jshargo/medical-interview-conversations huggingface dataset:
Patient: No, I don't feel it anywhere else. 

Doctor: Ok, and have you tried anything that has helped relieve some of the pain? Any medications or anything? 

Patient: Yeah, I've tried some Tylenol and Advil, and that the Advil is actually helped taking the edge off a little bit, but the next morning I I have the stiffness and and pain again. 

Doctor: Ok, and for your pain, are there any kind of factors that make the pain worse, like bending down or standing straight up or laying down anything that makes your pain worse?
Patient: Uh no nothing that I can think of that really makes it any worse. 

Doctor: Ok, and is your pain worse when you wake up in the morning or is it worse as the day progresses?
Patient: It's worse in the morning. It gets a bit better as the day goes on. I asked about it, an hour into the day, I feel my best. It takes a little bit of time to to move around a little bit first. 

Doctor: Ok, approximately how much time would you say after you wake up, the stiffness and pain goes away?
Patient: I would say maybe 30 to 60 minutes. 

Doctor: Ok, alright. And no, you haven't had any trauma injuries in recently, right?
Patient: No trauma or injuries. 

Doctor: Ok and no fevers or chills?
Patient: No. 

Doctor: Ok, any night sweats?
Patient: No. 

Doctor: Any fatigue or malaise?
Patient: Yeah, I have been a bit more fatigued than usual, and yeah, I I've had some malaise as well. 

Doctor: Ok, and for how long have you had this? 

Patient: It's been similarly getting a little bit more progressive. I mean some days I'm just feeling like I just want to lay around and rest 'cause I'm feeling just so burnt out and other days I'm ok but, I'm certainly more tired than usual. 

Doctor: Ok, I see. Other than that, have you noticed any kind of rashes or skin changes or changes in your nails at all?
Patient: Uhm, no, I haven't noticed any any rashes or any nail changes. 

Doctor: Ok, any shortness of breath? 

Patient: No. 

Doctor: Any changes in your bowel movements or urinary patterns?
Patient: No, I haven't had any diarrhea or any any urinary problems. 

Doctor: Ok, have you noticed any changes in your appetite or your weight? 

Patient: No, my appetite's been normal and my weight's been stable. 

Doctor: Ok, and have you noticed any difficulties or changes with your vision or any eye problems?
Patient: No, I haven't noticed anything like that. 

Doctor: Ok, have you noticed any kind of numbness or tingling sensation in your limbs specifically like your back and your legs? 

Patient: No, no tingling or numbness. 

Doctor: Ok, any muscle weakness at all?
Patient: Nope, I haven't noticed any muscle weakness. 

Doctor: Ok, and have you been sick at all recently with any viral or bacterial infections? 

Patient: Um I had a uh, and then I was diarrhea like several months ago and I had some antibiotics, but that was a yeah, so a few months ago. 

Doctor: Ok, and other than that, currently are you sexually active?
Patient: Yes I am uh I I have a girlfriend then we've, uh, we started dating about about, uh, six months ago. 

Doctor: Ok and do either of you have any history of any STI's at all? 

Patient: Uh, no history of STIs. 

Doctor: Ok, alright and is your partner fine or is she having any symptoms at all?
Patient: No, she she hasn't been having any symptoms then we we've been using a condom mostly. 

Doctor: Ok, alright and otherwise are you generally healthy or do you have any medical conditions?
Patient: Uhm, yeah, I'm I'm generally alright. I do have asthma actually and just, I had diarrhea a few months ago after eating at a buffet. So I think maybe it yeah, it was food poisoning or maybe something like that. 

Doctor: Ok. 

Patient: But yeah, so asthma and that's it. 

Doctor: Ok, and do you use any medications for your asthma?
Patient: Yeah, use that blue inhaler sometimes. I guess that just when I when I need it, but that hasn't been very often. 

Doctor: Ok and do you have any allergies to any medications or any environmental factors?
Patient: I do have environmental allergies, I I'm not sure if it's like ragweed or or pollen, but something like that. 

Doctor: Ok, and have you had any hospitalizations or previous surgeries?
Patient: Uhm, never. 

Doctor: Ok any family history of any medical conditions, any autoimmune conditions or any musculoskeletal conditions?
Patient: Yeah my mother has a uh psoriasis. 

Doctor: Ok.
Patient: Yeah, and so she's had to, I know use like like creams and stuff like that for her skin. 

Doctor: Ok, and currently right now, do you work? 

Patient: I do, yeah I work uh, at a bank. 

Doctor: Ok, and your mother, so she had psoriasis. Did she ever have any joint pains alongside the psoriasis?
Patient: I don't believe so. I think she had just more issues with her with her skin. 

Doctor: Ok, and so you work and then what's your living situation like?
Patient: Yeah, so I live with my girlfriend in a condo in the city here. 

Doctor: Ok, and do you use any recreational drugs like marijuana? 

Patient: Yes, sometimes yeah, I'll smoke like once or twice per week, with that with a friend or something like that. 

Doctor: Ok, and do you smoke?
Patient: No cigarettes, no never. 

Doctor: Ok and you drink alcohol?
Patient: Sometimes, yeah, I'll have a beer or two on weekends or or a cocktail with friends. 

Doctor: Ok, alright, so those were just some of the questions I had. Now I'm just going to quickly uh, ask some specific questions. So have you noticed any kind of swelling in the areas that you are having pain or redness or anything like that?
Patient: Uhm no, I haven't noticed really any any uh redness or or swelling 

Doctor: OK and no so, are you able to bend down and stand up straight or extend backwards so without pain or are you in any pain? 

Patient: Uhm, I do get it. It's a bit stiff. Uhm I, uh, yeah, I'm not really too sure it's like, not really, it's more more more stiff. 

Doctor: Ok, and yeah, other than that, do you have any questions or concerns?
Patient: Uhm, yeah, I was just wondering, yeah, like like what what this could be possibly? 

Doctor: Yeah, so definitely what so this this seems like it started off like 3 months or six months ago, and it's been going on and it's happening in the morning. And how old did you say you were?
Patient: Uhm I'm 26. 

Doctor: OK, yeah, so uh, it seems progressive and you're getting some pain in your other joints as well and it's mainly from your middle to lower back. It can be multiple things that we would have to rule out. So you first you have a family history of psoriasis so it can be psoriatic arthritis. You don't have any other skins, changes or any other symptoms. It can also be since you have had a you were sick for months ago with a what might be gastroenteritis. It can be sometimes a few months afterwards you can get something called reactive arthritis - where you get this progressive pain in your joints and stiffness. And otherwise it can also be something called ankylosing spondylitis, which can present in men your age and it's kind of like a progressive, dull back pain and that has some morning stiffness as well. So yeah, there's definitely multiple things that it can be. So first we would need to do a full physical examination and book an appointment or for that in person. And we will get some lab work done as well, as well as a X Ray of the of the spine and your sacroiliac joints. And we'll also get some blood work with CBC, CRP and ESR. So those are just inflammatory markers as well as the rheumatoid factor antinuclear antibodies. Those are just some things that will test for different kind of rheumatological issues and to see if you have any arthritis. So yeah those are and then will also get an X Ray of your hands and knees since you're having pain there as well. So yeah, those are some steps that we'll take. Do you have any questions or concerns?
Patient: No, that that sounds, that sounds great, thank you. 

Doctor: Alright, yeah, so I will get in touch with you shortly.
Patient: Sounds great, thank you. 

Doctor: Alright, take care.
Patient: Yeah. 

Doctor: I know that you've been having experiencing a cough. Can you tell me a little bit about that?
Patient: Yeah, I um I've had this cough for the past two weeks and it just doesn't go. 

Doctor: OK. have never had anything like this before?
Patient: I’m I usually get a cold once a year or so. But the cough doesn't last this long, like it's usually over in a week or week and a half or so. 

Doctor: Mm. And it's it's not letting up.
Patient: Mm. 

Doctor: OK um. I'm gonna ask you a few questions about the cough itself. Is this a dry cough that you're experiencing? Or are you producing like any any mucus or coughing up anything?
Patient: There was some mucus um earlier on, but now it's it's all, it’s a dry cough. 

Doctor: Now, it's dry OK how long, what was the timeline for that? I guess how long?
Patient: Yeah, so maybe for the first four or five days there was this like whitish clear kind of mucus that was coming up and then after that was a a dry cough. 

Doctor: OK, OK. And do you feel like the intensity of the cough got worse over the last two weeks, or has it gotten any better?
Patient: Kind of the same, I would say. 

Doctor: And has the cough gotten more frequent over this time as well?
Patient: No. 

Doctor: How often would you say that you're coughing?
Patient: Uhm? It's hard for me to quantify, maybe a couple of times an hour, maybe three or four times an hour or so. 

Doctor: Is there anything you can think of that triggers the cough, or is it spontaneous?
Patient: It’s kinda, spontaneous um. Can't really think of anything. 

Doctor: OK. And along with the cough, are you experiencing any difficulty breathing? 

Patient: No. 

Doctor: OK, have you noticed any fevers?
Patient: Uhm, no. 

Doctor: OK um. Have you had any sore throat? 

Patient: Um I did initially um for the first two or three days and then that got better. 

Doctor: OK um. Have you had any runny nose?
Patient: I did initially yeah, I have like had all those flu symptoms for the first couple of days, but the cough just kinda stayed. Everything else resolved in the first uhm three or four days I would say. 

Doctor: OK. Thank you for sharing that have you had, did you have any chest pain at any point? 

Patient: No, but I guess like sometimes when I'm coughing too much my chest hurts a little bit. 

Doctor: OK, so it feels kind of sore after all that?
Patient: Yeah. 

Doctor: OK. OK, have you been in contact, I guess it's hard to say because it started a while ago, but before it started bringing contact with anyone that's been sick? 

Patient: I I work at the hospital, but. Um I'm wearing PPE all the time, and I'm very careful so. 

Doctor: OK. Have you traveled anywhere outside of the province?
Patient: No. 

Doctor: OK, any belly pain? 

Patient: Uhm, no. 

Doctor: OK, um so I'm just gonna ask you some questions about your overall health. Have you had any respiratory problems in the past?
Patient: No. 

Doctor: OK. Or do you have any chronic conditions that you see your family  for regular thing?
Patient: I’ve got acid reflux and uh, I also have anxiety. 

Doctor: Are you currently taking any medications?
Patient: Um. I I used to, not anymore. 

Doctor: Uh, was there any particular medication that you stopped recently?
Patient: No, no. I used to take. I used to take something for anxiety two three years ago. 

Doctor: OK. And what do you do for your reflux?
Patient: I just avoid right now, I'm just trying to avoid the foods that make things worse for me and I feel like that's helped me quite a bit, uhm so yeah. I quite like acidic foods and chocolates and things like that. 

Doctor: Sure. That's no fun. 

Patient: Yeah. 

Doctor: Do you have any allergies?
Patient: Just hay fever. 

Doctor: And do you have any family history of respiratory problems or heart problems?
Patient: No. 

Doctor: OK, and this is in terms of your lifestyle. Do you live with family, alone?
Patient: I I live with my partner. 

Doctor: OK, and do you have any kids or pets living with you? 

Patient: No. 

Doctor: Do you smoke?
Patient: Uh I don’t, no. 

Doctor: Drink alcohol? 

Patient: Um occasionally. On Christmas. 

Doctor: Oh OK, I see. And do you use any other substances?
Patient: No. 

Doctor: OK. Uhm, and what do you do for work? 

Patient: I’m a clerk at the hospital. 

Doctor: OK. Right, you just say you working at the hospital. And, uh. I can't think I thought I had another question for you, but I can't remember it. Anything else that you wanted to tell me about that I didn't ask you.
Patient: Um. No, I guess I was just wondering why I still have a cough. It's been such a long time. Um yeah, and I was wondering if I could get any medications just to help with that. It's not really. Yeah, it's everyone's like scared at work when I cough. I have. I have had the covid test and I don't have it, um so yeah. 

Doctor: When we got the last test done? 

Patient: Um I had the test done when I first started having symptoms about two weeks ago? Since then I've been at home and I'm just waiting for my symptoms to get better, but I you know, I kind of like get back, and I don't want to be coughing when I get back. Um yeah. 

Doctor: OK. Well, I'm gonna have a quick listen to your heart and lungs I'll do a quick physical exam and then I will go get the  that I'm working with all kind of go over everything you talked about, and then we'll come back and talk to you about where to go from here.
Patient: Sounds great. 

Doctor: OK well thanks for chatting with me.
Patient: So I've had this, uh, this cough that it started two days ago and it's been getting worse. I've been bringing up this rust colored sputum. 

Doctor: OK, and so that's been going on for a few days?
Patient: Yeah, yeah about two days. 

Doctor: OK, and how often are you coughing?
Patient: It's it's happening all day. Really, throughout the day and really any type of exertion or or movement, I'm getting short of breath and it's triggering a cough. 

Doctor: OK, and the shortness of breath, is it just with the exertion or it can, is it happening at rest? How are you feeling right now? 

Patient: Yeah, even right now it feels like I'm not able to get, I don't know, a full breath, it just feels like it's more difficult to to breathe. 

Doctor: OK, have you felt any kind of dizziness or fainting episodes?
Patient: No, I haven't. 

Doctor: OK. Have you been feeling any chest pain at all? 

Patient: Uh, no, I, I I haven't had any chest pain. 

Doctor: OK, and so with your coughing you're producing the rust colored sputum, but how much would you say you're producing?
Patient: Uh I would say, yeah, maybe three or four teaspoons every every couple hours. 

Doctor: OK, are you producing any blood like in your cough or sputum at all?
Patient: No, it wasn't really red, it's kinda orange. 

Doctor: Orange, OK. Any greenish or yellow material? 

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

Doctor: OK. Any fevers or chills?
Patient: Yeah, I have had, I've had both of those. I've had a I I checked my temperature this morning and it was 38.2 and I was pretty chilly last night. 

Doctor: OK. Uhm, and before these symptoms started, were you having any similar symptoms at all before?
Patient: Ah, no, I mean a few weeks ago, probably like a yeah a couple of weeks ago I had a runny nose. And and sore throat for a couple of days. It went away on its own though. 

Doctor: OK. Uhm, any anything that makes your symptoms better or worse that you've tried? 

Patient: I did try some over the counter cold medicine. It, I think it might have helped me sleep last night, but didn't really do a whole lot. 

Doctor: OK, does your shortness of breath improve with any positions or does it improve when you're not exerting yourself?
Patient: Uh, not really. It's kind of always there, 

Doctor: It's ok. Do you have to wake up at night to take a deep breath? Or do you feel any kind of shortness of breath with laying down at all? 

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

Doctor: OK and do you notice any kind of swelling in your feet, ankles, arms, legs, anything like that?
Patient: No, I haven't. 

Doctor: OK, have you been in contact with anyone that's sick recently?
Patient: Uh, I don't I, I mean I see my granddaughter and I might have got a cold from her a few weeks ago, but recently I haven't seen anybody. 

Doctor: OK, are you having any night sweats? 

Patient: No, just a chills last night. 

Doctor: OK. Are you breathing faster?
Patient: Yeah, I have felt like I've been been breathing a bit faster. 

Doctor: You have any muscle aches or anything like that? 

Patient: Ah no, not really. 

Doctor: OK, and give any other symptoms like chest pain, runny nose, sore throat, anything like that?
Patient: Uh, no. Just been really tired these last couple of days and I've just felt like sleeping all day. Haven't felt like eating either, my appetite has been really poor. 

Doctor: OK, uhm. And other than that, have you experienced any kind of headaches, nausea or vomiting?
Patient: No, I haven't. 

Doctor: OK, any fevers or, you said you have had some chills, right? 

Patient: I have yeah. 

Doctor: OK. And then a fever too. Kind of a sensation of your heart racing at all?
Patient: Ah, yeah, right. It doesn't feel like it's well, it does feel like it's beating a bit faster than usual, just not feeling too well. 

Doctor: Yeah, so yeah, we'll do a physical examination and get all your vital signs as well right after. Any, so you said you haven't been able to eat, ave you noticed any significant weight changes recently?
Patient: No, my weight's been about the same. 

Doctor: OK, any exposure to any dusts or animals, fumes, anything that might have triggered some of these symptoms? 

Patient: No, I don't think so. My husband and I, we moved into a new kind of apartment here and it, it's brand new. 

Doctor: OK, any kind of loss of sense of taste or smell?
Patient: No, that's been normal. 

Doctor: OK, any exposure or any travel outside of the country at all.
Patient: No, nothing like that. 

Doctor: OK, so just mainly the coughing with the rusty material as well as just the shortness of breath. Umm, and do you get any pain at all in your chest when you breathe in or out?
Patient: No, I haven't had any, had anything like that. 

Doctor: OK, any past medical conditions that I should know of? 

Patient: Yeah, I, umm, I had a stroke like that like six years ago. And I have type 2 diabetes. As well as GERD. 

Doctor: OK, and uh, yeah, I'm sorry you had you had a stroke six years ago or how are you after that? Were there any kind of, like did, after rehabilitation, do you have any symptoms still going on at all?
Patient: Yeah my, my left hand, still, still it gives me some some problems. I get uh, uh, Botulinum toxin injections for, for the tightness in my hand. 

Doctor: OK, OK, and are you taking any other medications at all? 

Patient: Yeah, I use metformin. Empagliflozin or an SGLT2, insulin and uh, and aspirin, I think. 

Doctor: OK, and any over the counter medications?
Patient: Yeah, I take a multivitamin and in vitamin D. 

Doctor: OK. Any allergies to any medications at all? 

Patient: No. 

Doctor: OK, any environmental allergies?
Patient: No. 

Doctor: OK, any ill contacts at all?
Patient: No, no. 

Doctor: Any recent or prior hospitalizations?
Patient: No, the last time I was in the hospital was I was for rehab after my stroke. 

Doctor: OK and so, but after that, no other hospitalizations or surgeries? 

Patient: No. 

Doctor: OK, any surgeries in the past?
Patient: Yeah, well I did have a C-section for my son but that was many years ago now and everything for that was, was OK. Yeah. 

Doctor: OK. Any family history of any lung or heart conditions? Any cancers?
Patient: Uhm, yeah, my dad had had a heart attack actually, but he was in his 80s when that, when that happened. 

Doctor: OK, uhm and currently right now, are you working at all?
Patient: No, I'm retired. I used to be a teacher for Grade 3, uhm, but yeah, but since retired and my husband and I just moved into a smaller apartment to make it a bit easier on us. It was a lot trying to look after the house. 

Doctor: OK, well congratulations on your new home. Are you at all, you or your husband requiring any kind of supports outside of the home at all? 

Patient: No, between us two we managed to get the shopping done, the cooking and and all the cleaning, and that sort of thing. I use a walker to get around when we're going longer distances. 

Doctor: OK. And currently right now, do you smoke at all?
Patient: Uh, yes I, I spoke about half a pack per day or maybe even less. 

Doctor: OK, and how, how long have you have smoked for? 

Patient: Since I was 15 maybe? 

Doctor: OK.
Patient: So yeah for like 45 years. 

Doctor: And have you, at all been diagnosed with COPD or anything like that?
Patient: No, I was tested actually, uh, a couple of years ago and that the results were normal. 

Doctor: OK. Alright, and have you thought of quitting at all? I know you've been smoking like for a very long time, but have you at all tried to quit before?
Patient: Like I've considered it, but I I just don't think it, it'll be possible at this time. 

Doctor: OK, well if you at all are wanting any information or want to talk about quitting at all, um, we can provide more resources. Do you besides smoking, do you use any recreational drugs like marijuana?
Patient: No. 

Doctor: No. Any alcohol at all?
Patient: No. 

Doctor: OK. Yeah, so those are some of the questions I had a, I will be doing a physical examination with your shortness of breath. I just want to get a good listen to your lungs and take all your vitals as well. However, yeah so after that since you're having some symptoms of what might be a pneumonia, it can be a bacterial infection, a viral infection, we will have to get some blood work done as well as a chest x-ray. And right now, with the pandemic going on, we will also do Covid swab test for you as well, just in case. Does that sound good? 

Patient: Yeah, that makes sense, thank you. 

Doctor: Alright and, if if you're while you're here, if your shortness of breath gets any worse at all, just let us know and we'll help you out.
Patient: OK, thank you, will do. 

Doctor: Thank you, bye.
Patient: Yeah, that sounds great, thank you so much. 

Doctor: OK yeah, no worries.
Patient: I'm not so good, these last few days I haven't benn able to reallykeep anything down and not feeling so good. 

Doctor: OK, I'm sorry to hear that. Um, when you say last few days, did you mean the past two days? 3 days? 

Patient: Well, I feel like maybe the last five days I just haven't been feeling so good and I haven't really felt like eating. But these last two days I've been really nauseous and I've thrown up a few times. 

Doctor: OK, when you say you haven't been feeling good for the past five days, is it that you feel achy? Do you feel hot like you have a fever, or do you feel weak?
Patient: Yeah, I do feel hot and um, yeah, maybe a bit tired. 

Doctor: Tired? OK. And nausea and vomiting. Are you throwing up or just feeling nauseous? 

Patient: Mostly nauseous, but yeah, yesterday I threw up like three or four times and then again today I threw up like two or three times. 

Doctor: OK, are you throwing up any blood?
Patient: No, I didn't see any red. It was mostly like yellow and umm, liquidy beacuse I haven't been eating much solids or like just like food. I've been mostly just having drinks. 

Doctor: OK, um, and so mostly fluid you said? 

Patient: Yeah. 

Doctor: OK, and what color is it?
Patient: Uhh, yeah, usually usually kind of like yellowish clear. 

Doctor: OK. Are you having any abdominal pain?
Patient: Maybe like after I vomit it kind of feels like squeezing a little bit. But I think, yeah, I think yeah that's just really just with when I'm heaving. 

Doctor: Right, um, are you, do you have any changes in your bowel movements?
Patient: Umm, no, I haven't noticed anything there. 

Doctor: OK. And so no diarrhea, no constipation? 

Patient: No, nothing like that. 

Doctor: OK, no blood in your stool?
Patient: Oh yeah, no problem swallowing. Just haven't felt hungry. 

Doctor: OK, so you don't have much of an appetite then.
Patient: No, not not really. 

Doctor: OK, alright, so um, any changes in in taste?
Patient: Um, maybe I mean, yeah, I think I might not be really tasting things the same. 

Doctor: OK, how about smell? 

Patient: Now that you say it, I might, uh, yeah I think my smell has been impacted as well. I can't really smell anything. 

Doctor: OK.
Patient: I thought that was kind of weird, but didn't think anything of it actually until you just asked me. 

Doctor: Yeah for sure. And how about any changes in your vision or hearing? 

Patient: No changes to vision or hearing. 

Doctor: OK, any discharge?
Patient: Uh, nothing like that that, but I mean my eyes were a bit, they've been a bit red these last two days. 

Doctor: OK, have they been in any pain?
Patient: Nope, no pain and I've been able to see everything OK. It's just I just noticed they were a little bit more red. I just thought maybe I don't know I was, I've just been tired. 

Doctor: Yeah for sure. Any coughing?
Patient: Uhh, yeah I haven't had a cough but um, I've had a cough for a few years now, so yeah, that's not really a change for me. 

Doctor: Alright, so no change in your cough. Is it a dry cough or a wet cough?
Patient: It's uh, oh, a dry cough usually. 

Doctor: Dry cough, OK. Any blood that you produce?
Patient: No blood, no blood. 

Doctor: OK, any shortness of breath? 

Patient: I'm not really able to exercise and stuff like that. 

Doctor: OK, have any wheeziness?
Patient: Um, no, I haven't had a a wheeze. 

Doctor: OK, how about any fatigue or tiredness?
Patient: Yeah, I've definitely felt a little bit more kind of groggy and tired this last week, really. 

Doctor: OK, and muscle aches to go along with that?
Patient: Yeah, bit in my like kind of upper arms and legs a little bit. 

Doctor: OK, you said you've been feeling groggy. Do you feel dizzy at all? 

Patient: Not dizzy, just maybe that I'm like moving in slow motion. 

Doctor: OK yeah, any confusion or memory loss?
Patient: No, I think I've been OK. 

Doctor: OK, any rashes? 

Patient: No, I haven't noticed any rashes. 

Doctor: OK, how about headaches?
Patient: Yeah, these last few days I've had a bit of a headache as well.It hasn't been very intense, so, um, I'm not worried about it too much. 

Doctor: Right, OK. It hasn't been intense you said? So have you had headaches like this in the past?
Patient: Yeah, I had similar headaches before I think. They come like this. Like if I didn't get a good sleep or from not drinking enough water or something, I'll kind of get a headache like this. Kind of feels like it's squeezing. 

Doctor: Yeah, that's understandable. But it's not like the worst headache you've ever had? 

Patient: No, no, it's pretty similar to headaches that I've had before. 

Doctor: OK, OK, good, and are you otherwise healthy?
Patient: Yeah, well I have high blood pressure and also, high cholesterol, so I do take medications for both of those. So yeah, I take a statin and Amlodipine I think.  DOCTOROK, OK, good. It's good that you're on both of those. Do you take any other medications like over the counter medications or herbal supplements?  Yeah, I've been taking vitamin D and also a multivitamin. I heard that that we don't get enough vitamin D throughout the winter. 

Doctor: Yeah, it's a great idea to take that, especially as we get older and if we live in a country where we don't get a lot of sun exposure like Canada, so that's good. And sorry before I move on, I forgot to ask you earlier if you have experienced any weight loss or night sweats recently? 

Patient: No, my weight's been, uh, about the same unfortunately and I haven't had any night sweats. But I mean now that you asked if I felt more hot than than usual, maybe. 

Doctor: OK, and did you take your temperature?
Patient: Uh, I did and the last time I checked it was a few days ago and at that time I didn't have a fever, but I mean, I'm still feeling hot so I'm not sure. 

Doctor: Yeah, OK. Alright, so I'll go back to your past medical history. Have you been hospitalized or have you ever needed surgeries in the past?
Patient: Um, no. Like the last time I was in the hospital with, it was for a colonoscopy a few years ago which came back normal. 

Doctor: OK, that's good. Um, are you up to date with all your immunizations? 

Patient: Uh, yeah, actually got the shingles vaccine a few months ago. 

Doctor: OK.
Patient: Probably closer to a year ago now, actually. 

Doctor: Oh great, OK, that's awesome and are you allergic to anything? 

Patient: Just peanuts. 

Doctor: Peanuts, OK. Do you know if you have a family history of any lung or heart conditions?
Patient: Yeah, my son has asthma. But nobody in my family's had a heart problem, though. 

Doctor: OK, how about any stomach problems or liver problems? Colon problems? 

Patient: Yeah, my dad actually had colon cancer. He was 70 and so that's why we went and decided to get a colonoscopy instead of just doing the immunohistochemistry test. 

Doctor: OK, yeah, that's a good idea. Um, so it sounds like you're, you know, preemptive with your health, which is good. Any other cancers that run in the family?
Patient: No, just my dad had colon cancer. 

Doctor: OK. And do you smoke at all?
Patient: No, I don't.  DOCTOROK, how about marijuana?  Um, no, I don't smoke marijuana. 

Doctor: OK, how about other recreational drugs?
Patient: I mean, I briefly like dabbled in the past at parties and stuff like that but that was when I was way younger, like in in my college years. 

Doctor: OK, what kind of drugs?
Patient: I think maybe we used cocaine a few times and MDMA, uh, but that was like a long time, probably like 30 years ago. 

Doctor: OK, were any of these drugs injected IV?
Patient: No, no, I've never done that. 

Doctor: OK, OK, that's good. Do you drink alcohol?
Patient: Usually, it'll just be one or two glasses of wine at a time and maybe two nights a week. 

Doctor: OK. 

Patient: And I usually stick with red wine. 

Doctor: OK, great, and who do you live with?
Patient: So um, it's just me and my son. 

Doctor: How old is your son?
Patient: Uh, he's 18. 

Doctor: OK, and do you live in a house or an apartment?
Patient: Um, yeah, we live in an apartment. Yeah, on the 8th floor. 

Doctor: On the 8th floor, OK, any issues in terms of like old carpet or mold or asbestos in the apartment?
Patient: It's a newish building so there isn't really any carpet actually in the unit, so yeah, it's pretty clean that way. 

Doctor: OK good. That's good. So those were all the questions that I had for you. Did you have any questions or concerns that you wanted to bring up before we ended the interview?
Patient: Well, I'm just hoping to to get this sorted out and feel better. 

Doctor: Yeah for sure. So you know, right now we're thinking it could be a viral GI viral infection because of your complaints of nausea, vomiting, loss of appetite and fever. But it could also be COVID and we are going to have to do a swab for you and run that test because you have a lot of symptoms that overlap with those symptoms. Um, and then, so just going off of that, we'll wait for the swabs to come back. If they come back positive, we will notify public health and they'll do a trace to see where you could have gotten this infection from. And then meanwhile, we do suggest that you isolate for two weeks so that you don't spread the illness, and even if the swab comes back negative, there is still a chance that you may have COVID and it's a false negative test. So we'll start there. If it turns out you don't have any of those viral illnesses and you have more of a, you know, bacterial picture, we can work you up for that and prescribe antibiotics. So that's where we will start. How does that sound?
Patient: Um, I'm just, I'm here because I've had this cough for the past two weeks and uh, it's just not going away. 

Doctor: Okay, and um, is it getting worse at all really?
Patient: Not really, it's just been the same. 

Doctor: How would you describe the cough? Is it a wet cough or a dry cough? 

Patient: It's a dry cough. 

Doctor: Okay, are you bringing up any uh, sputum or blood at all?
Patient: Uh no. 

Doctor: Um, would you describe it as like a, a barking cough, a harsh cough, or a muffled cough? 

Patient: Not really. 

Doctor: No, okay. Um, before you started uh, coughing, did you have any other symptoms, like runny nose, congestion, sore throat, anything like that?
Patient: Uh, no. 

Doctor: Okay, so it's just the cough? 

Patient: Yeah. 

Doctor: Okay. Any fevers or chills?
Patient: Nope. 

Doctor: Okay, and is the cough constant, or does it come and go?
Patient: It, uh, I guess it's just, it's there throughout the day. 

Doctor: It's there throughout the day, okay. And is it brought on by any activities or, or does it just come on by itself?
Patient: It comes on by itself. 

Doctor: Okay, and has it gotten any better at all or stayed around the same?
Patient: It's stayed the same. 

Doctor: Okay. Has this happened to you before, where you had a cough for a long time? 

Patient: No. 

Doctor: No, okay. Um, do you have any other symptoms like chest pain, sore throat?
Patient: No. 

Doctor: Okay. Um, any recent travel or contact with anyone that's been sick? 

Patient: I don't think so, no. I just went to my, I went to see my family DOCTOR: um, for some prescriptions. 

Doctor: Okay.
Patient: Um, three weeks ago. 

Doctor: Three weeks ago, okay. Any headaches at all? 

Patient: No. 

Doctor: Okay, nausea or vomiting?
Patient: No. 

Doctor: Any night sweats? 

Patient: Um, no, nothing like that. 

Doctor: Any fatigue at all?
Patient: No. 

Doctor: No. Any shortness of breath? 

Patient: No. 

Doctor: And no chest pain?
Patient: No. 

Doctor: Any diarrhea or constipation? 

Patient: No. 

Doctor: Okay. Um, any wheezing at all?
Patient: No. 

Doctor: Okay, any changes in your weight recently?
Patient: Um, no, no, I don't think so. 

Doctor: Any changes, sorry, any issues with your urination? 

Patient: No. 

Doctor: Are you sleeping well or does the cough keep you up at night?
Patient: Um, it's, it's not so, it hasn't interrupted my sleep. 

Doctor: Okay, and how's your appetite been like? 

Patient: No, everything's okay. 

Doctor: Okay, and any uh, loss of your sense of taste or smell?
Patient: No. 

Doctor: No, okay. Um, any exposure to any fumes or dust within your environment, or animals or pets?
Patient: No. 

Doctor: Um, and otherwise, do you have any medical conditions like asthma, COPD, anything like that?
Patient: Um, I went in for, I went in for a checkup three weeks ago, and uh, I found out I had high blood pressure. You know, who would have thought and then my doc started me on this pill called ramipril and uh, I've just been checking my blood pressure on a regular basis, and it's yeah, it's been good. But other than that, I'm very healthy. 

Doctor: Okay, and no asthma? 

Patient: No asthma. 

Doctor: Okay. And any allergies to any medications or any environmental allergies?
Patient: Um, just penicillin. 

Doctor: Just penicillin. And have you taken any antibiotics or penicillin recently?
Patient: No. 

Doctor: No, and um, what medications are you on?
Patient: Just, just that one. 

Doctor: Just the ramipril? 

Patient: I also take, I also take a multivitamin. 

Doctor: Multivitamin, okay. Have you been hospitalized before or had any surgeries?
Patient: No. 

Doctor: No, okay. Um, any family history of any lung or heart conditions?
Patient: Um no, no, I don't think so. 

Doctor: Okay. Any cancers? 

Patient: Yeah, uh, pancreatic cancer and colon cancer runs in the family. 

Doctor: Okay, and is that uh, any direct relatives, like your mom or dad or kids?
Patient: My, my grandparents on my mom's side. 

Doctor: Um, and currently, do you work um, or are you retired? 

Patient: I'm a lawyer. 

Doctor: Okay. And, uh, do you work from home right now? Or do you go in person?
Patient: Yeah I've been working from home. 

Doctor: You've been working from home, okay. Um, and what's your home situation like right now? Do you live with anyone? Do you live in a house or an apartment?
Patient: Um, I live, I live in an apartment. I, um, I live alone I just got, I had a divorce two years ago and since then I've been, I've been living alone. 

Doctor: Okay, I'm sorry. Um, and is, in your home environment, is there any kind of allergens like dust or any mold or anything like that? 

Patient: No, nothing like that. 

Doctor: Okay, and currently do you smoke at all?
Patient: Um, sometimes. 

Doctor: Sometimes, how often would you say you smoke? 

Patient: Um, maybe uh, two or three cigarettes. Maybe three or four days a week. 

Doctor: Okay, and how long have you been smoking for?
Patient: Um, so I, I used to smoke a lot when I was young and then I quit. And then I started again two years ago. 

Doctor: Okay. Um okay, and do you use any recreational drugs like marijuana? 

Patient: No, I don't. 

Doctor: Okay, um, and do you drink alcohol?
Patient: Yeah. 

Doctor: How much would you say you drink on an average day? 

Patient: More than I would like to mention. I, yeah, I, maybe 5 or 6 beers a day. 

Doctor: Okay, and um, is this something that's new for you, or has been going on for years now?
Patient: Again, that started about two years ago, so. 

Doctor: Um, and uh, do you use, so no other recreational drugs, right?
Patient: No, nothing else. 

Doctor: Yeah, so we can definitely talk more about alcohol usage definitely, especially when there's uh, people going through stressful times. There can be increasing substance use, including alcohol, so we definitely have a lot of resources that we can um, discuss today if you would like.
Patient: Yeah, I would really like that. Thank you. 

Doctor: You're welcome. Um yeah, but those are all the questions I had for today. We'll definitely do like a physical examination, but it seems you've just been having a cough for the last two weeks.
Patient: Yeah. 

Doctor: Without any other symptoms. Um, okay, so do you have any questions at all for me? 

Patient: Um no. 

Doctor: So what we'll do is, since you've had this cough for the last two weeks, we definitely want to do a COVID swab, just in case. You've been uh, working from home, but if there was any potential contact, they usually, it comes back in 24 to 48 hours.
Patient: Okay. 

Doctor: Other than that, sometimes uh, with a history of smoking, you can have something called uh, COPD. We can, like after the physical examinations and everything, we can potentially discuss doing pulmonary function tests as well. Um, and yeah, but other than that, it can also just be like a dry cough, can be just a viral upper respiratory tract infection that takes two or more weeks to resolve. In that case we wouldn't really. 

Patient: Sure. 

Doctor: Um, yeah, so we'll do the physical examination and then go from there.
Patient: I've had a cough that started like 4 days ago, um and it's just been getting worse, so I I wanted to come in. 

Doctor: OK yeah, it's good that you've come in. Um, so the cough started four days ago, has it been constant since? 

Patient: Yes it has. 

Doctor: OK, and how often are you coughing?
Patient: I um, I'd say a few times an hour now. Uh when it first started, it was a bit more intermittent, but now it's happening um all day long and throughout the night as well, it interrupted my sleep last night. 

Doctor: Oh OK, um is it a dry cough or are you producing sputum?
Patient: It's it's mostly dry. 

Doctor: OK, so no sputum, no blood? 

Patient: No blood. 

Doctor: OK. Um do you find that there are any triggers to your, to this cough, like um, environmental triggers, like the cold weather, um any old carpets at home, or um you know a particular time of the day, or exertion, anything like that?
Patient: No, interestingly, nothing like that seems to really make it worse. It's just been um kinda coughing all day. 

Doctor: OK, and um has anything made it better? Have you tried anything for this cough?
Patient: Uh I tried um drinking some uh like tea and some other cough syrups and it didn't didn't help. 

Doctor: OK, um how about, ah, OK. And if you were to describe the quality of this cough, would you say it's it's, it sounds barky, it sounds harsh, um how would you describe it? 

Patient: Uh harsh. 

Doctor: Harsh, OK. And if you were to rate your symptoms 1 to 10, 10 being the worst, how bad is it?
Patient: Uh, 6. 

Doctor: Six, OK. And and have you found that your symptoms are getting worse, staying the same, or getting better over the past four days? 

Patient: Getting worse. 

Doctor: Getting worse, OK. And have you ever experienced anything like this in the past?
Patient: Uh no. 

Doctor: No, do you feel wheezy at all?
Patient: No, I haven't heard any any wheezes. 

Doctor: OK, how about uh shortness of breath?
Patient: Yeah, I've definitely noticed some difficulty breathing, um yeah. 

Doctor: OK, and uh, when when did, when did your shortness of breath start?
Patient: Right around the same time as the cough or maybe shortly after, um yeah, shortly after. 

Doctor: Shortly after, OK. Do you find that there are any triggers for shortness of breath, like exertion?
Patient: Yeah, yeah exertion. Um as well as like the cough itself, I'm finding that I'm coughing so much throughout the day that I'm having a hard time catching up and catching my breath afterwards. 

Doctor: Yeah, for sure. Um OK, and any chest pain?
Patient: No chest pain. 

Doctor: OK. Um How about feeling like your heart's racing? 

Patient: No, nothing like that. 

Doctor: No, any swelling in your legs or arms?
Patient: No. 

Doctor: OK. Do you ever feel like you have uh pain in your calves after walking um a few blocks? 

Patient: No. 

Doctor: No, any fainting spells or dizziness?
Patient: Uh, no. 

Doctor: No, um have you had a sore throat? 

Patient: No. 

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

Doctor: Runny nose or stuffy nose? 

Patient: Not, no, but I've definitely, I feel like I've maybe noticed a change in my smell. 

Doctor: OK, how so?
Patient: I just uh, I feel like I haven't been able to smell as well. 

Doctor: Um when did you notice that? 

Patient: The, really, these last like 2 days. 

Doctor: OK, and any changes in your taste?
Patient: Uh I haven't really I, I thought, well, I wasn't really able to taste my food, but I thought that was because I couldn't, I wasn't smelling, um so I thought that was just going to go away, but the symptoms have gotten worse. 

Doctor: Yeah, and have you had a fever or chills in the past few days? 

Patient: Uh yeah, I've had a fever um or I felt hot anyway. 

Doctor: Did you take your temperature?
Patient: I haven't checked it, but um like I've been feeling pretty sweaty from how hot I've been. 

Doctor: OK um so we'll take your temperature today and we'll let you know. Um have you noticed any weight loss over the past few weeks? 

Patient: No. 

Doctor: No weight loss, how about fatigue or muscle aches?
Patient: Uh maybe these past couple of days, yeah. 

Doctor: OK um, any changes to your hair, nails, or skin, like rashes? 

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

Doctor: OK. Um any changes to your bowel habits?
Patient: Uh, no. 

Doctor: No, any nausea or vomiting?
Patient: Um, no, no. 

Doctor: No, OK. Any abdominal pains? 

Patient: No. 

Doctor: Any changes to your urine?
Patient: No. 

Doctor: Uh confusion or memory loss? 

Patient: No. 

Doctor: OK, and would you say that you are an otherwise healthy person?
Patient: Yeah, yeah, that's why, these symptoms um really surprised me. 

Doctor: Yeah, um so you've never been hospitalized or needed surgery in the past?
Patient: No, I haven't needed to, I haven't seen a DOCTOR: in a few years. 

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

Patient: Uh nope, just uh take a multivitamin and uh, and that's about it. 

Doctor: OK, um, OK, um any allergies?
Patient: Uh yeah, I'm allergic to um cats. 

Doctor: Cats, OK. And have you been around any cats recently? 

Patient: No. 

Doctor: No, OK. How about immunizations? Are you up to date?
Patient: Yeah I am. 

Doctor: OK. Um any family history of lung conditions or heart conditions? 

Patient: Uh, no. 

Doctor: How about cancers?
Patient: Nothing like that. 

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

Doctor: Um how about marijuana?
Patient: Uh sometimes I'll have a joint with friends or something like that on the weekend, but um yeah, so maybe once a week. 

Doctor: Once a week, OK. Um, how about alcohol, do you drink any alcohol? 

Patient: Uh, no 

Doctor: No, OK. Um and where do you live right now?
Patient: I live in a house um with my wife and uh 3 kids. 

Doctor: OK. Is anyone else sick at home? 

Patient: Uh everybody's been well. 

Doctor: OK, um any reason to believe that you've been around any sick contacts recently?
Patient: Um possibly, um I mean, I'm in sales, so meeting with clients all day, um maybe one of them were sick. 

Doctor: Yeah, yeah for sure. Um, any travel recently? 

Patient: Uh no travel, all the meetings have been in the city. 

Doctor: OK, OK good. So those were all the questions that I had for you today. Did you have any questions of your own or anything that you wanted to discuss today that I missed?
Patient: Um no, that, I was just worried about uh Covid. 

Doctor: Yeah, so that's definitely top on the list right now for things that we have to rule you out for. Um so we'll take a swab today, we'll send it off um for those PCR results, you should hear back in 24 to 48 hours. Uh in the meantime, you should isolate for 14 days, and that includes from family members when possible, and public health will get in touch with you if those results are positive and so they can they can do some contact tracing. If it's not Covid, it could be another viral illness that's going around, and I guess the best therapy for that is staying hydrated, um getting good sleep, and eating nutritious foods. Uh but if your symptoms get worse, like you're running a really high fever, um you're having neurological symptoms like you know seizures or fainting spells, um or if you're having difficulty breathing, um you should come back to the ER. So how does that sound?
Patient: Uh I just came in today I think I broke my leg or something, it's something that was, I heard a snap, I was in um just a dance class um and we have like these long uh dresses, it it was a traditional dance class and my foot uh slipped right onto, it got caught in my dress and it just kind of slipped and I I felt right on my, my leg kind of twisted and I fell down and I just stayed down. I knew something was not right and something was broken. 

Doctor: When did this happen? 

Patient: Just uh I would say like an hour ago 

Doctor: Hour ago, OK. Are you able to bear any weight on it at all?
Patient: No, not really. I I had to come in the ambulance. 

Doctor: OK, OK, and um if you were to localize this pain, where exactly is it?
Patient: It's pretty much my whole lower leg is painful, but I think where it looks like it broke is like the middle part of my lower leg. 

Doctor: The middle part, OK middle part of your lower leg, so kind of where your shins are? 

Patient: Mhmm. 

Doctor: OK, so in the shin area, OK. Um have you tried anything for it? I know it's only been an hour.
Patient: Uh no nothing. I just like I just want to make sure I keep it as still as possible um I didn't wanna even try anything. 

Doctor: OK yeah, that makes sense, if you were to describe this pain, would you say it's um sharp, dull, achy throbbing?
Patient: It's like sharp and throbbing. It's like probably one of the worst pains that I've felt in my life. 

Doctor: OK, OK. And 1 to 10, 10 being the worst pain ever, how bad is it? 

Patient: At 10 for sure. 

Doctor: Ten, OK, have you, so you said you've never experienced this before, um do you feel like it's getting worse, the pain, or has it been pretty much the same since it started, or is it getting better?