor: OK, yeah we need to recover after the knee surgery. OK, and do you smoke cigarettes?
Patient: I used to, but I quit when I was in my thirties. I used to smoke like probably a pack a day between my 20s and 30s. 

Doctor: OK, but it sounds like yeah, you quit, about 20 years ago then? 

Patient: Yeah. 

Doctor: OK, and do you drink alcohol?
Patient: Uh no. 

Doctor: OK, how about using any other recreational drugs? 

Patient: No other drugs. 

Doctor: Ok, and in the family, are there any heart conditions or or lung conditions?
Patient: No, not that I know of. 

Doctor: OK, and anybody in the family have a bleeding disorder or or a clotting disorder?
Patient: No, not not that I'm aware of. 

Doctor: OK, have you heard of anybody in the family having, I know you said you haven't had had this before, but anybody in the family having a deep vein thrombosis or or PE. 

Patient: Not that I know, not really. 

Doctor: OK. So that was everything that I wanted to ask about on history today. We'll do physical exam and I'll listen to your chest and have a look at your leg. We'll also order some imaging studies, with a CTPA it's called. Uh but before we go ahead with that, was there anything else that that you wanted to add?
Patient: No, I think that's that's all. 

Doctor: OK, so we'll get the lab work started, as well as the imaging ordered. It will look for, to see if there is any pulmonary embolism present, because with the surgery last week and being immobilized for a period of time, it is a risk factor for it, and leg swelling with uhm coughing up blood can be symptoms of this. So we'll wanna make sure to to do, to investigate for a pulmonary embolism.
Patient: Hey I I came in here today I I just was feeling just a bit short of breath over the last few days and I've had a so I normally have a cough, but I've just been coughing a lot more over the last week and I don't know if it's if it's something else. I I do have a COPD diagnosis which I was diagnosed with like a couple years ago, but this is this seems to be much worse. 

Doctor: OK, you said you were diagnosed with COPD couple years ago. Was that two years ago? Three years ago?
Patient: It was almost, probably five years ago. 

Doctor: Five years ago, OK, and have you always had this cough since then?
Patient: Yeah I’ve probably had a cough for the last 10 years, I think. 

Doctor: OK. 

Patient: Yeah. 

Doctor: And you you’ve mentioned that this cough has gotten worse over the last week?
Patient: Yeah, I've been coughing a lot more. Even just walking down the stairs from my bedroom to even the kitchen I just have to take a little bit of a breather, just start coughing. 

Doctor: OK. And is it a dry cough or are you bringing up any phlem?
Patient: No, I'm bringing up like this. It's usually before this week. It was like kind of a clear to yellow. Sorry clear to white material, but this past week it's been more yellow in color. 

Doctor: OK, any blood in there?
Patient: No, I mean notice any blood. 

Doctor: OK and you said you were also short of breath, uhm when did that start?
Patient: So that's just in the last few days. But just to clarify, I do get short of breath here and there sometimes I have to use puffers, but the last few days I've just been really short of breath, even even if I walk a little bit after like sit down and, can't really catch my breath. 

Doctor: OK. Alright, and do you get short of breath when you're laying down?
Patient: Uhm no, not really, it's mainly just when I'm moving around and doing stuff. 

Doctor: OK, how about when you're asleep? Does it wake you up and kind of make you gasp for air?
Patient: No. 

Doctor: No OK. So no orthopnea or PND. Alright, and the puffers that you're on, can you remind me which ones you're on again? 

Patient: So I'm on this one called Ventilin for the which I’ve been using a lot more recently just for relief and then, I'm on this other puffer thing. It's called spiriva. 

Doctor: OK, how often? How? How many times this week have you had to use your ventilin?
Patient: Uhm, Ventilin are probably used. Probably almost like 10 times this past week. 

Doctor: OK. Alright, any chest pain? 

Patient: Uhm? Just when I'm having like those coughing fits in with the breathing, I feel some discomfort, but that's it. 

Doctor: OK, OK. Alright and then any palpitations or feeling like your heart's racing?
Patient: Uh no. 

Doctor: OK. Alright, and do you ever feel like your calves hurt after you walk awhile?
Patient: No, not really. 

Doctor: No OK, any dizziness or fainting spells? 

Patient: Uhm, No, no, not that I know. 

Doctor: OK. Numbness or tingling?
Patient: No. 

Doctor: Confusion or memory loss? 

Patient: No. 

Doctor: Headaches?
Patient: No. 

Doctor: Changes in your bowel movements?
Patient: No. 

Doctor: Uhm nausea or vomiting? 

Patient: Uh, no. 

Doctor: Changes in your appetite?
Patient: No, not really. Eating about the same. 

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

Doctor: Runny nose or stuffy nose? 

Patient: Uh, no. I don’t have that. 

Doctor: OK, sore throat?
Patient: No. 

Doctor: Any changes in your vision or hearing?
Patient: No. 

Doctor: Changes in your smell or taste? 

Patient: No, not really. 

Doctor: OK, how about weight loss?
Patient: No, my weights been pretty steady. 

Doctor: OK, chills? 

Patient: Uhm, maybe a few times this, like from that last couple days I've been feeling a bit chilly. But I I don't know if I have a fever or anything like that. 

Doctor: OK, so you haven't actually measured your temperature right?
Patient: No. 

Doctor: OK, we can do that today. Any rashes? 

Patient: Uh no. 

Doctor: Fatigue?
Patient: No. 

Doctor: OK, um and besides the COPD do you have any other longstanding medical conditions?
Patient: Uhm. I I have a like high cholesterol. 

Doctor: OK. 

Patient: And. Just I, I used to take blood pressure medications but I don't right now. 

Doctor: OK. And what kind of blood pressure medications did you use to take, and how come you stopped?
Patient: I was on like a diuretic. Then the DOCTOR: said, like my blood pressure was really well under control, so I just stopped taking it. 

Doctor: OK, OK, and the  was OK with that. 

Patient: Uh no, I just stopped taking it. I didn't really like ask the doctor. 

Doctor: OK, well, we'll keep checking your blood pressure and that's something you should keep an eye on as well, just in case ou have complications with your kidneys. Does that sound OK?
Patient: Yeah. 

Doctor: OK uhm? And are you on any medications other than the puffers?
Patient: Just a Torva Staten. 

Doctor: For your cholesterol OK, and are you up to date with your immunizations?
Patient: Yeah, not even a vaccine. 

Doctor: Pardon me?
Patient: I even got the coronavirus vaccine. 

Doctor: OK, good Congrats. Did you also get the shingles vaccine and the pneumococcal vaccine?
Patient: Yeah I got them. 

Doctor: OK, OK good, any allergies?
Patient: Uh, no, not that I know. 

Doctor: How about a family history of lung or heart conditions?
Patient: Uhm? My father had lung cancer but he smoked a lot, I also smoke so I sometimes worry about that, but he had cancer and my mother, she was perfectly healthy. Yeah, so just my father. 

Doctor: Just your father OK. How much do you smoke? 

Patient: Probably half a pack a day. It used to be one pack, even 2 packs at one point in time, but right now it's half the packaging. 

Doctor: OK, alright, well, it's good that you're cutting down. And if you need more resources to help you do that, we have some available that we can refer you to. Do you take any other recreational drugs like cannabis, heroin, cocaine?
Patient: No, nothing like that, no. 

Doctor: OK. And do you drink alcohol?
Patient: Um just probably maybe like a couple times a month. 

Doctor: Couple times a month OK. And are you currently married? 

Patient: Yeah, I currently live with my sorry, wife, in an apartment. 

Doctor: OK, and any reason for you to believe you have old carpets, mold, dust, asbestos, pets, anything that could be triggering your symptoms?
Patient: No, nothing like that. We live in like a fairly new apartment. 

Doctor: OK, OK, good, and have you been in contact with any sick people recently?
Patient: No, not not really. Wie’ve been just to ourselves. 

Doctor: OK, and have you traveled anywhere recently?
Patient: No, just been on our house. 

Doctor: OK. Alright, well those were all the questions that I had. Did you have any questions of your own?
Patient: Uh, yeah I was just wondering what this can be. 

Doctor: Yeah, you know it sounds like you have a cough and shortness of breath, and both of these things you've had for a while, but now they're getting worse and based on your past history of COPD I would say this sounds like a COPD exacerbation. So for that we will start off with some basic blood work like CBC, electrolytes, your kidney function, ABG’s, as well as like a chest X Ray. And basically we should treat it we're going to take your oxygen saturation an give you some extra oxygen if you need. We’ll continue to use your bronchodilators an and in addition to both of that will also give you some steroids as well as antibiotics. And just to prevent any infections or if you already have it then it can help with that as well. And because your symptoms somewhat overlap with those of Covid will also do a covid swab just to make sure it's not that. And you should hear back about those results in 24 to 48 hours. How does that sound?
Patient: That sounds good. Thank you. 

Doctor: OK, yeah, no problem.
Patient: Oh, not too great I've had this cough the last few days. 

Doctor: OK, umm, how old are you? 

Patient: I'm 36. 

Doctor: OK, so for the past couple of days you said, so is that two days? Three days?
Patient: I think 3 three days. 

Doctor: OK and is it a dry cough or are you bringing up anything? 

Patient: It's dry. 

Doctor: OK, so no sputum, no blood?
Patient: No blood. 

Doctor: OK and do you feel wheezy at all?
Patient: No, no wheezing. 

Doctor: No  shortness of breath?
Patient: Now I ran to catch the bus yesterday and I was a bit more short of breath than I would usually be. 

Doctor: OK, and have you had a fever?
Patient: I've felt hot yes. 

Doctor: OK, did you actually take your temperature or do you just feel hot? 

Patient: I just got hot. 

Doctor: OK so we can take your temperature today. Any chest pain?
Patient: No chest pain. 

Doctor: OK, and any throat pain?
Patient: Yeah, my throat's been a little sore, but I thought it was maybe just because I was coughing so much. 

Doctor: OK and any issues swallowing food? 

Patient: Umm, no problems swallowing food. 

Doctor: OK, any changes in your smell?
Patient: Now that you mention it, yeah I thought it was maybe just plugged up, but I haven't really been able to smell these last few days. 

Doctor: OK, and how about hearing? Any changes in your hearing?
Patient: No changes there. 

Doctor: OK any ear pain?
Patient: No ear pain, no. 

Doctor: OK, any changes in your vision? 

Patient: Umm, I got glasses last year but nothing recently. 

Doctor: OK and any eye pain or discharge from the eyes?
Patient: No. 

Doctor: OK, and have you had any night sweats or chills?
Patient: Nothing like that. 

Doctor: Any weight loss? 

Patient: No weight loss, no. 

Doctor: OK and then how about changes in your bowel movements?
Patient: No, everything's been regular there. 

Doctor: OK, no diarrhea, no constipation, no blood in your stool?
Patient: No diarrhea, no constipation, and I haven't noticed any blood. 

Doctor: OK, any changes in your urine? 

Patient: Uh, no. 

Doctor: No, OK. Um, how about muscle aches or pains?
Patient: I felt pretty, uh, well, yeah, I guess achy and weak. 

Doctor: Did that start around the same time that you experienced your cough and possible fever?
Patient: :Yeah, I would say it started around the same time. 

Doctor: OK, any dizziness?
Patient: Uh, no. 

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

Doctor: OK, any fainting spells?
Patient: No. 

Doctor: Any rashes?
Patient: I haven't noticed any rashes. 

Doctor: OK, so it's your cough and just in general how you feel. Does it get better or worse with anything? Have you tried you know Tylenol and any antipyretics? 

Patient: Yeah, I tried some uh like day and night time Tylenol at home to sleep but still, when I woke up in the morning, still not feeling very good and the cough is still here too. 

Doctor: OK, yeah. Have you ever experienced anything like this before?
Patient: Maybe as a kid. I mean, I remember getting the flu. I had a cough and that sort of thing, but I haven't been sick for several years now. 

Doctor: OK. Umm, and then since you started having this cough too, now has anything changed? How are you feeling worse? Or do you feel kind of the same as when it started?
Patient: I would say I feel a bit worse. 

Doctor: OK, and has anyone around you been sick recently?
Patient: Umm, no, not that I know of. Yeah, everybody in the house has been OK. 

Doctor: OK, have you traveled anywhere recently? 

Patient: Umm, yeah, I was visiting some cousins up North several weeks ago, but that was just traveling within the province. 

Doctor: OK, and they're fine? No one is sick?
Patient: I haven't heard of anybody being sick. 

Doctor: OK, and are you otherwise healthy? Do you have any medical conditions?
Patient: I've been told I had high cholesterol before. But I don't take any medications for it. I've been just trying to lose some weight and exercise more. 

Doctor: Sure, OK. No surgeries or hospitalizations in the past?
Patient: No. 

Doctor: OK and no other medications?
Patient: Umm, no,  I just take a multivitamin. 

Doctor: Ok, and no other you know over the counter medications or herbal stuff?
Patient: No, I'll use my Tylenol or Ibuprofen or Advil I guess if I get the occasional headache.  And I guess, umm, something like Reactine or Claritin for the seasonal allergies but that's about it. 

Doctor: OK. And so you said seasonal allergies. Any other allergies?
Patient: Umm, no, just usually like in the springtime. 

Doctor: OK, and are you up to date with all your immunizations?
Patient: Yeah I am. Yeah I get the flu shot every year. 

Doctor: OK good. And in terms of family history, do any of your family members have lung conditions or heart conditions? 

Patient: I know mom has high blood pressure, but nobody's had a heart attack or, uh, no lung conditions either. 

Doctor: OK, any cancers that run in the family?
Patient: Umm, none, I can't think of any. 

Doctor: OK, and then do you smoke?
Patient: I just I smoke cannabis every once in awhile. 

Doctor: OK, how much do you smoke? 

Patient: Um, I would say maybe, I enjoy it on the weekends. 

Doctor: Did you say a joint on the weekends?
Patient: Yes. 

Doctor: OK, so is that like 1 milligram?
Patient: Yeah, I would say something about that. Yeah, it's not much. 

Doctor: OK. But no cigarettes though?
Patient: No. 

Doctor: OK, any other recreational drugs?
Patient: No. 

Doctor: OK, and do you drink alcohol? 

Patient: Umm, I do, yeah, I'll have like two or three beers on the weekend. 

Doctor: Sure. And and where do you live?
Patient: I'm just like 20 minutes down the road in a house here. 

Doctor: Sure, is it an apartment complex or is it like a full house? 

Patient: Yeah, it's a single family home. I live there with my wife and three kids. 

Doctor: OK, um any concerns with your living arrangements you know, like old carpets or anything like that?
Patient: Actually last year we had most of the carpets taken out, so not anymore. 

Doctor: OK good good. Did you have any other questions or concerns? Anything that you wanted to bring up that I didn't touch on today?
Patient: Yeah, I was just really worried that this could be COVID. I mean I have a cough and just have been feeling really hot so I was just concerned about that. 

Doctor: Yeah, for sure, and I think that's a valid concern. So right now I'm just going through, you know, a list of differential diagnoses that you could possibly have and COVID, it's definitely top on my list and so we will likely get a swab and run those tests and try to get that back to you as soon as we can. It could also be other respiratory infections, especially viral infections this time of the year. And so, if it comes back negative for COVID, it's probably you know something else like respiratory virus or even the flu. So we'll go from there. And if it turns out it's not a viral infection, we will likely see if it's some sort of bacterial infection in which we can prescribe antibiotics for those. But it definitely sounds like there's an infectious picture going on here because of the acuteness of the presentation, and just your symptoms. So we will do afollow up in a week or so. Until then, we will run all these labs. Does that sound good? 

Patient: Alright, yeah, that sounds good, so I guess I will kind of self isolate until the COVID results come back. 

Doctor: Oh yes please do so. That's that's a great point. I do suggest isolating for two weeks at least if you have any sort of symptoms, because even though the PCR that we do to test for COVID is supposed to be reliable and it's supposed to be specific and sensitive, there are sometimes false negative tests. You know, just to be on the safe side, if you're experiencing any of the symptoms that overlap with COVID symptoms, isolate for two weeks. But by the end of the week we should know what the test results are and then you will know for sure what you have.
Patient: Hi. So I just brought in my son he's 5. Essentially, when he, so today is Friday when he got home from school on Wednesday, he seemed fine, but he I don’t know that night he started to have a bit of like a cough. It just seemed like a little dry cough, but obviously I just wanted to keep him home, keep him safe and not like spread anything if he was sick. So he stayed at home on Thursday and he was like having a bit of a cough. Then yesterday it seemed to get a little bit worse and he was really tired, uh sorry. Today, today is Friday. He was like his cough is like getting a bit worse and I've been taking his temp the whole time and it got like a little high today, what was it? My thermometer says it was high. I'm just like trying to remember it was it was. It was like over 100 though. 

Doctor: Oh OK. 

Patient: Uh, 101 or something or maybe 100.1 if. But anyways it was so I I just thought I should probably bring him in 'cause I was really worried about him and you know so he could have maybe got covid and like at school or something. 

Doctor: Yeah for sure. Um OK, so just to clarify, he's had this cough and fever for the past five five days.
Patient: Mhm. 

Doctor: OK, OK so let's focus on the cough.
Patient: It’s Friday. Its been more like like 3 days.  Wednesday is when he came home, and then um he. And then today is Friday. So yeah, sorry. 

Doctor: Today is Friday OK. And um. OK, yeah sure uh so. Is this cough a productive cough, or is it kind of a dry cough? 

Patient: Uh I think it's dry. I haven't noticed him like spitting up anything. Yeah he yeah, its just like little cough. 

Doctor: OK, And. He is he. He's not bringing up any sputum or blood?
Patient: No. 

Doctor: No OK good. OK, and does he sound wheezy at all to you?
Patient: No, no, not that I've noticed. 

Doctor: OK, how about short of breath? 

Patient: Um I don't think so like he usually he's a really active kid and he has. He hasn't been running a lot outside in the past couple of days, so maybe he maybe he could have been having a harder time breathing. But also I think he's just been tired in general. 

Doctor: OK, yeah. OK, Uhm. Is his coughing getting worse with certain times of the day? Like is it worse at night, in the morning?
Patient: Mm I think it kinda just there the whole day. 

Doctor: OK, and it does it, how does it sound? Does this sound like a barky cough? Does it sound? Uhm? Like harsh, what is what would you say the quality of it, of the sound of the cough is? 

Patient: Uh, I, just sounds kind of dry. It's not like super loud. 

Doctor: OK. OK, and has he ever experienced anything like this in the past?
Patient: Um like he's had colds before, but I haven't like. I haven't like you this time he kind of had the fever, which is different than you know, having a regular cold. 

Doctor: OK. And are his symptoms getting worse? 

Patient: I think so 'cause yeah, the first day he just seemed like a little dry and then yesterday is coughing and today he actually has a fever. 

Doctor: OK, and is he complaining of anything like chest pain? Or feeling like his heart's racing?
Patient: No, I don't think so. 

Doctor: No, OK. Does he have a sore throat? 

Patient: Mm I don't think so. 

Doctor: OK, and is he having any issues swallowing food or fluids?
Patient: I don't know if he's having trouble swallowing, but he doesn't seem to have a big appetite right now. 

Doctor: OK, and is he, does he have a blocked nose or runny nose?
Patient: Maybe a bit of like a look at runny nose. 

Doctor: OK, and does he have any issues with smell or taste? 

Patient: He, this morning he really seemed like he wasn't like into his breakfast and I wonder if he's losing his sense of taste a little bit. 

Doctor: OK, how about vision or hearing?
Patient: I think those are fine. 

Doctor: OK, and is he complaining of any chills or night sweats? 

Patient: No. 

Doctor: OK, any changes in his hair, nails or skin like rashes?
Patient: No, I haven't noticed anything like that. 

Doctor: Any changes in his bowel movements. Pardon?
Patient: Um sorry no changes. 

Doctor: OK, no diarrhea, no constipation, no blood in the stool? 

Patient: No 

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

Doctor: OK, any changes in his urine? 

Patient: I haven’t really been looking, but I don't think so. 

Doctor: Any dizziness or fainting spells?
Patient: No, just like fatigue. 

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

Doctor: And is he and is he an otherwise healthy child? 

Patient: Yeah, actually he hasn't decided to like a vaccine that he hasn't had to go to the DOCTOR: like ever like. I mean, he broke his arm once, but that was it. 

Doctor: OK, um so no past illnesses and I guess no hospitalizations or surgeries except for the broken arm.
Patient: Exactly, like nothing. 

Doctor: OK, and were things normal with your pregnancy with him?
Patient: Yeah totally. 

Doctor: OK um. And then how about as a newborn, any complications after birth?
Patient: No, no, like everything is things really good. 

Doctor: OK, and then did he hit all his milestones up till now?
Patient: Yeah totally. 

Doctor: OK. Any, does he have any allergies? 

Patient: Um. No, no, I don't think so. I mean like he hasn't really taken a lot of medicine, so it's hard to say, but like nothing. 

Doctor: Is he up to date with all his immunizations?
Patient: Yeah. 

Doctor: Yeah OK. And. In terms of family history, are there any lung conditions or heart conditions?
Patient: Uh no everyone is really healthy. 

Doctor: OK, and. And are there and who does he live with and where does he live?
Patient: Um he lives with just me and my husband, and he has a little sister, like this in town here. 

Doctor: OK and, is she healthy?
Patient: Yeah, I think she, yeah she's healthy. 

Doctor: OK um? Any concerns for old carpets, mold, asbestos or any environmental issues like that in the home that you're in? 

Patient: No. 

Doctor: No, OK. Has he been around any sick contacts recently?
Patient: Not, not like outside of school. I like we know for sure, not outside of school, um but he goes to school right now so. Kinda hard to say. 

Doctor: OK. 

Patient: But they haven't. They haven't like contacted us about anything. 

Doctor: OK, sure. And has he traveled anywhere recently?
Patient: No. 

Doctor: No OK. OK, well those are all the questions I had for you today. Were, was there anything that I missed that you wanted to chat about today?
Patient: I don't think so. Um, like I, I realized that I can often times like you don't really do much for kids when you know when it's just like a virus or something. But we do, I guess need to have a covid test to go back to the school, even if you know either way 'cause they want us to be able to say. It's like the other kids have had an exposure. 

Doctor: Yeah for 

Patient: yeah, like. Sorry, go ahead, 

Doctor: No go ahead.
Patient: I’m just basically wanted to see if it was bad. I mean he doesn't receive your so scared. That's kind of what makes him in like it's gonna be a little bit. 

Doctor: Right, yeah, OK, so first thing is, first we need to do a covid swab just to make sure that he either has it or it doesn't have it and those results will come back in 24 to 48 hours. Um we do suggest because his symptoms are allowed with symptoms of covid that he isolate for 14 days and that includes from his his younger sister possible. And then if the swab comes back negative, there is a chance for false negatives. But also it could be another viral illness that's going around nowadays, and if his symptoms get worse, so if he has a really high temperature, if he has any neurological symptoms, like seizures or. If he's feeling weak, dizzy if he has any fainting spells, please do take him to the ER and. And so for now I'll just wait for those covid swaps to come back. How does that sound? 

Patient: Yeah, sounds good. 

Doctor: OK great yeah, yeah no worries and. I I should have mentioned if it was just the cough or if he was just short of breath or something like that and he didn't have the fever, we would add other things like asthma to the list of things he could be worked up for, but um right now it sounds like it sounds like an infection.
Patient: OK yeah, that's good to know. 

Doctor: Alright, sounds great. Have a good day.
Patient: Yeah, I'm just bringing in my old daughter who's really been complaining about having a runny nose and has been sneezing a lot over this past over this past week. I think the symptoms maybe started three or four days ago. 

Doctor: OK, and what symptoms started first?
Patient: I think the runny nose is what, what started first. And like kind of the nasal congestion. She was telling you that she felt that there was like pressure or congestion in her nose. 

Doctor: OK, and then this, when did this sneezing start?
Patient: Surely after that probably maybe the same day or or the next day. 

Doctor: OK, does she have any coughing at all?
Patient: Yeah, so she she did start to cough actually after that so that the cough has been there for the last, for the last maybe two to three days. It's a dry cough. 

Doctor: OK, for the last two to three days. OK, is she at all, coughing up any green or yellow material or any blood at all? 

Patient: No, nothing like that. 

Doctor: OK. So, and are her symptoms constant? Or do they come and go?
Patient: They've been pretty constant, and they've gotten a little bit worse since they started. Three or four days ago, I I think now yeah, her symptoms are at her, at the worst right now. Just not feeling very well. 

Doctor: OK, and have you been in contact with anyone at home or at school? If she's going to school versus at home for the pandemic right now, but any ill contacts at all?
Patient: Well, she has been going to school. There hasn't been any Covid cases where she goes and they've been cautious, but she is going to school right now. 

Doctor: OK. Any, anything that you've tried that has helped her like any over the counter cold medications? 

Patient: Uhm, uh, no. 

Doctor: OK. Any other symptoms like fevers, chills, shortness of breath, um, anything like that?
Patient: Uh, she did feel a bit warm to touch and has looked a bit flushed in her face. Just doesn't look like herself. 

Doctor: Does she behave like herself Like is she more tired at all? More irritable, anything like that?
Patient: Yeah, she's been a, maybe a bit more, maybe a bit more tired and and a bit more irritable, but not not too bad. She, she missed school today but went yesterday. 

Doctor: OK. Any recent travel at all?
Patient: No, we've been at home. 

Doctor: Any headaches, nausea or vomiting? 

Patient: Uhm, no. 

Doctor: OK, any chest pain that she's described?
Patient: No chest pain. 

Doctor: OK. Any changes in her bowel movement, constipation, diarrhea?
Patient: No, that's been normal. 

Doctor: OK. Any urinary problems?
Patient: No, she had a urinary tract infection when she was like little but hasn't had any since. 

Doctor: OK, any issues with their sleep or appetite?
Patient: She has been a bit a bit fussy, but she's been sleeping OK. 

Doctor: OK. Uhm, has she lost any weight recently?
Patient: No, no no. She's been gaining weight well. 

Doctor: OK, any exposure to any allergens or like fumes, dust animals?
Patient: No, I can't think of anything like that. We don't have any pets at Home and she's she's been hasn't been going anywhere else. 

Doctor: OK, has she been diagnosed with any medical conditions in the past? 

Patient: No, she just said, ah, just yeah had a urinary tract infection when she was younger and that's about it. 

Doctor: OK. Any allergies to medications that you know of?
Patient: Not that I'm aware of. 

Doctor: Is she on any medications?
Patient: No. 

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

Patient: No. 

Doctor: OK, any family history of any lung or heart conditions or anything else?
Patient: Uhm, I I have high cholesterol but, and ah, and I'm taking a, a medication for it, but no, nothing else. 

Doctor: OK, does, has she lost a sense of taste or smell at all?
Patient: No, she hasn't said any anything like that, just the nasal congestion. 

Doctor: OK. Did you feel any pressure in around her face at all? 

Patient: Uh, yeah, well yeah, I think so. She doesn't say, well, no pain but does feel like a bit of pressure with the congestion, I think. 

Doctor: OK, uhm any issues developmentally as she was growing up like to meet are all our milestones at an appropriate age?
Patient: She did yeah, she has met she was walking at the appropriate times and able to talk and does work really well in school and is social with with her classmates and peers. 

Doctor: So no, no issues or no complaints at all? 

Patient: No, there hasn't been any concerns. I feel that she's been developing normally. 

Doctor: OK. In our immunizations up to date?
Patient: They are, yeah. 

Doctor: OK and were there any complications at all during your pregnancy with her or after the pregnancy?
Patient: No, it was a vaginal delivery at 38 weeks and she was a normal weight. We were able to go home right away with with no complications. So yeah, things were good. 

Doctor: OK, and currently who does she live with? 

Patient: So myself and my, and my husband. 

Doctor: OK, and does anyone smoke in the house?
Patient: Uhm, my husband does smoke, but uh, I mean he smokes outside usually and and he smokes, I don't know, maybe a half a pack a day. 

Doctor: And I think that's all all the questions I have. Do you have any questions or concerns? 

Patient: Nothing else right now. 

Doctor: OK. So yeah, based on her symptoms, she does seem to have some just a cold like symptoms, viral symptoms. And it's been, it's been you said three or four days in total, right?
Patient: Yeah yeah. 

Doctor: Yeah, and so most likely it's just caused by a viral infection like common cold perhaps, it she doesn't have any worrying signs of any systemic things going on right now, so and no signs of like a bacterial infection that I would be concerned about that I would give antibiotics for right now. But definitely if her symptoms get worse at home and if she starts having any kind of shortness of breath, increased coughing with producing, more yellow or green material and if she gets more feverish, so will also do a physical exam and take her temperature today as well. But yeah, some of these things you just look out for, but yeah, so that that we'll do the physical examination and go from there.
Patient: Well, I thought I should start by saying I was recently hospitalised for pneumonia. I left five days ago, but as soon as I left that evening, I started coughing again and now I have all the same symptoms. I have a cough, I'm feeling short of breath and I have a feeling like I have a fever. 

Doctor: OK, and before you were discharged the day, can you let me know what you had and what kind of things were you treated with? 

Patient: I was treated with some antibiotics, I don't know exactly which ones. They said I had some sort of bacterial pneumonia. 

Doctor: OK. But then it got resolved and they sent you home?
Patient: Yeah, that's right. 

Doctor: So are your symptoms similar to when you got admitted?
Patient: They are similar, but I feel like they are also worse now. 

Doctor: OK, worse, OK, so you're having a cough, shortness of breath and fever, and did that all start together? Or did one come before another?
Patient: Um, so the cough came first, then the shortness of breath, and then the fever. 

Doctor: OK, and the cough, how would you describe the cough? 

Patient: Um, it's harsh, it's persistent. 

Doctor: Are you producing any sputum?