jshargo/medical-interview-conversations huggingface dataset:
Patient: Um, uh no. 

Doctor: No, OK. Um do you currently smoke? 

Patient: Uh I do, yes. I've been trying to quit, I um I smoke about a pack of cigarettes per day now. I used to smoke like 2 packs per day. 

Doctor: OK, well it's it's good that you've cut down, um if you need any additional help cutting down we have resources that we can refer you to.
Patient: Yeah, that would be great. 

Doctor: Yeah, um how much, for how long have you been smoking? Like how many years?
Patient: Uh well, I started when I was a teenager, so probably like 35. 

Doctor: OK. Um and do you do any marijuana? 

Patient: Uh no. 

Doctor: No, OK, OK, um how about alcohol? Do you drink alcohol?
Patient: Yeah, a few beers on the weekend. 

Doctor: OK. Um and then where do you live currently?
Patient: I live in an apartment by myself. 

Doctor: OK. Um and any reasons to think that there are any old carpets, mold, or um asbestos or anything like that that could be exacerbating your symptoms?
Patient: Uh I mean I do have a carpet in the bedroom so, but I mean that that's the only carpet in the apartment. 

Doctor: OK. Um and do you live with anyone?
Patient: No, it's it's just me and my dog. 

Doctor: OK. Uh have you, have you been around any sick contacts recently?
Patient: Um maybe, I mean I I usually will see uh, a couple of friends, we'll meet up to grab some coffee in the morning in the morning um but I feel like they have been uh OK. 

Doctor: Yeah OK, how about um travel, have you traveled anywhere recently?
Patient: No. 

Doctor: No, OK. OK, well I think those were all the questions that I had for you. Did you have any questions or concerns or anything that I missed that you wanted to discuss?
Patient: Um no, I just wanted to, um, yeah, come in because it's been really difficult to breathe. 

Doctor: Yeah, so OK, well we'll do a physical exam on you um to try to understand um how bad your COPD exacerbation is. Um we'll also try to get an um oxygen saturation on you, and we do want that reading
Patient: Yeah, so I've been feeling just really down recently in the last week. I started off by having this sore throat which started around 5 days ago and then I also noticed I've been getting some chills over the last few day. And on top of all of that, within the last three to four days I've been getting muscle aches all over my body. 

Doctor: OK, alright so the sore throat started 5 days ago and then the fever started when? 

Patient: So the fever. I think I haven't measured it, but I started having chills like 3 days ago. 

Doctor: Three days ago, OK, and the muscle aches started two days ago?
Patient: I would say 3 days ago as well. 

Doctor: Three days ago, OK. OK, are you having any trouble swallowing foods or fluids?
Patient: A little bit with solids with a sore throat but liquids, I'm doing OK right now. 

Doctor: OK. And is it hard for you to like, are you having issues vocalising at all?
Patient: No, I think my voice has been the same. It's just when I'm not talking, especially if I'm swallowing my own like spit, it still hurts sometimes, but mainly with solid food. 

Doctor: OK, OK and then, are you having any issues with taste or smell? 

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

Doctor: OK, how about hearing or vision?
Patient: No, no changes. 

Doctor: Any weight loss over the past few weeks? 

Patient: No, I probably have gained weight. 

Doctor: OK, any fatigue or exhaustion?
Patient: Now that you mention it, I do feel pretty tired over the last few days, I don't know if it's just because of my muscles aching all the time, or I don't know. I have definitely felt very tired. 

Doctor: OK, how about changes in your hair, nails or skin like rashes? 

Patient: No, nothing like that. 

Doctor: Do you have a cough at all?
Patient: No, I haven't really noticed the cough. 

Doctor: How about shortness of breath or wheezing?
Patient: No, no shortness of breath or wheezing. 

Doctor: OK chest pain or you feeling like your heart's racing? 

Patient: No. 

Doctor: No, and how about dizziness or fainting spells?
Patient: Uh, no, I haven't had any of those. 

Doctor: OK, how about changes to your bowel movements? 

Patient: No, I don't think so. I go regularly once a day and I haven't noticed any watery stool or diarrhea. 

Doctor: OK, that's good. Any changes in your appetite?
Patient: Yeah, with a sore throat I tend to like eat softer foods right now. I can't really, I don't really feel like eating. 

Doctor: Yeah, OK. How about nausea or vomiting?
Patient: No, no, nothing like that. 

Doctor: OK, OK, and any issues with joint pain? You said your muscle aches, but how about joints?
Patient: Um, no, I don't think it's specifically my joints. I think more so I would say like around in my thighs. Then I would say just my upper arms hurt a lot. And even, uh, my upper back area hurts a lot as well, so it's kind of just everywhere. But those are some areas that hurt the most. 

Doctor: OK, OK, are you otherwise healthy? 

Patient: Um, yeah, I do have a couple of things on my list. I do have high blood pressure. I have diabetes and other than that, I also have like high cholesterol. 

Doctor: OK.
Patient: Yeah, that's just some of the things that I've been diagnosed with. 

Doctor: Yeah, OK, and do you take medication for any of these things?
Patient: Yeah, so I take for the blood pressure, I take this medication called the Ramipril. 

Doctor: OK yeah. 

Patient: And then for diabetes I'm taking Metformin. And then for the cholesterol I'm taking this medication called Crestor, yeah. Yeah, but other than that, just like vitamin D and multi vitamins. Those are some of the medications that I'm taking. 

Doctor: Sure yeah, are you up to date with all your immunizations?
Patient: Yup. 

Doctor: OK, do you know if you got a vaccine called Shingrix for shingles and Pneumovax for pneumococcal infections?
Patient: Yeah, I actually think I got them just this past season. Uh, with all this COVID going on, I just wanted to make sure I got all those vaccines as well. So yeah, I recently just got them. 

Doctor: OK, good. And and how about any allergies? 

Patient: Uh, no, I don't have any allergies. 

Doctor: OK, how about family history of lung conditions or heart conditions?
Patient: Uhm, no lung conditions and uhh heart conditions, both my mom and dad suffered from like high blood pressure. My dad also had a heart attack when in his 60s. Now there is some heart conditions that run in the family. 

Doctor: OK, OK. And then any cancers in the family? 

Patient: Uhm, m son actually got diagnosed with colorectal cancer just a few years ago. 

Doctor: Oh, I'm sorry to hear that.
Patient: He's doing OK though. Like it was pretty scary at the time. 

Doctor: How old was he when he was diagnosed? 

Patient: I think he was, yeah in his forties, 46. 

Doctor: OK, well he's yeah, that's young. Have you had a colonoscopy?
Patient: Yeah I had it done. Everything came back normal so yeah, I'm not sure where he got it from. 

Doctor: OK. Have you had any sick contacts recently? 

Patient: No, no sick contacts that I know of. I've been mainly in my house. I do go outside for groceries and some things like that, but other than that I'm retired. I don't really go out too much. 

Doctor: Yeah, OK, and you said you're retired. Do you live alone? Do you live with anyone?
Patient: No, yeah, I live alone now. And I live in London in an apartment 

Doctor: OK, any old carpets? Mold, dust, asbestos? 

Patient: No, nothing like that. It's a pretty safe building. 

Doctor: OK, good, and do you smoke?
Patient: I used to. I used to smoke, probably in my 20s to late 40s, but then I quit. 

Doctor: OK, good, good for you. How much did you smoke before you quit?
Patient: Probably one to two packs a day, I would say. 

Doctor: OK, that's good, that's good that you quit. Do you drink any alcohol?
Patient: Uhm, I just stick to some red wine, maybe a couple times a week. 

Doctor: OK, couple times a week so two to three times?
Patient: Yeah, I would say two to three times and, uh, I probably go through maybe 1 bottle every two weeks. 

Doctor: OK, OK. And then any marijuana? 

Patient: No, no, I've never had any marijuana or any recreational drugs, no, nothing else. 

Doctor: OK, good, well those were all the questions that I had for you today. Did you have any questions of your own for me?
Patient: Yeah, uh, with all this COVID and the pandemic going on, I don't know, I like, I've been mainly at my house, but like I said I do go to do my own groceries. Of course I wear a mask, but I don't know if I might have caught COVID,  so that's something I was worried about. 

Doctor: Yeah, for sure. I think just because your symptoms do overlap with those of COVID, we will be doing a COVID swab today and you should hear back about your results in 24 to 48 hours. But you should still self-isolate for 14 days because you do have similar symptoms and if it's not COVID, it's probably another viral illness that's going around these days and for that you don't need any medication, like prescribed medications, but just keep an eye on that, on your symptoms. Stay hydrated, eat well. If you need to lower your feve, you can use Tylenol. And if your symptoms worsen or you start getting neurological symptoms like weakness or seizures or anything like that, you should seek help from the ER. How does that sound? 

Patient: Sounds good. I just had another quick question. I did get the shingles and the pneumococcal vaccine back then but I didn't get the flu vaccine, like should I get it? Is it recommended? 

Doctor: Yes, it's definitely recommended. So we won't give you the vaccine right now because you have symptoms. But once you are healthy again, you should definitely get the get the flu vaccine and you should get it once a year.
Patient: OK, I just never took those vaccines, but I'll do that from now on. 

Doctor: Yeah, it's a good idea, and even if you get the flu, your symptoms won't be as severe if you have the vaccine, so it's definitely something to consider.
Patient: I've had, I've had this cough for the past two weeks. I was just worried about it. 

Doctor: OK, past two weeks? Have, is it a dry cough or is it? Are you bringing up phlegm? 

Patient: I'm it's mostly dry, but just sometimes there's like a little bit, I guess, yeah, the flat little bit of phlegm. 

Doctor: OK, what colour is the phlegm?
Patient: It's like whitish, sometimes it's clear. 

Doctor: OK, is it ever green or bloody? 

Patient: No. 

Doctor: No, OK. Do you have any shortness of breath?
Patient: Sometimes, yeah. 

Doctor: Sometimes, OK. With the cough or outside the cough as well? 

Patient: With the cough. 

Doctor: Any chest pain?
Patient: Um, no not initially, but like since the past few days, especially after I've like coughed a lot, it just kind of hurts me a little bit. 

Doctor: OK, OK, any, do you ever feel so it just hurts after coughing. 

Patient: Yeah. 

Doctor: So is it kind of like a sharp pain or like a dull achy pain?
Patient: I don't know, it just feels like like my muscles are hurting like I'm just like coughing so much it's just.. 

Doctor: OK.
Patient: Dull pain. In the middle of my chest then it goes away. 

Doctor: OK, OK, and do you ever feel like your heart's racing? 

Patient: No, no. 

Doctor: OK. And have you noticed any swelling in your legs, arms, or abdomen?
Patient: No. 

Doctor: No, OK. Any headaches? 

Patient: No. 

Doctor: Confusion or memory loss?
Patient: No. 

Doctor: Have you noticed any fevers?
Patient: No. 

Doctor: Any weight loss? 

Patient: No. 

Doctor: No. Excessive fatigue or tiredness?
Patient: Uh, no, not really. I've haven't been fatigued. I think I'm I'm fine and feel normal. Other than the cough of course. 

Doctor: OK, sure. Any rashes? 

Patient: No. 

Doctor: How about changes in your vision or hearing?
Patient: No, no concerns there. 

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

Doctor: No, a sore throat? 

Patient: Uhm, no. 

Doctor: OK, changes to your smell or taste?
Patient: No. 

Doctor: No. Have your bowel movements been normal?
Patient: Yeah. 

Doctor: Yeah. How about urine? 

Patient: Yep, they've been, no concerns. 

Doctor: Any nausea or vomiting?
Patient: Uhm, no. 

Doctor: No. OK. Have you ever experienced anything like this in the past? 

Patient: I kind of had this about, I don't know three or four years ago. I just had this cough, but then it kind of went away on its own in about a week. But now it's been like 2 weeks so I don't know what's happening. If it's something I just want to make sure it's nothing serious. 

Doctor: Yeah, for sure. When you had this in the past, were you ever done given a diagnosis?
Patient: No, I didn't go to see a doctor. I just kind of stay at home. 

Doctor: OK.
Patient: I thought it was just like a mild infection or something. 

Doctor: Mhmm. Have you tried anything for the cough this time around?
Patient: I had some like lozenges and I haven't, and those have been helping me. 

Doctor: OK.
Patient: Yeah.  OK, good. If you were to describe your cough, is it barky, harsh, muffled, like what what would you say the sound of it is?  Uhm, I don't know. It's kind of like, like a normal cough, you know, like when you're clearing your throat or something, or when you're like when something gets stuck in your throat, just like like a normal cough. I don't think it's barky. 

Doctor: OK OK, are you otherwise healthy? Do you have any longstanding medical conditions?
Patient: No, I don't. I don't. 

Doctor: No, OK. Have you had any hospitalizations or surgeries in the past?
Patient: I have my wisdom teeth removed. 

Doctor: OK, when was that?
Patient: About 8-9 years ago, when I was 17 years of 16 years old, ah, 17 years old. 

Doctor: OK, OK, and are you on any medications? 

Patient: I'm just taking this birth control pill. 

Doctor: OK, which one?
Patient: Uhm, yeah, it's called, uhm, I forget the name. 

Doctor: Ah, no worries. And when did you start it?
Patient: I started three years ago. 

Doctor: Three years ago, OK. And no side effects, no issues with it? 

Patient: No, no, it's all good. 

Doctor: And are you up to date with all your immunizations?
Patient: Uh, yeah, I think so. 

Doctor: OK. Did you get the flu shot this year?
Patient: No I didn't. 

Doctor: No. OK yeah, we recommend getting it out once a year. Just yeah, for your safety and for everyone else's and even if you get the flu, maybe your symptoms won't be as severe and then, do you have any allergies?
Patient: Uh, I don't, no. 

Doctor: No, OK. Any family history of lung conditions or heart conditions? 

Patient: Uhm, My mom has diabetes. 

Doctor: OK.
Patient: And my dad has high blood pressure. 

Doctor: OK. Uhm, and then any cancers in the family? 

Patient: No. 

Doctor: No, OK. And have you been in contact with any any sick people recently?
Patient: No, I've just been staying at home. 

Doctor: OK. Uhm, any travel recently? 

Patient: No. 

Doctor: No, OK. How about umm smoking, do you smoke?
Patient: Uhm, once in awhile. 

Doctor: OK, what's once in awhile? 

Patient: Maybe when I'm out with my friends I might sometimes, have a cigarette or two. I used to smoke a lot more, but I'm trying to cut it down. 

Doctor: OK. How long have you been smoking for?
Patient: I started smoking in high school, so when I was 18 years old. 

Doctor: Mhmm. 

Patient: And at that time I would have about 6 cigarettes a day, but then I like I, I knew that smoking wasn't good for me, so I'm trying to cut it down, but my friends still smoke, so sometimes when I go out with them, I'll just have a cigarette or two, maybe like once a month, I would say. 

Doctor: Once a month, OK. OK. And then any other recreational drugs like marijuana or cocaine or anything like that?
Patient: I tried a few in high school but not since then. I had, yeah, I had cocaine once. 

Doctor: OK, and do you drink alcohol? 

Patient: Yeah I have a glass at night. 

Doctor: OK. Glass of wine or beer?
Patient: Glass of wine. 

Doctor: And, and where do you live right now? 

Patient: Uh, I live, I live in an apartment with my boyfriend, about 20 minutes from here. 

Doctor: OK. Any old carpets at home? Dust, mold, asbestos, anything that would be triggering your cough?
Patient: I don't know. I have not really had a problem but been here at this place for about a year and a half. 

Doctor: OK.
Patient: It is an old building but it's been OK so far. No recent changes. 

Doctor: OK, OK, good. So those were all the questions that I had for you today. Did you have any questions of your own? 

Patient: No, I was just worried this cough isn't, isn't serious, right? You don't think I have Covid? 

Doctor: So because your symptoms do overlap with that of Covid, we're going to get a swab on you done and you should get those results in about 24 to 48 hours. And if it's positive, public health will be in touch umm, to do some contact tracing. In the meantime, because you have a cough, it is recommended that you isolate for 14 days. And if it's not Covid, but it's probably something like acute bronchitis or some other viral infection that's going around at this time of year, so for that we can, you can just treat it with like supportive treatments. You know, like staying hydrated, uhm, good nutrition, good sleep and just keep an eye on your symptoms. If they become worse or really severe like you're having neurological symptoms and just seek help from the ER.
Patient: For sure. Thank you. 

Doctor: Yeah, take care.
Patient: Yeah, I woke up this morning and I was just feeling suddenly feeling very short of breath and I just wasn't sure what was going on, so I thought I would come in. 

Doctor: OK, this this morning suddenly feeling short of breath. OK, and this cough was not also something that happens suddenly this morning?
Patient: Yeah. 

Doctor: OK, have you ever had anything like this before?
Patient: Um no not I mean if I I get a call from time to time when I get sick, but I've never really felt short of breath. 

Doctor: OK, is this cough a dry cough or are you bringing up any sputum? 

Patient: Um it's a dry cough. 

Doctor: OK. OK, have you had any fevers?
Patient: Um yeah, I checked it this morning. I was like it was kind of mild, so 37.4 I think. 

Doctor: OK. That was just this morning?
Patient: Yeah. 

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

Doctor: OK Um. Have you felt at all like you're going to faint?
Patient: No, no. Although I I should let you know and maybe I don't know if it's related um, but I had a seizure last night. And, I was fine after and then I went to bed. Um I don't know if that's related, but I thought I should let you know. I do have a seizure disorder I have epilepsy. 

Doctor: OK OK, thank you for sharing that with me. Have you ever had any issues like this following seizures in the past?
Patient: No, I usually don't get seizures very often. Um I kind of forgot to take my med. I think that might have yeah. 

Doctor: Alright, OK. No worries um. OK, is there anything, in terms of this shortness of breath and this cough, is there anything that makes it feel worse? 

Patient: Um I. 

Doctor: In any position?
Patient: Yeah, I. I mean, I haven't really been in a lot of positions like it, just started three hours ago or so, so I haven't really. 

Doctor: That's a hard question.
Patient: Yeah I haven’t done much since then. 

Doctor: Have you had any nausea or vomiting? 

Patient: No. 

Doctor: Any belly pain
Patient: Uh no. 

Doctor: OK, any diarrhea?
Patient: Uh no, no I don't. 

Doctor: OK, have you been in contact with anyone that's been sick lately?
Patient: Uh no, I haven't. 

Doctor: OK, have you traveled anywhere?
Patient: No, I've just been at home. 

Doctor: OK, anything else you wanted to tell me that I didn't ask you about?
Patient: Um no no. I. 

Doctor: Have lost any of your sense of taste or smell?
Patient: No, I haven't. 

Doctor: Have you had any sore throat?
Patient: No. 

Doctor: Runny nose? 

Patient: No. 

Doctor: OK, uhm. So in terms of your overall health you said that you have epilepsy. Any other chronic conditions that you've been diagnosed with?
Patient: No, that's it. 

Doctor: You said you take a medication. What medication or medications are you currently taking? 

Patient: Um I'm taking Keppra. 

Doctor: OK. And normally, are you having any difficulty remembering taking it, or was it just kind of a brain fart?
Patient: No, it just kind of happened, it was, it was my daughter's birthday and we kind of just, I usually sort of have it with dinner time, but we did things a little bit differently and had like a celebration earlier on and so I completely forgot because I didn't have dinner later. 

Doctor: Oh yeah, that makes sense. It happens for sure. K, do you have any allergies?
Patient: No. 

Doctor: Do you have any family history, any any diseases that run in your family? 

Patient: Yeah, epilepsy runs in the family. My mom had it. 

Doctor: OK. And in terms of your lifestyle, you said that you have a daughter. So do you live with your family? Do you live with your daughter?
Patient: Yeah, yeah, I live with my daughter and my wife. 

Doctor: How old is your daughter? 

Patient: Pardon me. 

Doctor: How old is your daughter?
Patient: She's 16 years old. 

Doctor: Oh wow sweet 16 

Patient: Yeah. 

Doctor: Right, OK, so are you currently working?
Patient: I I am yeah. 

Doctor: What do you do for work?
Patient: I’m an accountant. 

Doctor: OK cool, are you working from home or still working out?
Patient: I’m working from home yeah. 

Doctor: Nice and thats sounds great. OK, and uh. Do you smoke? 

Patient: I don’t, no. 

Doctor: Do you drink alcohol?
Patient: On the weekends, one or two class says a wine. 

Doctor: OK. And did you use any other substances? 

Patient: No, I don't. 

Doctor: OK, I think that about covers my questions for now. So I'm gonna take everything we talked about. I'm going to go over it with the  was working today and now we'll come back shortly and talk to you about the next steps if there's any tests we want to do or how we want to move forward with this so.
Patient: Yeah I have my 2 year old daughter here with me. I don't know what's happening with her, but she seems to be getting really sick. So I'll give you that kind of timeline. So two days ago she was feeling hot and her fever hasn't broken. We've been giving her Tylenol, but she still seems to have a fever. The last time I checked her temperature was 38.5 and she seems to have issues swallowing food. She's drooling and she seems short of breath. 

Doctor: OK, and when did she start getting short of breath?
Patient: That started yesterday. 

Doctor: Has her fever been getting worse or has it stayed around the same?
Patient: So I just checked the first day. It was like 38, 38.5. 

Doctor: OK, and when did the trouble swallowing start? 

Patient: That started yesterday as well. 

Doctor: OK, and has it been getting worse at all?
Patient: I think so. Now she's barely even drinking fluids. 

Doctor: OK, so it's both solids and fluids. OK, have you noticed any swelling in her neck area or redness or swelling in her throat? 

Patient: Yeah, I've noticed some of that. 

Doctor: OK, you see a lot of redness in there?
Patient: I see, yeah, I see quite a bit of redness in there. 

Doctor: And has she been drooling at all?
Patient: Yeah, a little bit today. 

Doctor: OK. Alright, any coughing?
Patient: Not hat I noticed. 

Doctor: No coughing. OK, and do you notice that she's increasingly fatigued, or just not herself? Or is she irritable? 

Patient: Yeah, she's very irritable. 

Doctor: OK, do you notice any kind of paleness or blueness in her skin? Anything like that?
Patient: She's not blue. She's looking a little pale though. 

Doctor: OK, and sorry, when did the shortness of breath start? Is it getting worse at all?
Patient: Shortness of breath started yesterday as well, moreso today which is why I brought her in. 

Doctor: OK, any other symptoms like nausea or vomiting or diarrhea or constipation? 

Patient: Um, no nothing like that. 

Doctor: OK, and how's her appetite and sleep?
Patient: It's been, it's been not great. She's not eating well, I guess because she's in a lo of pain and she didn't sleep well for the past two nights either. 

Doctor: OK uhm, has she had any recent infections at all, like a cold or anything like that? 

Patient: She did have a cough 2 weeks ago, yeah. 

Doctor: OK, and did it just go away on it's own or did she need any antibiotics or any other medications?
Patient: I think no, she didn't need any antibiotics. It kind of went away on its own. 

Doctor: OK, any sick contacts within the last week or two weeks?
Patient: I mean, she goes to daycare so she might have picked something up from there. Yeah, last I checked, no one at daycare was sick like right now. But three weeks ago there was someone who was sick. 

Doctor: OK, any past medical history? 

Patient: Um, no, she's been pretty healthy otherwis. 

Doctor: Any issues during pregnancy or after birth at all?
Patient: No. 

Doctor: Are her immunizations are up to date?
Patient: Um, yes, she didn't get the H. flu vaccine though. 

Doctor: OK, OK, any hospitalizations or anything like that in the past?
Patient: Um, no. 

Doctor: OK, and any family history of any medical conditions?
Patient: Um, no. 

Doctor: And currently, who does she live with at home? 

Patient: I'm she lives with myself as well as her older brother. 

Doctor: OK, alright, so yeah those are all the questions that I have.
Patient: Do you think this is like an urgent matter? 

Doctor: Because she has not been vaccinated with the H.flu vaccine and some of the symptoms that she's displaying like the drooling and trouble swallowing and now especially the shortness of breath are very concerning, I really think we should go to the Emergency Department. I'll give them a call to le them know that you're coming. Yeah, and what they will most likely do there is get a test done to see if she has H. flu and also they might do perhaps like a COVID swab as well. They might get an X Ray of her neck as well to see it. So what I think might be going on is with H. flu you can get swelling of your epiglottis and it can kind of obstruct your throat. It's very urgent matter, so that's why we will make sure you get to the ER and, uh, you know, we'll go from there. Does that sound? I know it may be very worrying right now. Do you have any questions at all? 

Patient: Yeah, do you know how long will she have to be in the hospital? 

Doctor: So right now we just need to make sure that she's stable, like all her vitals. You know when she gets to the ER, they can give her the appropriate antibiotics as well. And based on that, we need to make sure her breathing get stabilized, so she might be in the ER for one day. If they think she needs to be on IV antibiotics in the hospital, she might be in the hospital for a few more days or even a week. So it's really hard to say right now, but our priority right now is to make sure she's stabilized in the ER.
Patient: OK. OK yeah, that sounds good. 

Doctor: So I'll give them a call right now, and, uh, you can head over to the ER. Or if you need a ride, we can arrange to do that for you too. 

Patient: OK, great, that sounds great. 

Doctor: Thank you.
Patient: Yeah, so for the past two days I I've I've noticed that I can't smell things as well, as I used to be able to smell them and I seem to have lost my sense of taste as well. And I have this mild dry cough. I'm just worried it's covid. 

Doctor: OK. You said for a couple days?
Patient: Yes, for two days. 

Doctor: OK, have you ever had anything like this before?
Patient: No, no, nothing like this. 

Doctor: OK, when you say you feel like you've lost sense of taste and smell, is it totally gone or do you taste a little bit? Or how? How is that working for you?
Patient: The smell isn't totally gone I can still smell something if it smells really really bad and and then and then I can taste really, really salty foods, but I can taste normal things like I can't taste of banana. 

Doctor: OK, is that been pretty consistent throughout the last couple of days or is it on and off? 

Patient: It's been pretty consistent, yeah. 

Doctor: OK. And did this dry cough that start at the same time?
Patient: Yes. 

Doctor: And when you say sorry, you said mild cough, and I my next question was do you feel like it's a dry cough or you producing any sputum? Any blood? Or is it to not, not bringing up anything?
Patient: It's dry. 

Doctor: OK, has that gotten worse over the last couple of days? 

Patient: The dry cough? Um it's been pretty consistent as well. 

Doctor: OK is there, have you done anything to try to make it better? Have you taken any over the counter medications or?
Patient: No, I haven't tried anything. 

Doctor: OK, OK. Have you had, in addition to these symptoms, have you had any fevers?
Patient: Fevers, no fevers. 

Doctor: OK, any difficulty breathing?
Patient: No. 

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

Doctor: OK, any sore throat? 

Patient: No. 

Doctor: OK, any chills or night sweats?
Patient: No. 

Doctor: OK, any muscle ache or general weakness?
Patient: Uh no. 

Doctor: OK, so generally it seems like you're pretty well other than this loss of taste slash smell and the dry cough that correct, 

Patient: Yes. 

Doctor: OK and then recently have you been in contact with anyone that's been sick?
Patient: Um no not that I can remember or yeah, not that I can remember. 

Doctor: OK, have you traveled anywhere? 

Patient: Um I went hiking with my partner two weeks ago. I guess there were some people who kind of brushed by us, but other than that I don't see where else I could have gotten this from. 

Doctor: OK, was that hiking somewhere close by?
Patient: Yeah, it was like half an hour from where we are. 

Doctor: OK. Are your immunizations up to date? 

Patient: Yes. 

Doctor: OK, and can you think of any for this dry cough, just a circle back to that. Can you think of anything that triggers it? It's called the cold or being around certain things like cats or dogs or any other environmental things?
Patient: No. 

Doctor: OK. Have you had any chest pain? Thats the other thing . I'm not sure if I asked you . 

Patient: No no chest pain. 

Doctor: OK. And in terms of your general health, do you? Do you have any chronic conditions that you live with?
Patient: Um no no. 

Doctor: Do you take any medications? 

Patient: No. 

Doctor: OK, have you ever had any surgery or been hospitalized for another reason?
Patient: Um no. 

Doctor: Do you have any allergies?
Patient: No allergies. 

Doctor: Do you have any family history of respiratory problems, cancers or heart problems?
Patient: No, nothing like that. 

Doctor: OK. And just in terms of free lifestyle, so do you live with family? 

Patient: Um no. 

Doctor: OK, do you read along with a partner or roommate?
Patient: I live with my parents and my younger sibling. 

Doctor: OK. And is that in town here?
Patient: Yes, yeah. 

Doctor: OK. And in general, do you eat a healthy diet? Do you exercise?
Patient: Yeah, I think so. 

Doctor: Do you smoke? 

Patient: Uh no. 

Doctor: OK, do you drink alcohol?
Patient: Uh I I have drank alcohol before but not not regularly. 

Doctor: OK um. And I do use marijuana?
Patient: Um I have taken edibles before but also not very regularly. 

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

Doctor: OK, and are you currently in high school? 

Patient: Uh yes, I am in my last year of high school. 

Doctor: OK, and how is that going?
Patient: Pretty good, yeah, we're doing things online now. 

Doctor: So you haven't really been out of the house? 

Patient: No. 

Doctor: OK. OK. Uhm I think that's all my questions for now. Uh I definitely like to get you a covid test just because your symptoms are consistent with some common covid symptoms. So basically that means that we would do a swab. It might not come back for a day or two. You definitely have to self isolate between now and when you get the results back, potentially even if it's negative, longer, if you're still having symptoms.
Patient: Yeah. 

Doctor: Otherwise, there probably. There might be a couple other tests we want to do. We might have more questions when we come back, we'll go over this with the  that I'm working with today, but just wanted to give you a heads up of what to expect next. Did you have anything else you wanted to tell me that I didn't ask you about or any questions?
Patient: No, uh thank you so much. 

Doctor: OK, well thanks for coming in today. Will definitely get you taken care of shortly. 

Patient: Thank you. 

Doctor: K thanks.
Patient: I I've had this cough that's been ongoing and and getting worse, and and now I've been having this like sharp pain in my in my chest. 

Doctor: OK, and when did the cough first start?
Patient: So yeah, like the cough started, uh, started maybe a couple of weeks ago. 

Doctor: A couple weeks ago, OK, and has it gotten worse since then, or has it stayed about the same? 

Patient: Uh it, it got worse initially, but it's been about the, uh, well, actually yeah, it's been getting worse 'cause now I've I've started to notice blood in the sputum that wasn't there at first. 

Doctor: OK, and when did you first notice that?
Patient: So I, I first saw some blood, uhm, two days ago. It was a really small amount so I didn't worry too much, but I I brought up blood yesterday and again this morning. It's been just about enough to cover a tissue, so it's not a lot of blood each time, but it's pretty red. 

Doctor: OK, and before that were you getting any production throughout your coughs for the last few weeks, like were you producing any sputum?
Patient: Uh, no. 

Doctor: No, OK. Can you just describe your cough currently? Is it more of a wet cough or dry cough?
Patient: Uh it, yeah, it's it's dry mostly with the exception of bringing up some of the blood. 

Doctor: And is the blood just in like sputum that you're bringing up? Or are you coughing up blood into the tissue, for example?
Patient: Blood is, I'm coughing that up into the tissue. 

Doctor: OK, and do you remember 2 weeks ago prior to that, were there any factors that might have caused this, like for example, did you travel anywhere or see or was in contact with anyone that was sick?
Patient: No I haven't uh, traveled anywhere. I have been doing volunteering and and things at the homeless shelter here in in town. It's been really cold out. 

Doctor: OK, uh, and how long have you been volunteering there? 

Patient: Uh, I started this winter, so the last three, three or four months. 

Doctor: OK, and were you in contact with anyone there that was sick or was having similar symptoms at all?
Patient: There are certainly some people around that that had some that would have a cough, or were not feeling very well but, uh, and sometimes I would see people who would even have a hospital gown on, that that that uh came from the hospital. So yeah, there were definitely some people who weren't feeling well. 

Doctor: OK, and do you know if anyone at the homeless shelter or anywhere else around your surrounding has had tuberculosis?
Patient: No, not that I'm aware of. I haven't heard of that. 

Doctor: OK, are you having any other symptoms at all besides the the coughing and the blood, like coughing up blood as well?
Patient: Yeah, I've been uh, starting to get like this sharp chest pain as well. I kind of feel it on the left sides and in center I guess kinda more so. 

Doctor: OK and your chest pain, when did that start? 

Patient: So, uh, this started, yeah, 'bout a few days ago as well. It's been within the last week. 

Doctor: OK, and uh, would you describe it as, so you said it's kind of a sharp pain, does it move around anywhere?
Patient: No, the pain I feel it about in the same spot each time. 

Doctor: OK, and are you feeling the pain when you're coughing or is it when you're exerting yourself, like when do you feel the pain, and how long does it last?
Patient: I, yeah, I will feel it when I cough. I also feel it uh, if I'm maybe moving around as well. Like changing positions or things like that. It hurts for a few minutes and then it it will kind of settle down. If if I'm, if I stay stationary and sort of lean forward a little bit it will it will start to feel better. 

Doctor: Sort of feels better? OK, and besides, besides like leaning forward, has anything helped reduce that pain at all?
Patient: Yeah, well if I lie flat, uhm it, it's uh, or sorry. No actually, the pain gets worse if I I lie flat or if I'm if I'm taking a deep breath in. But really, the only thing that helps the pain is if I try to lean forward when I'm sitting down. 

Doctor: OK, I see, and do you have any pain when breathing in or out?
Patient: I do, yeah it it gets worse if I if I'm taking a deep breath in, and even more so after I after I cough, if I'm trying to catch my breath, I'll feel it then too. 

Doctor: OK, and uhm, other than these symptoms, do you have any kind of shortness of breath? Do you have any dizziness or increased sweating, any of those symptoms? 

Patient: I have been sweating at night, but, uh, yeah that's it. 

Doctor: And how about any fevers or chills?
Patient: I I have felt a bit hot. That's more so yeah, maybe when I've been having night sweats, but I feel OK now. 

Doctor: OK, and when you say night sweats, are your sheets and blankets like soaked your pillows? 

Patient: Yeah, there there have been a few few nights for sure, but it doesn't happen every night. But over these last several months, it's been weird, I've woken up soaked. 

Doctor: OK, uh, do you have any other symptoms like a headache or nausea, vomiting?
Patient: No. 

Doctor: Have you measured a temperature at all? 

Patient: Uhm no I haven't. 

Doctor: OK, we can do that today. Do you have any other symptoms like feeling like pounding your chest, racing heart, anything like that?
Patient: No, nothing like that. 

Doctor: Have you noticed any swelling in your extremities, like your legs and hands? 

Patient: No. 

Doctor: OK, and do you have any issues with your bowel movements? Any Constipation or diarrhea?
Patient: No. 

Doctor: OK, any issues with your sleep and appetite? 

Patient: Uh, no. Sleep's been OK, and I've been eating well, but I have uhm, lost some weight and and I've been more fatigued over the last couple months. 

Doctor: OK. Before the two weeks or a couple of weeks that you had this, were you sick at all recently? Like with a cold or any flu like symptoms?
Patient: No, I I uh, I guess I've been fatigued over the last couple of months, but I haven't had any flu like symptoms. 

Doctor: OK, and do you have any exposure to dust, fumes, animals anywhere in your surrounding? 

Patient: I do have uh, two cats at home, but I've had them for seven years now and I've been tested for allergies and and I'm clear there. 

Doctor: OK? Do you live with anyone right now?
Patient: Yeah, I live with my husband and we have three daughters as well. 

Doctor: OK, and are any of them sick at all or have any similar symptoms. 

Patient: Yeah, my my husband's had a cough uh, as well, he hasn't brought up any blood or anything though. But my my daughters have felt OK. 

Doctor: OK, and do you have any past medical diagnosis like high blood pressure, diabetes, asthma, anything like that?
Patient: Yeah I do have uh, type 2 diabetes, as well as high blood pressure. I've been diagnosed with depression before as well. I do take a few medications for diabetes and blood pressure. I'm not on insulin though. 

Doctor: OK, and do you know what medications you take?
Patient: I think an ACE inhibitor and, and I think Ramipril and uh, metformin. 

Doctor: OK, and do you take anything for depression?
Patient: I used to take a a citalopram, but I stopped and and things have been been stable. 

Doctor: That's good. Any hospitalizations or surgeries in the past? 

Patient: I had two C sections for my second daughter and and 3rd. 

Doctor: OK, any complications at all with those C sections?
Patient: No, everything was was good. 

Doctor: OK, any other surgeries or hospitalizations?
Patient: No. 

Doctor: OK, do you have any family history of any lung conditions, heart conditions, any cancers?
Patient: My dad had a stroke when he was in his late 60s, but that's the only thing I can think of. 

Doctor: OK, and I know you said you volunteer at the homeless shelter, but do you do anything else for work at all? 

Patient: Yeah, I've been doing some administrative work from from home because of covid, so with the extra time I've been trying to to do some extra volunteering. 

Doctor: That's really good. And so besides, so you live with your husband and three kids, does anyone in smoke in the house or do you smoke at all?
Patient: No, I don't. No one smokes in the house. 

Doctor: OK, does, uh, do you take any recreational drugs like marijuana? 

Patient: No. 

Doctor: And how about alcohol?
Patient: Sometimes I'll have some like red wine with dinner, but that's only on like Christmas or an occasion. 

Doctor: OK. Yeah, alright so uh other than that, sorry, I think I might have forgotten to ask you a couple questions. So no fainting spells, no shortness of breath, nothing like that? 

Patient: No, I haven't had anything like that, just a stern cough. 

Doctor: OK, and no chest pain on exertion?
Patient: No, it's the chest pain, well, I guess if I'm like moving around a lot, but it's not, it doesn't come on uh, like because of like physical activity. I just feel it like anytime I'm, like when I'm breathing in or even just moving my body around in the chair. 

Doctor: And any like fatigue or increased tiredness. 

Patient: Yeah, I've had some fatigue for sure. 

Doctor: OK, and have you lost any weight recently?
Patient: Yeah, I I have actually. I'm I'm down 20 pounds. I thought that was great. I I was 200 pounds just two months ago. 

Doctor: And have you been trying to lose weight or that 20 pounds just went away spontaneously? 

Patient: Uh, I mean I I guess I've tried to make changes to my diet here and there because of the diabetes, but I don't really think that it would be enough to lose 20 pounds. 

Doctor: OK, I see. Yeah so, do you have any questions? Those are all the questions I have. Do you have any questions or concerns?
Patient: No, I was just, I guess just concerned about the the blood in the, in the cough. 

Doctor: Yeah, so definitely that's something concerning. We want to make sure there was no, so you work at a homeless shelter, where there may be a tuberculosis case, and your symptoms of coughing up blood as well as losing a significant weight recently, and some of the other symptoms that you described as well, point towards uh TB as one of the causes. No lung cancer history right, in your family?
Patient: No. 

Doctor: OK, uhm so we definitely want to do testing for TB. Will do us a smear today of your sputum and we will, since you have been in contact with your family, we will have to contact a public health if the tests come back positive, and it seems that, we'll also do some other testing. Sometimes with tuberculosis you can get something called pericarditis, and some of the symptoms you are having may point to pericarditis as well, so we might have to do an EKG. We might have to further do an ultrasound, an x-ray, for example. So first we'll just get the TB test done and then if it comes back positive, you will need to isolate, be admitted to the hospital as well, and be on a course of antibiotics. So I know this is a lot to take in. Do you have any questions or concerns at all?
Patient: Not right now. Guess will wait until some of the results come back and yeah, get started. 

Doctor: Yeah, so we'll just do the TB test first, alright? 

Patient: Alright, thank you. 

Doctor: Welcome, take care.
Patient: Hi I am having difficulties breathing and I've just had this cough and it's, It's been two months now. 

Doctor: Two months, so did the two months of the difficulty breathing or the cough?
Patient: Two months of difficulty breathing and the cough is gotten worse. I've had a cough for a couple years now. I'm a smoker. 

Doctor: OK and is is this cough different at all?
Patient: It's just, it just doesn't go away. 

Doctor: OK, and when did the shortness of breath start? 

Patient: About two months ago. 

Doctor: OK, and is it getting worse?
Patient: oh yeah 

Doctor: OK. Are you bringing up any sputum at all with your cough?
Patient: Uhm? I sometimes uhm, yeah I do. 

Doctor: OK and is is there any color to it or is it clear? 

Patient: it's pink in color 

Doctor: It's pink in color?
Patient: Hmm 

Doctor: Ok. Have you coughed up any blood at all?
Patient: Sometimes 

Doctor: sometimes? 

Patient: Streaks of blood here and there. 

Doctor: Little streaks of blood? OK, and have you ever coughed up any just without without it being in the sputum, just onto a tissue or anything like that? Just coughing up any blood?
Patient: No. 

Doctor: OK. So an are your symptoms just constant over the last two months or do they come and go? 

Patient: Shortness of breath just kind of stays. 

Doctor: OK, and is there anything that helps with your shortness of breath, like taking a rest or any positions in particular?
Patient: Yeah, sometimes resting does help. I find that it's worse when I'm moving around, I'm huffing and puffing more. 

Doctor: OK, and is it worse at all when you lay down?
Patient: No. 

Doctor: No? And do you find yourself ever having to wake up at night and gasp gasping for air?
Patient: No, it hasn't gotten that far but seeing how bad it's been over the past two months and how fast is progressing, I won't be surprised if I can't even sleep. It's been quite difficult I I don't even know why I waited so long. I should have come in earlier. 

Doctor: Well, I'm glad you came in today. We can definitely try and help you with what's going on. Do you at all use any kind of medications to help you with your symptoms?
Patient: I've just been using my inhalers a bit more but they don't always help. 

Doctor: OK, and what are you using the inhalers for?
Patient: Oh, I have COPD. 

Doctor: COPD? OK, and when were you diagnosed?
Patient: It's been 15 years now. 

Doctor: 15 years and do you know the how many puffers are you taking? 

Patient: Uhm, I'm taking uhm, I'm taking two puffers. 

Doctor: OK, and do you have one that that you take when you when you absolutely need it?
Patient: Yeah, yeah I do. That's the one that I've been trying to use but 

Doctor: Has it been less effective at all recently?
Patient: Yeah, it hasn't been helping. The blue one I tried to keep taking the blue one and it's just, you know it's not helping. 

Doctor: Have you been sick at all recently with fever? Chills, like runny nose? Any cold like symptoms?
Patient: No. 

Doctor: No, nothing like that? Have you been in contact with anyone that's been sick?
Patient: Oh no. I've been staying at home. I've been very careful these days. 

Doctor: Yeah for sure. Any so this started two months ago? Are you having, so you have not traveled then I'm assuming? 

Patient: No. 

Doctor: OK, are you having any kind of dizziness or fainting spells?
Patient: Oh no, no no. 

Doctor: No? OK, any kind of swelling in your legs or hands that you've notice? 

Patient: No 

Doctor: OK. Any headaches at all?
Patient: No. Well, sometimes I do. But it's not been severe. It's been there for the past uhm always when I'm stressed out I get these headaches. It's nothing new. 

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

Doctor: No? Any diarrhea or Constipation?
Patient: No. 

Doctor: No OK, any fevers or chills recently?
Patient: I have a mild fever. It just, it's been there. 

Doctor: When did you notice?
Patient: Uhm I was just checking my temperature about a month ago and noticed that I had a fever. 

Doctor: OK. This was a month ago?
Patient: Yeah. 

Doctor: Have you had it recently at all?
Patient: I haven't checked it recently, but I do feel a little hot. 

Doctor: OK, are you getting night sweats at all?
Patient: Sometimes. 

Doctor: Sometimes, OK. And are you getting any kind of significant weight loss?
Patient: No. 

Doctor: No, then your weight's been fine? 

Patient: It's been the same. Although I have been eating quite a lot more now with the pandemic and being home, you know that might be still in the same. 

Doctor: And so are you having, do you feel like tired throughout the day or increased fatigue?
Patient: Oh my God. So tired I can, you know, with the difficulty breathing I feel like all my energy spent just trying to, trying to get to the bathroom. 

Doctor: OK, and how? Is there like? How much do you walk or move around that you get short of breath? Or are you short of breath at rest as well?