jshargo/medical-interview-conversations huggingface dataset:
Patient: She's feeding well. She's doing uh, she eats everything, yeah. 

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

Doctor: Um, and does anyone smoke in the house? 

Patient: Um, her dad, but he, he doesn't smoke in front of her. 

Doctor: And what's her living situation like? Who does she live with? And do you live in a house, apartment?
Patient: Oh yeah, we live in an apartment. It's uh, me, my partner, her and the cat. 

Doctor: Okay. And any difficulties or complications with her growth? Like in terms of her weight or her height? 

Patient: No, no complications. She's doing okay. 

Doctor: Okay. And in terms of her milestones, has she been meeting all of them on time?
Patient: Yes. 

Doctor: Okay. Alright, so I think those are all the questions I have for you today. Do you have any questions or concerns?
Patient: Uh, no. 

Doctor: Yeah, so based on the symptoms, oh yeah, sorry I forgot to ask one other question. Has she, are her immunizations all up to date? 

Patient: Oh no, no. I don't, I don't get those. My friend's, my friend's daughter developed autism and I'm just, I don't want that, you know, so no. I don't vaccinate my kids. Or I don't vaccinate my daughter and I haven't been. Yeah, uh no, I won't be doing that. 

Doctor: And have you been vaccinated throughout your life?
Patient: Um, maybe when I was young, but I, yeah I don't, I just don't believe in vaccinations. I, yeah, no, I don't, I don't get those. 

Doctor: Yeah, so there is definitely uh, there's a lot of research done beside, behind vaccinations and a lot of prevention goes into them, but definitely there is some anecdotal evidence of very loose associations to autism that have been found to be invalid and like they have been invalidated by the research. So definitely, it's very important to get your child vaccinated. In fact, the sum of the symptoms that your child may be having right now can be caused by something called pertussis, and um, there's usually a vaccination for that. Like after pregnancy as well, so that's something that is definitely on the differential, and at this time we definitely need to make sure she's okay and get her vitals done, see her oxygenation saturation, and just do supportive care while she's in the hospital, and we may need to admit her, but we'll do the full physical examination today, get a COVID swab done as well. And usually it, she's currently in the, it seems to be the second phase, where she's vomiting and coughing a lot, and then it usually, after that phase, two or three more weeks of just coughing. And so, we're going to do some supportive care for her right now, but yeah, definitely, you should consider vaccinating your child. We recommend that to every parent as there's a lot of diseases out there that can be completely prevented if you vaccinate your child. 

Patient: Okay, I'll think about it. 

Doctor: Alright, so, so for now we're gonna just make sure that she's doing well, okay?
Patient: Um yeah, so I'm here because I've had this fever, this cough, and now my head hurts. That's been going on for about the past four days and I just want to make sure um it's nothing too serious. 

Doctor: Yeah, yeah, that's great. So can you tell me, have you, did you measure your temperature?
Patient: Uh no, I haven't actually measured it, I just feel hot and feel chills. 

Doctor: OK, but we can take your vitals here um and uh you you said that you've had a cough for the past four days, dry cough or wet cough?
Patient: Um it's been pretty dry. 

Doctor: Um, any uh no blood or any um sputum um coming up right?
Patient: No, no. 

Doctor: OK and has the the cough gotten worse or better or the same, has it been the same since the past four days?
Patient: Um it's it's actually getting worse. 

Doctor: OK, is there anything that makes it better or worse?
Patient: Uh no, I don't think so. 

Doctor: OK. Uh have you tried anything for your cough? 

Patient: I've tried like decongest like cough suppressants but it doesn't seem to have helped. 

Doctor: OK. OK, and then tell me about your headache. That started four days ago as well?
Patient: Yeah. 

Doctor: And uh where exactly is it? 

Patient: So it's like just on the front part of my head. 

Doctor: And does it feel like uh, what does it feel like? Is it like a throbbing sensation? A band like sensation? Um is it sharp, is it dull?
Patient: Uh it feels pretty throbbing right now. 

Doctor: Is it both sides or on the uh left or right?
Patient: Uh it's it seems like it's both sides. 

Doctor: If you had to give it a number from 1 to 10 with 10 being the most severe pain ever, what number would you give it? 

Patient: Uh I would give it about like a seven. 

Doctor: Oh wow, OK. And how's it changed over the past four days?
Patient: Uh, it's just gotten a little bit worse. 

Doctor: Um is it uh is it, what was I gonna say, is it constant or does it come and go? 

Patient: Um It seems pretty it seems pretty constant. 

Doctor: Have you taken anything for it?
Patient: I tried like some Tylenol for it and it seems to help a little bit. 

Doctor: Does it, is there a certain time of the day when it's worse? Before going to bed, at the end of the day, waking up, anything like that? 

Patient: No, nothing like that. 

Doctor: Have you had a similar headache in the past?
Patient: Uh yeah, I guess I have, a little bit in the past, but that was also when I was like sick. 

Doctor: Sure, um does it wake you up in the middle of the night?
Patient: Uh no, it hasn't woken me up. 

Doctor: OK, um I guess other than the headache, I'll ask you about, and the cough and fever, I'll ask you if you've had any other symptoms. So have you had any confusion?
Patient: Uh no, no confusion. 

Doctor: Any changes in your vision or your hearing? 

Patient: No. 

Doctor: Um any um redness in your eyes?
Patient: No. 

Doctor: Any loss of taste or loss of smell? 

Patient: No 

Doctor: Um any runny nose or stuffy nose?
Patient: Uh nope. 

Doctor: OK, any sore throat? 

Patient: No. 

Doctor: OK. Any chest pain or difficulties breathing?
Patient: No. 

Doctor: Any palpitations? Do you feel like your heart's racing? 

Patient: No. 

Doctor: OK, any belly pain?
Patient: No belly pain. 

Doctor: Diarrhea?
Patient: No. 

Doctor: OK, any aches or pains in your body?
Patient: No. 

Doctor: Uh any rashes that you've noticed?
Patient: No, no rashes. 

Doctor: Any discolouration of your fingers or toes? 

Patient: Uh I don't think so. 

Doctor: OK, alright um and do you have any medical conditions?
Patient: No, I think I'm healthy otherwise. 

Doctor: OK, alright and have you had any hospitalizations or surgeries?
Patient: Uh, no. 

Doctor: OK, um what about medications? Are you taking any? Over the counter or otherwise?
Patient: Uh I take some multivitamins, that's it though. 

Doctor: OK, any family history of lung or heart problems uh or anything else, or cancers?
Patient: No. 

Doctor: And do you currently live alone or do you live with someone else or with other people? 

Patient: I live with um my husband and our our daughter. 

Doctor: OK, have you had any, have you traveled anywhere?
Patient: No, not recently. 

Doctor: Have you uh, what do you mean by recently?
Patient: Uh like I have traveled in the past two years. 

Doctor: OK, that's fine, that's fine. Have you had any contact with anyone who might be sick? Either you or your husband or your daughter?
Patient: Uh no, I don't think so. 

Doctor: Have you gone out of the home at all? 

Patient: Uh just to do like essential things like groceries and the bank and things like that. 

Doctor: Do you wear a mask and maintain social distancing?
Patient: Yes. 

Doctor: OK um alright, uh do you drink alcohol?
Patient: I drink like once once in a while, have a glass of wine. 

Doctor: OK, how, I guess how often would you say?
Patient: Uh once a week. 

Doctor: OK. And do you smoke?
Patient: Um no, not anymore. 

Doctor: Uh how much did you smoke in the past?
Patient: I I'd have like half a pack, um but I only smoked between like the age of 20 to like 25. 

Doctor: OK. Do you smoke marijuana or have any edibles with marijuana in it?
Patient: No. 

Doctor: Any recreational drugs?
Patient: No. 

Doctor: OK um alright well uh, and you said that you don't have a family history of any problem? 

Patient: No. 

Doctor: Yeah OK, alright, I think that's all the questions I had for you. So uh looks like you've had a fever, cough, and a um and a headache that's gotten worse in the past four days and your headache's pretty bad, a seven out of ten. Um and uh it could be that you have uh some sort of an infection, uh including um, with Covid being one of the possibilities, and so um continue to take Tylenol and and um monitor your uh fever. If it continues to get worse, or you um notice that your symptoms are just not getting better, um you should come back, you should uh, we'll also do a Covid, we'll also send in a request for a Covid swab. Um and uh we'll ask you to quarantine for the for the next 14 days and try to stay away from your husband and daughter as well, if you can at home. Um and uh I guess a couple of other questions that I wanted to ask and I should have asked earlier, do you have any um any stiffness in your neck or any difficulties moving your neck?
Patient: Uh no, nothing like that. 

Doctor: OK alright, and um do you have any questions?
Patient: Hey, uh I just had this cough that's been like really bothering me. 

Doctor: OK, how long have you had that for? 

Patient: Uh like in the past few days, it's been really like gross and I've been coughing up this like gunk, but I've had it for, I've honestly had a cough for like three months, it's just like sometimes it's like there, and sometimes it kind of goes away. It feels like it keeps coming back. 

Doctor: OK, have you had any chest pain?
Patient: Um no, like it kinda hurts when I cough now but not not like on its own. 

Doctor: OK, have you noticed any fevers at home? Or fevers at all in the last couple days?
Patient: Uh I've been feeling like hot at night in the past couple days, uh but like I didn't actually take my temp. 

Doctor: OK, have you had any night sweats? You wake up, the sheets are soaked?
Patient: Uh no, not that. 

Doctor: Nothing like that, OK, have you noticed any unexplained weight loss over the last little while?
Patient: Um, no. 

Doctor: So so you go on the scale, you lost a few pounds, but you haven't been trying to basically. 

Patient: No, like I, I don't really weigh myself, but I don't think so. 

Doctor: So you haven't been noticing clothes have been fitting loose or anything like that?
Patient: No, no, like I wish but no. 

Doctor: Got it, got it. Now let's talk about what you're bringing up with your cough. What colour is it?
Patient: It's really gross. It's kind of like greenish. 

Doctor: Greenish, OK, and also any red or any blood with it?
Patient: No. 

Doctor: OK. And doesn't smell at all, smell funky?
Patient: I haven't noticed. 

Doctor: OK, so you've just been bringing this stuff up for the last couple of days, when specifically? Two days ago, three days ago? 

Patient: Like maybe maybe three days. 

Doctor: Three days ago, and you said before that you kind of had this dry cough before. Uh when did you first notice that? Three months ago, you said?
Patient: Yeah, I was uh, I I do like um, it like sounds silly but I do like a pole dancing class just for exercise and I was like at my class and I kind of just started to like feel like I was like a little coughy and like I don't think there's anything special, that was just like when I noticed it. 

Doctor: OK, anyone at the class sick at that time?
Patient: I don't think so, like it's a really long time ago, I don't really remember. 

Doctor: Got it, got it. Anyone sick near you or around you in the last couple of weeks?
Patient: No, no, not that I can think of. 

Doctor: OK, and regarding other, any, we already talked about chest pain, uh you've been able to eat food alright? 

Patient: Uh yeah, like uh yeah it's like pretty normal. 

Doctor: So no nausea, no vomiting?
Patient: Uh no, none of that. 

Doctor: You don't have a stiff neck at all, do you? 

Patient: No, no I don't. 

Doctor: OK, but how about other parts of your body? Any pain? Tenderness anywhere?
Patient: I don't think so, no. Like I'm I'm a little tired now, um like the cough is like maybe for like a month, it's been kind of waking me up a little bit so my my sleep hasn't been great, but I don't think it's like I have like pain. I'm just like tired. 

Doctor: OK so the cough does wake you up at night?
Patient: Yeah. 

Doctor: Does it wake you up every night?
Patient: Yeah, like pretty well, for like the last, not like all three months, but probably the last month. 

Doctor: OK. Alright. I'm just gonna move on, talk a little bit about you and the past. Uh so any issues that you've seen a  for before? 

Patient: Uh just like eczema. 

Doctor: OK, and do you take anything for that?
Patient: Just like moisturizing creams, um like my family DOCTOR: back home said like, a couple times when it was really bad she would give me one like to go get at like shoppers, but right now it's not bad so I just have just like a regular cream. 

Doctor: Got it, ever been hospitalized before? 

Patient: Uh, no. 

Doctor: OK, any surgeries?
Patient: No. 

Doctor: OK so aside from the eczema, it sounds like you're pretty healthy eh?
Patient: Yeah. 

Doctor: OK. Do you have any allergies?
Patient: Uh I think maybe um maybe cats because, I I don't have one, but sometimes I've noticed stuff, but I've never like, it's never really been too big of an issue. 

Doctor: OK, so you've never taken any medications or got stung by a bee and had any trouble breathing or even a certain food? 

Patient: No. 

Doctor: Nothing like that, OK, are you taking any medications right now?
Patient: Uh no. 

Doctor: OK, and you just go to Western? 

Patient: Mhmm. 

Doctor: Do you live uh near campus with anyone?
Patient: Uh I have like a roommate, yeah we, I live in an apartment with a roommate. 

Doctor: OK, have they been sick at all in the last little while?
Patient: No. 

Doctor: OK, and last little while, have you done any traveling?
Patient: No. 

Doctor: So you haven't been outside the country or any exotic locales in the last little while? 

Patient: No, like I'm planning to on March break, but I haven't gone anywhere. 

Doctor: Got it, got it, so you live in town uh with your roommate and you're currently a full time student?
Patient: Mhmm. 

Doctor: OK, and just regards to anything, do you smoke? 

Patient: No, like I don't um I don't smoke cigarettes like I sometimes sometimes smoke marijuana, but usually um usually it's like the vape. 

Doctor: OK, how often we say you do that a week?
Patient: Oh, like, maybe like once every like 2 weeks or something. 

Doctor: Got it, any other substances slash drugs? 

Patient: No, like alcohol sometimes, like. 

Doctor: OK so no cocaine, no heroin?
Patient: No. 

Doctor: And have you ever um injected drugs into your body? 

Patient: No. 

Doctor: Got it, got it. Just coming back to alcohol, uh how often would you say you drink?
Patient: Maybe like one one night like on the weekend. 

Doctor: OK and what do you drink, how much do you drink? 

Patient: I don't know, maybe like 5 or 6 beers. I guess it just depends on the night. 

Doctor: Got it, got it, and other questions, when was your last menstrual period?
Patient: Maybe like 2 weeks ago? 

Doctor: Two weeks ago, OK. Are you sexually active?
Patient: Uh yeah, just with my boyfriend. 

Doctor: OK, so do you two use contraception, birth control?
Patient: Yeah, we use uh like condoms. 

Doctor: OK, any chance you could be pregnant right now? That was a strange question to ask if you're sexually active, but any unprotected sex in the last two weeks? 

Patient: No. 

Doctor: Got it, alright, and we're just kind of going over things,so it sounds like you've had this cough or a cough for a little while but it's only become bad in the last three days. You're waking up at night and you're kind of bringing up this foul or not this foul but this kind of greenish sputum, but it's, no blood in it, and otherwise you don't have any constitutional symptoms so I will go review your story with the doctors. Anything else you'd like to bring up with them before I go?
Patient: I don't think so, I just like I like I hope I just can feel better 'cause I've been missing like my exercise stuff 'cause I feel like it's just like coughing and it makes it hard to like do well. 

Doctor: Got it, got it. We'll see what we can do. OK, thank you very much.
Patient: Uh, I've had this cough ongoing for a couple of months now, uhm, and recently I've started to notice some blood. 

Doctor: OK, so this cough has been going on for how many months? 

Patient: I would say maybe six months. 

Doctor: Six months, and have you had this cough before, then?
Patient: Yeah, I've had a cough before and kind of for a long time, 'cause I've smoked for a while. 

Doctor: OK, I see, Uhm, what kind of cough do you have, is it productive? Like, is it a wet cough or is it a dry cough? 

Patient: It's usually a dry cough, but recently I've been bringing up a little bit of blood. 

Doctor: OK, and is the blood mixed in with like sputum that you're bringing out or is it that you're just coughing up blood?
Patient: It's mostly red, yeah, mostly blood. 

Doctor: OK, I see, and is your coughing constant or does it come and go?
Patient: It's kind of like, constant throughout the day. 

Doctor: OK, and have you noticed any kind of greenish or yellowish color of your sputum? 

Patient: Not really, no. 

Doctor: How much blood would you say you're coughing up now in an average day?
Patient: I would say, maybe two or three teaspoons. 

Doctor: OK, I see. Has your coughing gotten worse or has it stayed about the same? 

Patient: It's been about the same. 

Doctor: OK, is there anything that makes your symptoms better or worse?
Patient: Not really, it's just kind of been there most days. 

Doctor: And do you have any other symptoms like shortness of breath or chest pain, runny nose, anything like that? 

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

Doctor: OK, so with your coughing, you don't feel like you have any difficulty breathing?
Patient: No, I mean, I haven't had any shortness of breath, I've just had uh, well yeah, actually sorry, I have had difficulties breathing as well. 

Doctor: OK, and when did that start?
Patient: Uh, well that's been an ongoing problem for the last several years now, I thought it was related to smoking, but it's gotten worse. 

Doctor: I see, OK, and do you have any chest pain with inspiration or expiration?
Patient: No, no chest pain. 

Doctor: OK, any dizziness? Any fainting episodes?
Patient: Nothing like that. 

Doctor: OK, any recent travel outside of the country?
Patient: No, I've been at home. 

Doctor: OK, any headaches, fevers or chills?
Patient: No, no fevers or chills, and I haven't had any headaches either. 

Doctor: OK, any losses in sense of taste or smell?
Patient: Uhm, yeah, I have been a bit more nauseous recently, but I haven't had any vomiting. 

Doctor: OK, and when did you start feeling nauseous?
Patient: It kinda comes and goes, I've had that problem for the last two months or so. 

Doctor: OK, and do you feel nauseous at anytime particularly in the day, like after eating, Or does it just come on randomly? 

Patient: Randomly. 

Doctor: OK, and have you been having any kind of diarrhea or Constipation, changes in your bowel movement?
Patient: No. 

Doctor: OK, any blood in your stools at all?
Patient: No. 

Doctor: OK, have you been feeling fatigued at all? 

Patient: Yeah, a little bit more tired recently, yeah. 

Doctor: And how recently would you say?
Patient: I thought it was related to like, just being short of breath, Yeah, so maybe in the last couple of months as well. 

Doctor: OK, and when do you get short of breath? Is it when you do any activities? Is it when you're laying down? Is there anything related to it?
Patient: If I exert myself or if I'm  doing more activity, it it does get harder to to keep up with it, but yeah. 

Doctor: And do you notice you have to like get up at night to take a breath? Or when you're laying down,do you have any trouble breathing? 

Patient: No. 

Doctor: OK, and have you noticed any kind of swelling in your extremities or anything like that?
Patient: No swelling. 

Doctor: OK, have you had any night sweats? 

Patient: No 

Doctor: OK, and how about your sleep and appetite, have they changed it all?
Patient: Oh yeah, my appetite's been less. I've lost some weight over the last few months. 

Doctor: OK, and how much weight would you say you've lost? 

Patient: Maybe ten to fifteen pounds. 

Doctor: OK, and how much do you weigh?
Patient: I think now I weigh about one hundred and sixty pounds. 

Doctor: OK, so yeah, ten to fifteen pounds in the last, how many months would you say? 

Patient: Maybe two months. 

Doctor: Two months, OK. Have you recently had any infections, like viral symptoms, like runny nose, fever, or any cold like symptoms?
Patient: No. 

Doctor: OK, and any exposure to anyone that you know of that might have tuberculosis?
Patient: No, I've been been mostly at home. I Haven't really been seeing many people lately. 

Doctor: OK, and do you have any past medical history or any diagnosis like COPD, asthma, high blood pressure, diabetes, anything like that? 

Patient: Uhm, I had a cataract surgery, but that's about it. 

Doctor: OK, and are there any medications that you take on a daily basis?
Patient: Multi-vitamins. 

Doctor: Multi vitamins, OK, any allergies that you know of to medications or any environmental allergies? 

Patient: I think sulfa, but that's it. 

Doctor: OK, and what kind of reaction do you get?
Patient: Uh, I get a rash. 

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

Patient: I just had cataract removed from my right eye, and uh, that's about it. 

Doctor: OK, any Contacts of yours that have been sick recently?
Patient: No. 

Doctor: No, OK, and in terms of your family history, are there any cancers like lung cancer in your family or any heart conditions, anything like that? 

Patient: I think my great uncle had lung cancer, my mom had type 2 diabetes, but that's it. 

Doctor: OK, and currently right now, do you work?
Patient: Yeah, I'm retiring soon. I work as a bus driver. 

Doctor: OK, and in the past have you worked in any environment where you were exposed to any metals, toxins, any asbestos or anything like that? 

Patient: Uhm, I don't think so. 

Doctor: OK.
Patient: I worked as a bus driver for quite a number of years now. 

Doctor: And where do you live right now? In an apartment? In a home? And who do you live with?
Patient: I live in a home with my wife and it's just us two. 

Doctor: And do you know if there's any like asbestos exposure in your home at all? 

Patient: I don't think so, no. 

Doctor: OK and currently do you smoke?
Patient: I've been cutting down, but I do smoke, yes. I smoke about a half a pack per day now. There was a time I was smoking two packs per day for a number of years and I started smoking when I was probably fifteen. 

Doctor: Mhm. 

Patient: Yeah, so it's been about forty, Yeah, forty-ish years at least. 

Doctor: And have you thought of quitting at all?
Patient: Yeah, I've been trying. I was thinking of maybe talking about a prescription for helping quit or something like that today. I was feeling like this is causing some of my symptoms like my cough, shortness of breath. 

Doctor: Yeah, well, it's really great that you're thinking about quitting. We can definitely help you with some resources, and some medications. Have you tried anything before that I should know of, to help you quit?
Patient: I've tried nicotine patches and gum, but that's it. 

Doctor: OK, so yeah, there's uh, like other options as well that you can take. Have you heard of Champix? 

Patient: Uh, I did hear of it actually. Yeah, so one of my friends tried it and it worked well for them so, Yeah. 

Doctor: OK, yeah, so we can, if you're wondering about that, I can give you some information on that medication, like a whole package for you and then we can discuss if that could work for you.
Patient: That sounds great. 

Doctor: OK, sweet. And other than smoking, do you use any recreational drugs like marijuana?
Patient: No, I don't. 

Doctor: OK, and do you drink alcohol?
Patient: Well I'll have one or two beers on the weekend. 

Doctor: OK. Alright, so yeah, that's pretty much all the questions I had right now. It seems that your symptoms, You do have that cough and the shortness of breath and it's been chronic, but now you're coughing up some blood as well, so that is definitely something that's concerning and we want to make sure there is nothing going on so we will get a chest X-ray for you and see if we can find anything there. Are still producing the bloody sputum? 

Patient: Yeah, that's been coming up a daily still. 

Doctor: OK, so if you think you can produce that, we can even take a sample of that as well and see if there is any presence. The one thing that we are concerned about with some of your symptoms and a long history of smoking as well is lung cancer. So yeah, we will do a chest X-ray, get some cytology done as well and then once we have that in the future we may need to maybe do a biopsy but right now we'll do a few of the first things that I mentioned and then go from there.
Patient: Sure, I've been feeling very short of breath for the past, uh, two weeks, but even before that, I started feeling a little bit short of breath and I can't stop coughing and it just feels like it's really hard for me to breathe. 

Doctor: OK, so this started two weeks ago?
Patient: Yeah, it started two weeks ago. 

Doctor: OK, and you're also coughing?
Patient: Yeah. 

Doctor: OK, and how long have you been coughing for?
Patient: The same amount of time, it started about, maybe three weeks ago, I started coughing more, um, but now it's worse. 

Doctor: OK, and what kind of cough are you having? Is it a wet cough or a dry cough?
Patient: It's definitely wet. My phlegm looks green. 

Doctor: OK, and how long have you noticed it being green?
Patient: It's been like that for the past two weeks. 

Doctor: OK, and before that, were you having coughing as well?
Patient: Yeah, before that I was still coughing but not as much. 

Doctor: OK, uhm, and was there anything that happened, uh, did you get sick at all recently, or were you in contact with anyone who was sick?
Patient: No, not that I know of. 

Doctor: OK, any kind of fevers at all?
Patient: No, no fevers. 

Doctor: OK. Have you noticed any kind of, uh, coughing up blood or blood tinged sputum at all? 

Patient: Uhm no not that, no blood. 

Doctor: OK, and how much sputum are you bringing up in an average day now?
Patient: Uhm, I'm bringing up about, I'd say it would fill like two, two of my palms, like the inside of my palm. 

Doctor: OK. Alright, and is your coughing like constant or does it come and go? 

Patient: It's pretty constant now. 

Doctor: OK. And have you had at all any kind of, uh, fevers or anything like that?
Patient: No fevers. 

Doctor: OK, and how about your shortness of breath? Is that, when does that happen? Is it mainly with exercise and exertion, or can it happen even when you're just going on about your day?
Patient: Uhm, its, uh, ok, its more with exertion, but right now even at rest, I'm coughing and feeling short of breath. 

Doctor: OK. And are you feeling at all any kind of, uh, chest tightness or pain? 

Patient: Uh, yeah, some chest tightness. 

Doctor: And is that mainly when you're coughing and short of breath or, uhm, at other times as well?
Patient: Uhm, other times as well. 

Doctor: OK. Are you having any other, any other like, can you describe your chest pain a little bit? Is it kind of a pressure pain or is it a sharp pain, aching pain? How would you describe it?
Patient: Uhm, I would say it's a, uh, it's a tightness in my chest. And it feels, I guess throbbing or achy? 

Doctor: OK, and does this pain, uhm, move to anywhere else or does it just stay in your chest? 

Patient: Uh, it just stays in my chest. 

Doctor: OK, have you been feeling dizzy or have you fainted at all?
Patient: Uh, no. 

Doctor: Have you been feeling increased sweating and confusion? Anything like that?
Patient: No. 

Doctor: OK, have you felt your heart racing and anything like that?
Patient: No. 

Doctor: OK. Alright, and is there anything that makes your symptoms better or worse? 

Patient: Uhm, I guess activity makes it worse, un, and like cold air, things like that. 

Doctor: OK. And other than that, have you recently at all traveled outside of the country or outside of the province?
Patient: Uh, no. No, not recently. 

Doctor: OK, now are you having any wheezing at all?
Patient: Uhm, some wheezing, yeah. 

Doctor: OK. And any kind of headaches or nausea or vomiting. 

Patient: No, nothing like that. 

Doctor: OK, and any fevers or chills.
Patient: Ah, nope, nothing like that. 

Doctor: Any night sweats?
Patient: Ah, sometimes I feel sweaty, but that's just with the shortness of breath. 

Doctor: OK, and how long does your shortness of breath usually last?
Patient: It lasts about, uh, I don't know, I kind of feel short of breath all the time, but when it's really bad, it lasts about five-ten minutes and then it goes back to like my normal shortness of breath. 

Doctor: OK. And has this happened to you before?
Patient: Uhm no, I don't think so. 

Doctor: OK. 

Patient: Like not, not this bad, I've always had some shortness of breath but nothing like this. 

Doctor: OK. And , uh, do you have any kind of diarrhea or constipation?
Patient: Uhm, no nothing like that. 

Doctor: OK, how about fatigue? 

Patient: Yeah, I feel fatigued. 

Doctor: OK, and is that just about today or is it, do you think it's because of your shortness of breath?
Patient: Yeah, it's probably cause of my shortness of breath. 

Doctor: Are you having any of these symptoms when you're trying to sleep?
Patient: uh yeah, I think its, yeah when I'm laying down sometimes I feel more short of breath than usual, but once I shift positions it goes back to it's normal. 

Doctor: Ok. Is it, do you ever have to wake up at night to catch a breath or anything like that? 

Patient: Ah, no, it doesn't wake me up. 

Doctor: And have you noticed any kind of, uh, significant weight loss or anything like that recently?
Patient: No. 

Doctor: OK, and have you at all had any changes in your appetite or anything like that?
Patient: No, no change in appetite. 

Doctor: OK. Any exposures to any like dust, fumes or any irritants recently
Patient: No. 

Doctor: OK And, in the past, have you been diagnosed with any medical conditions?
Patient: Uhm,  just COPD, uhm, and, I also have some congestive heart failure. 

Doctor: OK, and when were you diagnosed with both of them?
Patient: COPD I've been, I got diagnosed about seven years ago, CHF about two years ago. 

Doctor: OK, and uh, right now do you have any symptoms of any swelling in your extremities like legs, hands or anything like that? 

Patient: Some swelling in, some swelling in my legs, yeah? 

Doctor: OK, and do you have any kind of shortness of breath when you're lying down, at all?
Patient: Uh, a little bit. Yeah, a little bit I would say. 

Doctor: OK. And any other medical conditions?
Patient: Nope, no others. 

Doctor: Any allergies?
Patient: No. 

Doctor: Any medications you're on right now?
Patient: Yeah I'm on, uh, an ACE inhibitor, I'm on, uh, Spironolactone, uhm, I'm on, I have some puffers for my COPD. I believe, what do I have, I have, um, I have a long acting beta agonist. And I guess I have a short acting as well for when I need it. 

Doctor: OK. And do you have, so is it just the two, two puffers? 

Patient: Mhm. 

Doctor: OK, and are you using, like the blue one, the blue one more at all, are you having to use the short acting one more?
Patient: I'm definitely using the short acting more, like I'm using it almost every day. 

Doctor: And does it help at all?
Patient: Uh I4 think so. 

Doctor: OK yeah, so other than that, are you on any other medications?
Patient: No. 

Doctor: No, OK. And have you been taking your Spironolactone?
Patient: Yeah, I've been taking all my medications. 

Doctor: OK, any previous hospitalizations or surgeries? 

Patient: I was hospitalised two years ago for shortness of breath and some low oxygen, that's when they diagnosed me with CHF. 

Doctor: I see OK and did they say at all, It was caused by, like your COPD or what was it caused by? Do you remember?
Patient: Uhm,  I guess just, yeah, I'm not really too sure, they said I had some heart condition and my heart isn't functioning as well as it should be. They did an echo on me. 

Doctor: OK, and have you at all had any kind of heart attacks or anything like that? 

Patient: No. 

Doctor: No, OK. and did they, when you were having shortness of breath, did you have a like a pneumonia or infection that you had to get antibiotics for any or anything like that?
Patient: Uhm, no. Actually I might have gotten some antibiotics at one point, but not during that visit. 

Doctor: OK. OK, And currently right now do you smoke?
Patient: No, I stopped smoking two years ago. 

Doctor: Yeah no, that's really good. And definitely with these symptoms and your condition that definitely helps to quit smoking whenever you can, so congratulations for that. Any alcohol at all?
Patient: I drink some alcohol. I drink maybe once a week. 

Doctor: OK, and any recreational drugs like marijuana? 

Patient: I smoke once in a while. 

Doctor: OK, how often would you say you smoke marijuana?
Patient: I smoke about a joint a week. 

Doctor: OK, and uh, do you use a, like the provincial marijuana, or do you have any other source, what would you say you use? 

Patient: I use uhm, Pardon me, what was that? Do I use? 

Doctor: Like uh, do you get it from a store that sells the joint?
Patient: Yeah, I get it from like a medical dispensary. 

Doctor: OK, OK, I see. Yeah, I just want to make sure because some, if you get it from other sources there might be more irritants in there that can cause some of your symptoms and for them to get worse as well. So yeah.
Patient: Oh I see, I see, OK. 

Doctor: Yeah, and other than that, do you have any questions or concerns at all? 

Patient: No, what do you think I should do from, For now? 

Doctor: Yeah, so right now what we're going to do is because you're having the coughing, shortness of breath, and you have a history of COPD & CHF, we definitely want to make sure that you're not having, uhm, what I think you might be having isn't just an exacerbation of your COPD, and especially with the green sputum it might be like a bacterial infection that's causing your symptoms to get worse, so we'll do all the appropriate testing, we'll do, a chest X-ray, we'll get some blood work done as well, w'ell give you some uh, Ventolin as well while you're here, and we might give you like a steroid medication as well. So we'll do some of those things right now for you to kind of help you right now, as well as do some of those tests that I mentioned. Depending on what comes back, you might require an admission to the hospital just because we want to make sure you don't go home with an exacerbation, especially with the CHF as well, we need to, we will need to get that under control because that can get worse with your COPD exacerbation as well. So we need to make sure some of that, swelling goes down, if we need to adjust your medications while you're here. So yeah, let's just, I'll get back to you, we'll do some of those testing and then see where to go from there. Is that OK?
Patient: Yeah, so I've just been feeling a bit off over the last week. First I started having like, just a scratchy throat and that was probably I think 5 days ago that happened and then over the last 3 days I've been having diarrhea and also my whole body is just hurting. 

Doctor: OK, and so, when did the sore throat start? 

Patient: I'd say like 5 days ago it started and it first began like kind of a tickle, but now it's more like, even swallowing food hurts a lot. 

Doctor: OK, have you been eating or drinking less than usual?
Patient: Uhm, yeah my appetite's been a bit less over the last few days just because of how much it hurts. 

Doctor: OK, have you noticed any neck swelling?
Patient: Uh, no, not really. 

Doctor: OK, how about any redness in the back of your throat? 

Patient: I checked, I didn't see too much. 

Doctor: OK, And have there been any changes to your voice?
Patient: Uhm, a little bit, I wouldn't say too significant. 

Doctor: OK, and muscle aches, like, when did those start?
Patient: Yeah, so that started just 3 days ago. I remember waking up and my thighs were hurting, then my upper arms and then it kind of went into my upper back and now it's kind of just general pain in all of the muscles. 

Doctor: OK, are you having any muscle weakness?
Patient: Uhm, I would say it's mainly pain, I don't really feel weakness. 

Doctor: OK, and how has your energy been? Have you been having fatigue?
Patient: Yeah, I would say, uh, I don't know if it's because of the pain, but I definitely feel a lot more tired. 

Doctor: OK, and you mentioned diarrhea as well. When did that start?
Patient: Yeah, diarrhea also started around 3 days ago. I normally go 1 or 2 times a day, but now I'm going like 6 or 7 times a day and it's all usually pretty watery. 

Doctor: OK, have you noticed any blood in the stool? 

Patient: No, I don't think I noticed blood. 

Doctor: OK, and have you noticed any, really like, dark or tarry looking stool?
Patient: No, it's usually just been loose watery stools. 

Doctor: OK, and have you been experiencing any other symptoms besides the sore throat, muscle aches, fatigue, and diarrhea? 

Patient: Uhm, no, I don't think so. Those are probably all of the symptoms. 

Doctor: OK, so quickly to run through a review. Have you been having any fevers or chills?
Patient: No, not that I've noticed. 

Doctor: OK, how about any headaches?
Patient: Uh, no. 

Doctor: OK, and have you had a runny nose?
Patient: No. 

Doctor: Have you had a loss of smell or taste?
Patient: I don't think so. I haven't been really eating too much recently, but I don't think so, no. 

Doctor: OK, have you had a cough? 

Patient: No. 

Doctor: Shortness of breath?
Patient: No. 

Doctor: A wheeze?
Patient: No wheezing. 

Doctor: OK, you said you haven't had a cough, but have you brought up any sputum?
Patient: No. 

Doctor: OK, and have you had any chest pain? 

Patient: No chest pain. 

Doctor: Alright, any dizziness or lightheadedness?
Patient: Nope. 

Doctor: Any feeling as though your heart is racing.
Patient: No. 

Doctor: OK, have you had any abdominal pain?
Patient: Uhm, maybe just a little bit with all the diarrhea, I feel like I do have some, Just, tenderness in my abdomen. 

Doctor: OK, uh and have you had any nausea or vomiting?
Patient: No, not really. 

Doctor: OK, have you had any urinary problems? 

Patient: Uhm, no. 

Doctor: OK, and any rashes anywhere?
Patient: No, not that I've noticed. 

Doctor: OK, and have you had any changes to your weight recently or over the last several months?
Patient: No, my weight has been around the same. 

Doctor: OK, and have you been diagnosed with any medical conditions before? 

Patient: Yeah, so I have high blood pressure and high cholesterol. 

Doctor: OK, do you take any medications for either of those?
Patient: Yeah, so for the cholesterol I'm taking this medication called Crestor. For the high blood pressure I'm taking this medication called Ramipril. 

Doctor: OK, uhm, and do you take any other medications like over the counter or supplements or prescribed?
Patient: Just multi-vitamins. 

Doctor: OK, have you been hospitalized before? 

Patient: Just, like, in my teens I had my appendix removed but that's it. I have been pretty good otherwise. 

Doctor: OK, have you had any other surgeries besides the appendix removed?
Patient: No, that's the only surgery. 

Doctor: OK, and any allergies to medications?
Patient: No, not that I know of. 

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

Patient: Yeah, so I currently live with my wife and son. We live in a house just in London, and like, I made sure to just isolate myself to one room and I wear a mask around them just in case. 

Doctor: OK, well that's good. Yeah, it's important to be socially distancing, especially when having symptoms. Has anybody else in that house been sick?
Patient: No, no one has been sick recently, at least in my house, but uh, just two weeks ago I did attend a family event, and just last week I found out, uhm, someone was having symptoms. They just got tested two days ago and their test result hasn't come back. 

Doctor: OK, I see. And have you traveled anywhere outside of the province or outside of the country?
Patient: No, it was just here in London, so nothing other than that. I haven't left the province. 

Doctor: OK, and what was the approximate number of people?
Patient: It was just five peaople so we satyed within the limits stated for the city and they were people, in like, my circle as well, so yeah, I don't think I was doing anything wrong. 

Doctor: OK, just to give an idea of like, risk and contact tracing as well if we need to. And, uh, do you smoke cigarettes? 

Patient: No, I don't smoke. 

Doctor: OK, and do you drink alcohol?
Patient: Yeah, maybe a one or two beers a week. 

Doctor: OK, and uh, do you use any recreational drugs?
Patient: No, never. 

Doctor: OK. And, uh, in terms of family history, does anybody in the family have any heart or lung conditions? 

Patient: No, no, not that I know of. I Do you think my brother, my older brother, has high blood pressure. 

Doctor: OK, nobody's had a heart attack or a stroke?
Patient: Uh, no. 

Doctor: Or any cancer in the family?
Patient: Oh yeah, cancer, uh, so my father has. It's not the bad skin cancer, it's the one where they can just zap it off. 

Doctor: OK, uh, and so, he hasn't needed surgery for it?
Patient: No? 

Doctor: OK, and I think that's all the questions that I wanted to ask today. Was there anything else that that maybe I forgot to tell you or forgot to ask about? 

Patient: Yeah, I was just wondering, I don't know the results of the contact that I had, uh, so should I also get tested today? 

Doctor: Yeah, certainly with nonspecific symptoms such as what you've been experiencing, we will do a test for covid today. However, we will do some lab investigations as well, because it could be something else, so we'll wait for some of those results to come back, and it's great that you've already taken the initiative to isolate from family members and whatnot. And so I ask you to continue doing so, and we will get back to you when the results are in.
Patient: Yeah, nice to meet you I, I've been having just over the last week my cough that's been getting worse and I had a fever a couple of nights and just yesterday I noticed that I started having a loss of taste and smell so that got me really worried. 

Doctor: OK, so yeah, let's rewind a little bit. The cough you said started a couple of weeks ago, so would that be about 2 weeks? Three weeks?
Patient: I would say last week, so like 7 seven days ago. 

Doctor: Seven days ago, OK. So that started seven days ago and then when did the fever start? 

Patient: The fever I hasn't been constant, but I've like had some nights where I just feel really chilly and then during the day sometimes even getting these chills I've been recorded at a temperature, but I think I've had a fever at least three times in the last week. 

Doctor: OK, so you haven't actually taken your temperature, but it you just feel like you have chills?
Patient: Yeah. 

Doctor: OK, we could take your temperature today. And then the loss of smell and taste. Do they both happen at the same time?
Patient: I think the taste happened like before, but that was just yesterday and then yesterday morning like at breakfast, I couldn't really taste anything and then continued during lunch and dinner, but smell, I kind of lost around the evening. 

Doctor: OK. 

Patient: Yeah, all just started yesterday. 

Doctor: OK. Um alright, so let's go back to the cough and has it been constant since it started?
Patient: Yeah, it's been pretty constant. It's been getting worse, especially like in the last few days. I'm mainly coughing like before I was coughing mainly at night, but now I'm coughing throughout the day. 

Doctor: OK, um so yeah, you mentioned possibly a trigger would be like time of day at night? Or did you notice any other triggers like you know, the cold air or dust or anything at home that could be potentially triggering your cough?
Patient: Uh no, not really. Like I've lived in the same place for awhile, no new changes and I've been barely going outside, so I don't think there are any triggers. 

Doctor: OK, and in terms of the quality of your cough is that, would you say it's harsh? Barky?
Patient: Uhm, I would just say it's like kind of harsh at times, but mainly it's a dry cough, like I'm not bringing anything up. 

Doctor: OK, OK. And then you said dry cough so no sputum or blood right?
Patient: No. 

Doctor: OK. Have you ever experienced anything like this in the past?
Patient: Not the loss of taste and smell, but like the other stuff when I just had a cold or flu like symptoms previously, but the taste and smell is something completely new. 

Doctor: OK. And then, um, have you experienced any shortness of breath? 

Patient: Um, not really, no. 

Doctor: No, OK. How about we wheeziness?
Patient: No. 

Doctor: Chest pain? 

Patient: No chest pain. 

Doctor: OK. Uh, experienced any weight loss recently?
Patient: No, not that I know. 

Doctor: OK, how about fatigue? 

Patient: I have been a bit tired in the last few days. The fevers at night and morning. Just feeling a little bit crummy, just not really energetic, energetic to do anything. 

Doctor: Yeah, for sure.
Patient: Just been planner, just sitting on the couch. 

Doctor: OK. Any changes to your hair, nails, or skin, like rashes?
Patient: No, I haven't noticed anything like that. 

Doctor: OK, you mentioned loss of smell. Do you have a runny nose or a stuffy nose?
Patient: I did have a runny nose earlier this week, but that's kind of subsided. Other than that, I don't really feel too much congestion. I've been taking Tylenol, the Tylenol cold so I don't know if that helped. 

Doctor: OK, how often are you taking the Tylenol cold?
Patient: I just took it like for four days just before going to sleep in the last week. 

Doctor: Oh, I see. OK. OK and then. Any I do have a sore throat? 

Patient: No. 

Doctor: No, ok. How about any changes to your vision or hearing?
Patient: No, nothing like that. 

Doctor: Any pain or discharge in the eyes or ears? 

Patient: No. 

Doctor: OK. Do you ever feel like your heart's racing?
Patient: Uh no, not really. 

Doctor: No, OK. And any swelling in your limbs? 

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

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

Doctor: OK. Confusion or memory loss?
Patient: No, not that I can tell. 

Doctor: OK, any changes in your bowel habits like constant constipation or diarrhea.
Patient: Oh no, not really. 

Doctor: No, no blood in the stool, right?
Patient: No. 

Doctor: OK, any changes to your appetite?
Patient: Um, just maybe in like a little bit with the loss of smell and taste, the food is not really the same in the last day, last few days? 

Doctor: Yeah yeah, that makes sense. Any nausea or vomiting?
Patient: No. 

Doctor: No, OK. And any changes in terms of urine?
Patient: No, I've been peeing alright. 

Doctor: OK, good. Any major or a longstanding medical conditions, or are you otherwise healthy? 

Patient: No, I've been fortunate otherwise healthy. I had asthma as a kid, but like I haven't had to use the puffers for more than a decade. 

Doctor: Oh ok. OK. And what triggers your asthma?
Patient: I think back then it was just when I did sports and I was running around a lot. I've been fine for the last 10 years at least. 

Doctor: OK. OK, that's good. And any surgeries or hospitalizations in the past?
Patient: No. 

Doctor: No, OK. Any are you on any medications?
Patient: Currently just the other thing, Tylenol cold, but other than that no other medications. 

Doctor: OK, not even other over the counter medications or herbal supplements?