jshargo/medical-interview-conversations huggingface dataset:
Patient: Sorry 8 pounds, 8 pounds. 

Doctor: Yeah, no worries. And then otherwise she is, so she's been healthy otherwise, been doing well, uh just in terms of how she's been doing uh with other systems of her body, have you noticed any concerns for her bowel movements? 

Patient: Uh no, she's been pretty regular. 

Doctor: OK, any concerns for peeing?
Patient: Uh no, she's been going pretty frequently and she's, yeah no changes there. 

Doctor: And we already talked, she hasn't had any fevers, when she coughs does she ever bring anything up? 

Patient: Uh no, I haven't noticed any phlegm, no. 

Doctor: OK, and when she's having these wheezy episodes, do you ever notice that she looks like she's really straining to breathe, really struggling?
Patient: Uh yeah, so she, it's not like she turns blue or anything like that, um she just slightly slightly has a hard time catching her breath. 

Doctor: OK, so these usually recover on their own?
Patient: Yeah. 

Doctor: You don't give her anything for it?
Patient: No. 

Doctor: OK, uh does she have any allergies? 

Patient: Um no, well she has some seasonal allergies, but nothing that she's been tested for. 

Doctor: OK, do you give her anything for seasonal allergies?
Patient: Sometimes she takes like Reactine or like over the counter stuff, but um no, no prescribed medications. 

Doctor: OK, so she doesn't have any allergies where her face swells up or she has trouble breathing?
Patient: No. 

Doctor: OK, and this, these episodes mainly happen when she's playing with friends, so do they happen in a certain environment? Like for example, is this in a friends house or is this outdoors or has it been across different settings? 

Patient: It's been across different settings but I will say it's worse when um when when there's colder weather. 

Doctor: OK.
Patient: Yeah. 

Doctor: And do these episodes ever happen in your home?
Patient: Yeah. 

Doctor: And what's the context from them happening in your home? 

Patient: Um usually when she is out and about running around in the backyard with her friends um is when I've mostly noticed it, yeah. 

Doctor: OK, so she doesn't have any symptoms at rest?
Patient: Oh, no. 

Doctor: And she doesn't have any symptoms at night? 

Patient: Uh at night, so there was one one one night when she had some issues um with like wheeziness but it did resolve on its own. 

Doctor: OK. And did she wake up at night with that or just?
Patient: Just trouble falling asleep, I think yeah. 

Doctor: OK. Alright, so we already talked about, so she doesn't really have any past medical issues that she's seen a  for, uh any surgeries? 

Patient: No surgeries. 

Doctor: OK. Is she taking medications right now?
Patient: Um no, no medications. 

Doctor: Aside from the occasional Reactine? 

Patient: Uh yeah, aside from that, nothing, no regular medications. 

Doctor: And she's in school?
Patient: Um yeah, she's uh she's in Grade 3 now. 

Doctor: OK, and does she live with you?
Patient: Uh yeah she lives with me and my husband. 

Doctor: OK, do you two live in a house in town?
Patient: Um yep, in a townhouse 

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

Patient: Um so my husband is an ultrasound technician and I am a uh kindergarten teacher. 

Doctor: OK, excellent, and this is a question we just ask everyone, has there ever been any CC CAS involvement in the family?
Patient: No. 

Doctor: And does anyone smoke in the household?
Patient: Uh, no no. 

Doctor: OK, uh do you keep any carpets or pets in the household?
Patient: We have carpets, but they're new carpets. We just got them, uh maybe six months ago, and nothing else. 

Doctor: So no pets, no dogs? 

Patient: No. 

Doctor: OK. Any wood burning fireplaces, stoves in the household?
Patient: No. 

Doctor: And changed your air filters?
Patient: Yeah. 

Doctor: Alright, excellent, so I think I have all the information I need, we're just going to do a physical exam and then I'm going to go talk to the physician and I'll come in and see your daughter and we'll talk about next steps from there. Do you have any questions that you'd like me to direct to him before that happens? 

Patient: No, thank you so much. 

Doctor: Alright, have a good one
Patient: I just bringing my son in today because he's had this cough that's been going on for a few days now and for these past two days, I've noticed that he's been just tugging at his ear more as well. 

Doctor: OK, so you said the runny nose started two days ago?
Patient: Yeah, yeah he had a cough yeah cough and runny nose started about yeah 2-3 days ago 

Doctor: Okay, the runny nose, what color is the discharge? 

Patient: Pretty clear and watery 

Doctor: OK, and the coughing is it dry, or is it bringing up any phlegm?
Patient: It's been dry. 

Doctor: It's been dry OK. And does it sound harsh? 

Patient: Not really, 

Doctor: No?
Patient: I don't know. It sounds kinda like a typical cough. 

Doctor: OK, has he lost his sense of taste or smell? 

Patient: He's been a bit more irritable and not eating as much but I'm not sure. 

Doctor: OK, how about changes in his vision or hearing?
Patient: No 

Doctor: OK. Any fevers?
Patient: Uhm, I don't think so. But he, we haven't checked and he's been, yeah, as I said, kinda, a little bit irritable. 

Doctor: OK, any weight loss recently?
Patient: Uhm no, he's been gaining weight. Actually, sorry, I think it. Yeah, he has had a fever. The fever. Yeah the fever started like yesterday. 

Doctor: Oh OK, did you take his temperature?
Patient: Yeah, my my wife just texted me and told me that she checked it, checked it and said it was over 38. 

Doctor: Oh OK. Yeah, we'll definitely take a temperature here as well just to make sure. Has he had any rashes?
Patient: No, 

Doctor: No rashes OK. And how about shortness of breath or wheezing?
Patient: No, I haven't heard that. 

Doctor: No, OK. And then have you actually taken a look into his ears?
Patient: No, I haven't. He has just been tugging at the right one. 

Doctor: Is he itching it at all?
Patient: Uh yeah, I guess just kind of like really rubbing it around the outside and pulling on the lobe a little bit. 

Doctor: OK, any discharge? Oh sorry go ahead 

Patient: Sorry I'm just gonna say yeah he's been kind of fussy and pointing at it and no discharge from the ear. 

Doctor: No discharge, OK. Does it look swollen?
Patient: No, the outside of the ear looks normal. 

Doctor: OK, OK, and how have his bowel movements been?
Patient: That's been normal, . 

Doctor: Normal. Any changes in his urine?
Patient: No, it's been normal. 

Doctor: Nausea or vomiting? 

Patient: Nope. 

Doctor: uhm headaches?
Patient: No, I don't think so. 

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

Doctor: No, any confusion or memory loss? 

Patient: No, I don't think so. 

Doctor: No OK, is he an otherwise healthy child?
Patient: Yeah, he he is. I mean he, uhm about six months ago he had uhm croup I think but he recovered quickly from that and he didn't need to be hospitalized or anything. 

Doctor: OK, and his mother's pregnancy with him, was it complicated in any way?
Patient: She had gestational diabetes, but it was diet controlled and she's healthy now from that perspective. 

Doctor: OK, OK, that's good. Uhm and then was he born at term? 

Patient: He was yeah he was born over like 38 weeks I think 

Doctor: Oh OK, good and was it a C-section or a vaginal delivery?
Patient: Uhh vaginal. 

Doctor: OK, any complications during the delivery? 

Patient: Uhh no. 

Doctor: No, OK, how about uhm after birth? Was he hospitalized for any reason?
Patient: No, he wasn't. He was able to go home. 

Doctor: OK, that's good. Uhm and has he been developing normally in terms of his motor movements, like behavior wise, social wise, like is he on par with his peers in terms of milestones? 

Patient: Yeah he is. Yeah, everything's been normal that way and he's been growing well too. 

Doctor: OK, good. growing while gaining weight well, OK, is he on any medications?
Patient: No, he's not. 

Doctor: OK. Is he up to date with all his immunizations?
Patient: He is, yeah, we've been following along with with that. 

Doctor: OK, does he have any allergies?
Patient: I don't think so. 

Doctor: No, Ok. Any family history of lung or heart conditions?
Patient: Uh, no. 

Doctor: No OK. Does anyone at home smoke?
Patient: Uhm I do but not like in the house or anything like that, usually just well, it will always be either outside or when I'm at work. 

Doctor: OK OK, any old carpet, dust, mold, asbestos, anything like that in your home?
Patient: No. 

Doctor: No. OK. Who does he live with? 

Patient: So yeah, he lives with me. It's just me and my wife. 

Doctor: OK. Any pets at home?
Patient: We have a a dog. 

Doctor: OK. Has he been in contact with anyone sick recently? 

Patient: Uh. Not that I can think of. 

Doctor: OK is he in like daycare?
Patient: No, no my wife's been, been looking looking after him at home. She's the primary caregiver, well while I'm at work. 

Doctor: OK, any trouble recently?
Patient: No no. 

Doctor: No, OK. Well, those are all the questions that I had for you today. Did you have any questions of your own? 

Patient: Uhh no, just was wondering what what might be going on? 

Doctor: Yeah, for sure, so right now it sounds like a viral picture. It sounds like he has a cold and possibly an ear infection. I'd have to take a look into his ear to be able to tell more uhm because some of his symptoms overlap with those of covid we'll probably do a swab and you should hear back in about 24 to 48 hours. Uhm and so after I take a look into his ears, we can do one of a couple of things, so if his tympanic membrane looks like it's been perforated, or if there's pus in there, then we'll prescribe him a 10 day course of antibiotics, and if I see like middle ear effusion or his tympanic membranes bulging, and he seems really sick like he has a high fever, what she does, I will again prescribe him 10 days of antibiotics. And if he has a middle ear effusion or a bulging tympanic membrane, just one of those two, and he doesn't seem to be too sick, we can reassess him in 24 to 48 hours. Uhm An antibiotic that we usually prescribe is amoxicillin. Uhh how does that sound?
Patient: I've had this cough for over a week now, and it just hasn't gone away. 

Doctor: OK, and uh, so this cough has been going on for a week. Can you describe the cough a little bit for me?
Patient: Yeah, so I mean sometimes I produce sputum and sometimes I don't. It's uh, white and whiteish clear in color. 

Doctor: OK, um, and it's been going on for more than a week.Has it been getting worse? 

Patient: It got a little bit worse at first, but then it's been kind of the same, um, since. 

Doctor: OK, have you noticed at all, um, like green or yellow color of your sputum or any blood tinged sputum?
Patient: Uh, No blood, and maybe a little yellowish. 

Doctor: OK, little yellowish, OK. And how much would you say you bring up, um, on an average day? 

Patient: Uh, a couple of teaspoons. 

Doctor: Couple of teaspoons OK.OK, has there been anything that um, makes it worse or better?
Patient: Nothing that I can think of. 

Doctor: OK, and have you had this happen to you previously in the past? 

Patient: No. 

Doctor: And is the cough uh, constant or does it come and go?
Patient: It comes and goes, uh, throughout the day. No particular time of the day it's worse. 

Doctor: OK, and, um, are you having any, uh, other symptoms besides the cough, um, like shortness of breath,sore throat, um, runny nose, congestion, anything like that?
Patient: Uh. yeah, I've had, um, a sore throat, uh, and a headache, as well. 

Doctor: OK, and when did the sore throat start?
Patient: Um, that started about five days ago. 

Doctor: Five days ago? And has it been getting worse? 

Patient: No, that's been about the same. 

Doctor: And do you have any difficulty, uh, swallowing at all?
Patient: It's a little sore, but, uh, it's been OK, to eat and drink. 

Doctor: OK, and have you noticed any kind of redness in your throat or any swelling around your neck?
Patient: No, I took a look in the mirror as best I could with my phone and I couldn't really notice anything that looked red. 

Doctor: OK, and how about the headache? When did that start? 

Patient: So it's been, uh, kind of off and on over the past, uh, week or so. Um, feels like a like a pressure sensation and my head is just really squeezing. 

Doctor: OK, and um. So is it on one side of your head or both sides?
Patient: Both sides. 

Doctor: And it's Kind of like a pressure and squeezing. Is it at all pulsating?
Patient: No 

Doctor: No? OK, Is it constant or does it come and go? 

Patient: It comes and goes. 

Doctor: OK, and have you taken any medications to make any of these symptoms better?
Patient: Yeah, I have used some Advil for the headaches and over the counter medicine at night time to help sleep. 

Doctor: OK. Uh,and do you recall doing anything in the last few weeks which you might believe that Uh, caused some of these symptoms? like for example, were you in contact with anyone that was sick at all?
Patient: Well, I'm a nursing student and I've been on rotations in the hospital recently. 

Doctor: And anyone that you probably saw in the hospital, anyone sick that you were in contact with? 

Patient: I did see some people who had, like, infectious symptoms. 

Doctor: OK, and other than that, have you been having any fevers or chills?
Patient: Yeah, I've felt chills. 

Doctor: OK chills, and when did you feel them? 

Patient: I've been feeling chills throughout the day and at night, I just feel like I can't get warm even with a blanket on. 

Doctor: OK, and have you taken your temperature at all?
Patient: No. 

Doctor: OK yeah, we can do that for you today. Uh, other than that any recent travel outside of the province. 

Patient: No, been just at school. 

Doctor: OK, and any loss of sense of taste or smell?
Patient: No. 

Doctor: Any nausea or vomiting? 

Patient: No. 

Doctor: Any night sweats?
Patient: No, 

Doctor: OK, any fatigue?
Patient: Yes. 

Doctor: OK, and When did that start?
Patient: Just over this past week I've been really tired, I've been been needing naps and not feeling rested in the morning. 

Doctor: OK, any chest pain at all? 

Patient: Yeah, It does feel sore, kind of, uh, the center of my chest. 

Doctor: OK, so any coughing at all?
Patient: Yeah, I feel it, like more, like it does hurt when when I'm coughing, that's kind of what I'm feeling it. I think it's being caused by how much I'm coughing.I kind of feel it there in the center. 

Doctor: And besides, when you're coughing, do you have any pain in your chest when you're breathing in or out?
Patient: No, 

Doctor: No? OK. Alright, any changes to your bowel movements, like any Constipation or diarrhea?
Patient: No. 

Doctor: Any urinary issues?
Patient: No. 

Doctor: OK, any changes with your sleeping or your appetite? 

Patient: No. 

Doctor: Have you noticed any significant weight loss in the last few weeks?
Patient: No, it's been the same. 

Doctor: OK. And have you recently, prior to your coughing, have you had any infections like a viral illness or like a cold for example, anything like that?
Patient: Yeah, now that I think about it, I mean, maybe like a month ago I had like a runny nose for a couple of days and it just went away. 

Doctor: OK, were you on any kind of medications or antibiotics at all? 

Patient: No, just went away on its own pretty quickly. 

Doctor: Alright, do you have any past medical conditions, like high blood pressure, diabetes, anything like that?
Patient: No, I don't, I'm healthy. 

Doctor: OK, do you have any allergies?
Patient: No. 

Doctor: Do you take any medications regularly? 

Patient: Uh, no. 

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

Doctor: OK, and any family history of any lung or heart conditions or any cancers? 

Patient: I think my mom has high blood pressure, but that's about it. 

Doctor: OK. I forgot to ask you this earlier. Have you been experiencing any wheezing?
Patient: Yeah I have noticed a bit of a wheeze, yes. 

Doctor: And currently you are nursing student. Where do you live?
Patient: I live with a couple of my classmates downtown. 

Doctor: OK, and do you live in an apartment or dorm, a house? 

Patient: An apartment. 

Doctor: OK, anyone sick in your household at all?
Patient: No, nobody's been sick. 

Doctor: OK, do you drink alcohol at all? 

Patient: Sometimes with friends, on a weekend. 

Doctor: Do you smoke cigarettes at all?
Patient: No, I don't. 

Doctor: And any recreational drugs like marijuana? 

Patient: Nope. 

Doctor: OK. Alright, so yeah those are all the questions I had for you. Do you have any questions or concerns?
Patient: No, I was just hoping to feel better. It's been going on for so long now. 

Doctor: You said it's more than a week now, right?
Patient: Yes. 

Doctor: Yeah, so what we will do today is, uh, first of all, with the pandemic going on, with some of these symptoms, we need to rule out coronavirus. And so we will be getting a swab done for you as well today and considering you are having these symptoms, we will also get another test done for you today to see if there's any bacteria causing what we call walking pneumonia. It's community acquired pneumonia that's fairly common in like the younger population. And so we'll see if you could have that. And so from there we'll see if we need to put you on any antibiotics which will help you. And if we need to get any blood work or X Rays we'll let you know as well. Is that OK? And if you feel like you have worsening symptoms like shortness of breath, you need to make sure you come back to the Emergency Department. 

Patient: Yeah, that sounds great. Thank you. 

Doctor: Yeah, you're welcome and take care, and we'll get all those things done for you and we'll be with you shortly.
Patient: Hi so I just like for I don't know like three or four days I’ve been having this really dry cough and my throat feels really scratchy. I just feel kinda crappy overall. And my head’s pounding 

Doctor: Your heads pounding. You have a headache right now?
Patient: Yeah, little bit. I just kind of feel just icky. 

Doctor: OK, and you say I've been feeling that for three to four days now. 

Patient: Yeah, yeah exactly 

Doctor: What did you first notice?
Patient: I first noticed that my throat was kind of scratchy and then I started coughing, but it's really like dry. 

Doctor: OK, so you haven't been bringing anything up with it?
Patient: No, 

Doctor: Any flem? 

Patient: no nothing. 

Doctor: OK, you haven't been noticing been running a temperature at home. Have you hot fevers?
Patient: I have felt really hot. 

Doctor: You felt hot at home, OK,
Patient: yeah, 

Doctor: You noticed any night sweats by night sweats. I mean you wake up sheets are soaked. 

Patient: I honestly I felt hot like all the time like yeah yeah night. I feel hot but during the day too I'm just like I'm I'm like hey I'm wearing like just shorts and like a tank top and I just still feel really hot. 

Doctor: OK. You notice, skin changes anything in your arms or legs it looks weird? New rashes?
Patient: I don't. I don't think so. I haven't really been looking, but you know. 

Doctor: No worries and then aside from that, any nausea? Any vomiting?
Patient: No, not that. No, nothing like that. 

Doctor: Any diarrhea?
Patient: No no. 

Doctor: Any aches in your joints anywhere?
Patient: No. I mean, I'm I'm tired, but I don't think they're not like hurting. 

Doctor: OK, so aside that aside from kind of this dry cough feeling hot that otherwise you're feeling OK. You don't have any other real concerns aside from that.
Patient: Yeah, just like I just feel crappy like. Yeah, I really. I don't think I know that's not like a a real like way to say. 

Doctor: Oh no, no, it's perfectly valid. We called that Malays in general. Just feeling a little bit off. Alright so this is going to talk about you for a little bit, but first, we'll get to that later. So any issues that you've seen a  for before? 

Patient: I have I have allergies. Usually in like the spring in the fall. 

Doctor: Do you have any allergies to any medications?
Patient: No, no nothing like that. It's just like I get, really bad allergies like I I've seen an allergist and some years I've gotten allergy shots. But like not every year. Otherwise, I'll take like Claritin. This isn't like this is maybe around like this is just before they normally start, so I don't really have them right now. 

Doctor: OK. 

Patient: Probably like in a few weeks they'd be really bad. 

Doctor: Now do any of these allergies can't make it difficult to breathe or you feel like your face is swelling up?
Patient: Uh. Like it feels like a little bit like plugged up an like what's that called like post nasal drip? But I don't really feel like I can't breathe. 

Doctor: It's just like a little stuffy.
Patient: Yeah, yeah, exactly. 

Doctor: And these shots at the allergist gave you, how often would you get those?
Patient: Those are the ones that I'd have like once. Usually like once a week for a little while, like in the winter before. 

Doctor: OK, so you don't carry an EpiPen with you.
Patient: No, no, they said it's not like one of those allergies and it's just like it's just like the seasonal ones. But they're just bad. 

Doctor: OK, sounds good. So you've seen an allergist. Any other doctors that you've seen in your life? 

Patient: My family doctor. I don’t really go very often. 

Doctor: OK, has there been any health issues that you've had in the past?
Patient: No, like I've been really healthy. It's just like the allergies and. 

Doctor: OK, any surgeries in your life? 

Patient: Uh, no, no. 

Doctor: No. Are you takin any medications right now?
Patient: I take. Claritin for allergies but I haven't like right now. I just have it with me just in case. I take birth control. 

Doctor: What type of birth control do you take?
Patient: Deyo 

Doctor: OK and you take that regularly? 

Patient: Yeah, it's just like the pill. It's like the one that goes for three months. 

Doctor: OK, so you don't have an IUD now you just take the oral contraception?
Patient: Yeah yeah, just the pill got it. 

Doctor: Got it. OK and then so you never had asthma in your life? 

Patient: No. 

Doctor: OK, any family history of asthma?
Patient: Like my cousin. 

Doctor: OK, what about your parents, brothers, sisters? 

Patient: No, nothing like that. 

Doctor: Do you know what eczema is?
Patient: Like, I've heard of it. 

Doctor: OK, anyone in the family have it?
Patient: No. Like the only thing, like my dad has allergies too. Same kind as me. 

Doctor: OK . Dad has allergies. OK, mother and father still alive?
Patient: Yeah. 

Doctor: Healthy? 

Patient: Yeah. 

Doctor: OK good, do you live with them right now?
Patient: Yeah, yeah, like I'm in high school. 

Doctor: OK so you live in a house with both your parents. OK any brothers sisters? 

Patient: Yeah I have a little brother. 

Doctor: How old’s he?
Patient: Like 14 now. 

Doctor: Has anyone in the family been sick recently? 

Patient: I think my brother we had like a cold a few weeks ago 

Doctor: He had a cold.
Patient: Yeah. 

Doctor: OK. 

Patient: But like we are doing our school from home now so. 

Doctor: Got it.
Patient: My mom works from home and my dad just works like on the farm so. So no one's been like seeing anyone or going anywhere to get sick. 

Doctor: OK, so sorry, do you live on a farm?
Patient: Yeah, 

Doctor: OK, in London?
Patient: Like just outside. 

Doctor: OK. Any travel or anywhere recently? 

Patient: No, like I just just came here. But like I don't really leave the house 

Doctor: So last last two weeks you haven't left the country?
Patient: No. 

Doctor: Nothing like that.
Patient: I wish. 

Doctor: You keep any animals on the farm? 

Patient: We have like a dog, but it's not like an animal farm 

Doctor: Got it. OK, another questions, are you sexually active?
Patient: Uh no. 

Doctor: But you're taking the birth control? OK, so when was your last menstrual period?
Patient: Like like I just got done like a week ago.  A week ago. And you haven't been sexually active since then.  No. 

Doctor: OK. So chances of being pregnant very low.
Patient: Oh Oh yeah yeah, it's been like a year. 

Doctor: Got it got it alright, do you smoke? Cigarettes?
Patient: No. 

Doctor: Do you drink alcohol?
Patient: Like before Covid, when I saw my friends like sometimes a little bit but like not really anymore. 

Doctor: OK, how much would you drink when you went out?
Patient: Oh like, I mean, our parents would sometimes let us have like a couple coolers, but like that, was it? 

Doctor: Got it. Any other drugs? Marijuana, cocaine?
Patient: Like I tried marijuana once at a party like a couple years ago, but like I had, I never did it again. 

Doctor: Got it so none of the harder drugs, cocaine, heroin?
Patient: No. 

Doctor: And I gotta ask this question for everyone. Have you ever injected drugs or anything into your arm or your body? 

Patient: No. 

Doctor: OK. Alright, thanks Jessica. So just to summarize, you kind of had a three to four day dry cough with a little bit of fever, some headache, and just in terms was quickly reviewing then. So you have been bringing anything up. No one in contact with these recently been sick. You don't have asthma, your not taking any medications aside from Claritin, and your little brother might have been sick about two weeks ago with kind of a common cold and we're hoping to get out of this visit is just kind of next steps and where to go from here, correct?
Patient: Yeah, like, I just want to know if I have to like take medicine or something. 

Doctor: OK. Alright perfect Thank you very much. You have any more questions? 

Patient: No, I don't know. I don't have any more questions. I just like I can go home soon like lay down. 

Doctor: Sounds good, thanks Jessica.
Patient: Hi, um so for the past week or so I've um I've had this cough um and some shortness of breath. I feel hot and I just feel kind of uh fuzzy like I just I can't concentrate on things very well. I get confused sometimes so I thought I'll come to you to get it checked out. 

Doctor: Yeah, yeah it's it's that was a really good idea to come in to get checked out. Um so can you uh, I'll talk I'll ask about each symptom a little bit. So starting with the shortness of breath can you um tell me how uh bad the shortness of breath has been? 

Patient: Uh it's been sometimes it's not so bad, some other times it's really bad. Um at first it wasn't that bad, but now like I'm having a hard time taking a deep breath in. Um it hurts and I just feel like I can't walk like 2 blocks even before getting short of breath. 

Doctor: And uh before this week how much did, did you ever feel short of breath before this?
Patient: No, nothing like this before. 

Doctor: No, OK. Um do you feel that the shortness of breath has gotten kind of worse over time?
Patient: Yeah, I think so. 

Doctor: And what about the cough? Did that start at the same time as the as the difficulty with breathing? 

Patient: Um it started before the difficulty with breathing. 

Doctor: Can you, uh is it a dry cough or a wet cough?
Patient: Um it was it was a dry cough at first, but now I'm seeing some phlegm um and it looks kind of yellow. 

Doctor: Have you seen any blood in the phlegm? 

Patient: No. 

Doctor: Uhm and, uh, are you hearing any wheezing sounds?
Patient: Yeah, a little bit. 

Doctor: OK. Um how uh, has the cough sort of improved or gotten worse over time? 

Patient: Um it's it's gotten worse. 

Doctor: OK. And you mentioned you also you also have a fever. Did you check your temperature?
Patient: Um I did I it was like 38.5 this morning. 

Doctor: And have you been checking your fever this past week, or was that the first time you, um, checked it? 

Patient: It's the first time I checked it. I I've felt hot though in the past and I've felt like I had chills. 

Doctor: Yeah. You're also feeling a little bit fuzzy. When did that start, and can you explain that a little bit?
Patient: That started about um, I think like yesterday morning. Um I just feel fuzzy like I can't concentrate on things as much as I used to be able to. And the other day I uh was cooking something and then I forgot I was cooking it. Um yeah, just a little bit confused. 

Doctor: Did you leave the stove on?
Patient: No, no, I had turned it off. I just forgot I left like the pot on the stove and made dinner. 

Doctor: OK, OK and you feel like this is very new, that this has not been going on for weeks or months where you forget things or having difficulties with concentration? 

Patient: No this has never happened before. 

Doctor: Uh OK. I'm gonna ask you about a couple of other uh symptoms just to make sure that you don't have any other um, just to get a full picture. So do you have a headache at all?
Patient: Um no, no headache. 

Doctor: OK, any changes in your vision or your uh hearing that has that has uh been very sudden or that has happened over the past week?
Patient: No. 

Doctor: Nothing like that, OK. Um any change in your taste, change uh, sense of smell?
Patient: No. 

Doctor: Sense of taste?
Patient: No. 

Doctor: OK uhm and uh any runny nose or congestion? 

Patient: Um a little bit of a runny nose, yeah. 

Doctor: And what's that discharge like? What colour?
Patient: It's also yellow. 

Doctor: Um any uh sore throat? 

Patient: Uhm no, no sore throat. 

Doctor: OK. And um any chest pain?
Patient: Yeah, it hurt hurts when I try to take a deep breath in. 

Doctor: When did that start? 

Patient: That started about the same time as my shortness of breath. 

Doctor: OK, uhm and uh any uh do you feel like your heart is racing?
Patient: Um no, not really no 

Doctor: OK. Do you get any chest pain otherwise um in this week when you're not trying to take a deep breath? 

Patient: No, there's no chest pain at rest. 

Doctor: Where is your chest pain?
Patient: It kind of feels like central to my chest um uh yeah, just in the chest area, it doesn't radiate to anywhere else. 

Doctor: OK OK. Does it get better right away after you um sort of stop taking that deep, stop doing deep breathing? 

Patient: Uh no otherwise it doesn't hurt. 

Doctor: It doesn't hurt, OK good. Um alright, and any uh belly pain?
Patient: Uh no. 

Doctor: Any nausea or vomiting? 

Patient: No. 

Doctor: Uh any changes in your bowel movements like diarrhea or constipation that is new in the past week or two weeks or so?
Patient: No. 

Doctor: OK. Um any um difficulties with uh peeing? Do you have uh any pain or any increase in how often you're going to the bathroom, or how um urgently you need to get to the bathroom? Anything like that?
Patient: No. 

Doctor: No, OK. Any pains in your joints or muscles?
Patient: Uh no. 

Doctor: Any fatigue uh in the past week?
Patient: Yeah, I've been feeling tired. 

Doctor: Um any um any weight loss recently?
Patient: Uh no. 

Doctor: OK, any um night sweats? Do you feel like you're drenched in sweat at night?
Patient: Um no, no night sweats, but I do feel chills. 

Doctor: Yeah, um and any swelling in your your belly or your um in your feet, in your legs? 

Patient: No. 

Doctor: No, OK. OK uhm can you tell me about any uh medical conditions that you might have?
Patient: Um sure I had a DVT uh two years ago. I have diabetes, for which I am on insulin. And I have hypothyroid. 

Doctor: OK. I've got to say it's quite impressive that you know uh the word DVT, most patients don't know that.
Patient: I've had a blood clot. 

Doctor: Any um, so are you on any medications uh other than the insulin? 

Patient: Um yeah, so I'm on insulin and I'm on Synthroid. I'm on aspirin as well, like baby aspirin. 

Doctor: Have you ever had any um COPD?
Patient: No. 

Doctor: Ever been diagnosed with asthma?
Patient: No 

Doctor: Heart attack or any heart related problems? 

Patient: No. 

Doctor: OK, OK. Um has, have you had any hospitalizations in the past?
Patient: Um no. Actually sorry, I have, for the DVT. 

Doctor: Yeah, yeah, yeah, I see. Any surgeries? 

Patient: Uh no, no surgeries. 

Doctor: OK. Um what what caused your DVT? Do you remember or do you know?
Patient: Uh I was, I was flying somewhere. I was well, I was flying back from somewhere and I got off the plane and um I guess they found uh blood clots. 

Doctor: I see, I see. OK. Any allergies to medications, environmental allergies, food allergies, anything? 

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

Doctor: OK. And I forgot to ask in terms of medications, are you taking anything over the counter? Any herbal pills, any vitamins, etc.
Patient: Just some um calcium, vitamin D. 

Doctor: Well, that's great. 

Patient: Yeah. 

Doctor: That's great. Uh yeah, that's very important that you know for women um um above the age of 65, I think, 50. Um uh OK, so in terms of your living situation, are you living with someone? Are you living alone?
Patient: Um I live with my husband. 

Doctor: OK, and are you, um, is there anybody else in the house? Any pets, animals?
Patient: Uh no, we don't have any pets or animals. 

Doctor: And uh are you able to take care of things like uh dressing, uh changing, going to the bathroom on your own? Do you need help? 

Patient: Uh no, I am pretty independent. 

Doctor: What about things like groceries or taking care of finances?
Patient: Uh no, I'm pretty independent in in that aspect as well. 

Doctor: OK, that's wonderful. Um have you had any recent travels?
Patient: No, I've been trying to stay at home because of Covid. 

Doctor: That's good. Um and any, do you think any exposures to anyone who could possibly be sick? For you or your husband?
Patient: Um I mean we we do laundry at a laundromat. Um but other than that, no. 

Doctor: OK. Um OK. Uh alright, well I think I have all the information I need today. Um let me go talk to my my preceptor and we'll come and do physical exams and listen to your chest and uh do a few uh lab tests to draw your blood and do a chest X Ray likely and then um uh go from there. You, it sounds like um sounds like with the with the fuzzy feeling, the fevers, the difficulties breathing, I think it would be a good idea for you to stay here for a couple of days maybe, but we'll um we'll let you know what happens and what the results show. I'm really glad that you decided to come in today. Do you have any questions for me?
Patient: Um no, thank you so much. 

Doctor: Welcome. Um so the likely diagnosis is um a pneumonia, either bacterial or viral, but given yeah, yeah could be either, OK.
Patient: Do I still need to isolate in this case? 

Doctor: Oh that's very true. Yep, Yep uh so.
Patient: Yeah, so I just came in because I've been having this cough that's getting worse over the last uh one and a half week and uh, I've also just recently in the last few days been getting some shortness of breath. Um and I also noticed uh my bowel movements have changed a little bit as well over the last week. 

Doctor: OK, so yeah, let's break this down. The cough, when did that start? 

Patient: The cough, I think it started uh probably like around 10 days ago. 

Doctor: 10 days ago, OK, and how about the shortness of breath?
Patient: That just started in the last uh I think 3 days. 

Doctor: OK, and then the the bowel bowel changes, when did that start? 

Patient: Yes, I think it also started in like, I would say, for the last three days I've been getting uh diarrhea. 

Doctor: OK OK, so let's go back to the cough, is it constant or um is it triggered by certain things like the cold air, dust, um you know, um, certain times of the day, like morning, evening?
Patient: Um, I would say it's pretty pretty constant since the last like 10 days, uh it's, there's no real pattern to it, and I've mostly just been inside my house. I don't think there are any triggers or I don't own any pets or anything like that, no new rugs, like uh, no no new changes really in my house. 

Doctor: OK, OK and um have you tried anything to make it better? 

Patient: Um, no, not really. I I've done some uh home remedies like trying to do one of those steam steam masks and see if that helps, but it didn't really do anything. 

Doctor: OK. Um and how about um the quality of that cough? Is it, does it sound harsh?
Patient: Um, yeah I would say it's getting a little bit harsh. It's more just like, I'm not bringing anything up, it's more like a dry cough um, but yeah, I would say it's getting worse, definitely. 

Doctor: OK. Um, is it a dry cough then, or are you producing a little bit of sputum or blood or anything like that?
Patient: No, no, I haven't seen any blood at all and rarely do I bring like up some sputum, but like most of the time it's just a dry cough. 

Doctor: OK, it's a dry cough. Um and would you say the cough's getting worse?
Patient: Yeah, I'd definitely say in the last um three to four days I've been just coughing nonstop, it's very irritating. 

Doctor: Yeah, have you experienced anything like this before? 

Patient: Um, probably a few years ago, I think I caught the flu or something and got really sick with a fever and just a lot of coughing. But since then, nothing else. 

Doctor: OK. Um the shortness of breath, 1 to 10, 10 being the worst, how bad is it?
Patient: Uh probably like a five. It kind of just started out with uh, three days ago, was kind of like I just couldn't take deep breaths like I noticed that my breathing was getting a little bit more more shallow and now it's, especially when I'm coughing, it's like I really have to sit down and catch my breath. 

Doctor: Yeah, um does anything make the shortness of breath worse? Like I guess um you know exertion, uh laying down, anything like that? 

Patient: Um, not really. Maybe like sitting down helps sometimes, but even when I'm sitting down I'm still coughing. 

Doctor: OK. OK and um do you have any wheeziness?
Patient: No, I don't think so. 

Doctor: OK, any chest pain?
Patient: Um, maybe from all the coughing, sometimes I feel like there's some pain there, but it's not not anything that's too painful. 

Doctor: OK, um do you feel like your heart's racing at all? 

Patient: Uh no, not really. 

Doctor: OK. Um have you noticed any swelling in your limbs?
Patient: No, I didn't notice anything like that. 

Doctor: OK, how about um pain in your calves when you walk a few blocks?
Patient: No, I've been fine that way. 

Doctor: OK. Dizziness or fainting spells?
Patient: Uh no, not really, I I thought maybe with the shortness of breath that would happen, but like so far that hasn't happened to me.  OK, any fevers or chills? 

Doctor: Uh no I, maybe like a few chills, like I'm not sure actually, it was hard to tell, but I haven't had any fevers.
Patient: OK, we'll take your temperature today just to make sure. Um any weight loss over the past few weeks? 

Doctor: Uh no, probably weight gain.
Patient: OK, any changes in your hair, nails, or skin, like rashes?  Uh, no, I haven't noticed anything like that. 

Doctor: OK, any changes in your vision or hearing? 

Patient: Uh no, no, that that's all been fine. 

Doctor: How about um loss of smell or taste?
Patient: No, I haven't had uh, I think my taste and smell are still pretty good. No, no issues there. 

Doctor: OK, um have you had a runny nose or stuffy nose? 

Patient: No, no, no no congestion really. 

Doctor: OK, and um have you had a sore throat at all?
Patient: No, no sore throat. 

Doctor: OK. Um any issues swallowing food?
Patient: No. 

Doctor: No, changes in your appetite? 

Patient: Maybe just a little bit, like I don't really feel like eating when I'm coughing all the time, but other than that, no, not really. 

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

Doctor: OK um constipation?
Patient: No, diarrhea. 

Doctor: Diarrhea, right. Um how often are you having a bowel movement right now? 

Patient: I would say uh like I've been going, probably more than eight times a day, probably in the last few days like 10 times a day. 

Doctor: Oh wow, OK, and each time are you producing a lot of stool, or is it just a little bit each time?
Patient: Like a little bit, but it's mostly liquidy. 

Doctor: OK. Any solids at all? Like is it semi solid at all? 

Patient: Um maybe a little bit, but mostly it's just liquid. 

Doctor: OK, um any blood in the stool?
Patient: No, I've been checking uh no, I didn't notice any blood or change in colour. It's mainly just um liquid diarrhea. 

Doctor: OK, any changes in your urine? 

Patient: No. 

Doctor: No, OK, um any confusion or memory loss?
Patient: No, not that I know of. 

Doctor: OK, um how about muscle aches or joint pains? 

Patient: No, nothing like that. 

Doctor: OK, and are you otherwise healthy or do you have any long uh standing medical conditions?
Patient: Uh, so I do have diabetes and high blood pressure. 

Doctor: OK, do you take any medications for those conditions?
Patient: Yeah, so for diabetes I'm taking this medication called uh like I think metformin and then for the blood pressure, uh I think it's, I forgot the name, I think it's something like um ramipril or something like that. 

Doctor: Yep, OK, and you're taking that um as directed, right?
Patient: Yeah, I've been taking that regularly and my blood pressure, I've been measuring, it's been pretty steady, no changes. 

Doctor: OK, that's good. Have you had any hospitalizations or surgeries in the past? 

Patient: I did have my appendix removed, probably in my 20s, but uh that was the only thing. 

Doctor: OK, um and do you have any allergies?
Patient: No, not not really. 

Doctor: OK. Are you up to date with all your immunizations? 

Patient: Yep. 

Doctor: OK. Are you on any other medications besides the ramipril and metformin?
Patient: Just uh like multi vitamins for men over 50. 

Doctor: OK, OK. Um any family history of heart conditions or lung conditions that you know of? 

Patient: Um yeah, so my family, like diabetes is pretty big, it runs in the family and uh my father in his 60s uh like died from a heart attack. Um other than that, not anything else I can think of, no. 

Doctor: OK, any cancers in their family?
Patient: Uh no, I don't think so. 

Doctor: OK, do you smoke? 

Patient: I used to, I I quit probably five years ago, but before that I used to smoke probably a pack a day for more than 20 years. 

Doctor: Oh OK, well good job for cutting down and quitting, um.
Patient: Yeah. 

Doctor: Yeah, um do you do marijuana at all?
Patient: No, no no no drugs. 

Doctor: Any other recreational drugs? You said no, right? 

Patient: Yeah no, no, I don't do any drugs. 

Doctor: OK, um do you drink alcohol?
Patient: Yeah, I probably have maybe um some whiskey maybe a couple times a week. 

Doctor: OK. Um and where do you live right now?
Patient: Uh, so yeah, I just live in the city in London uh in an apartment with my, just wife, my wife. 

Doctor: OK, um is she also sick or is she OK? 

Patient: No, she's been completely fine, and I've been kind of isolating myself from her over the last week. 

Doctor: OK, well that's good and that's smart, um just because you don't know what you have, right?
Patient: Mhmm. 

Doctor: Yeah OK, do, can you think of any other sick contacts that you may have had over the past one or two weeks or even three weeks? 

Patient: Um I go to the grocery store, then I go to work, I haven't noticed anyone being sick at work, but you know, you never know like who comes in asymptomatic and like they might be carrying it, with this virus like mainly I'm worried about covid and you know just how fast that's spreading everywhere. 

Doctor: Yeah, for sure. Um yeah, for sure, have you traveled to anywhere recently?
Patient: No, uh we've been in Canada, Ontario, haven't left to go anywhere. 

Doctor: OK. OK, well those are all the questions that I had for you. Did you have any questions or did you have any concerns, anything that you wanted to discuss today? 

Patient: Yeah no, I just uh was wondering if I can get the covid test, that would just, I wanted to make sure I don't give anyone covid if I do have it. 

Doctor: Yeah, for sure, I think that's a good idea. Um so, and it's definitely something that we need to rule out, so we'll do a covid swab today um and you'll hear back within 24 to 48 hours, um but in the mean time, regardless of whether you actually have covid or not, because your symptoms overlap with covid, um it's good to isolate for 14 days and that includes trying to isolate from your wife as well if possible, and public health should be in touch if it's positive uh to do contact tracing. Um and if it's not covid, it's probably another viral illness that's going around at this time of year. Uh if your symptoms get worse, um you know you're having neurological symptoms or or if your fever gets really high, or you're having a lot of trouble breathing, then you should go see the ER. How does that sound?
Patient: My, if my breathing gets worse uh I'll just go to the emergency Department? 

Doctor: Yes, please do. 

Patient: OK, sounds good. 

Doctor: Alright, take care.
Patient: Yeah, so my daughter, she's had this hoarse voice for the past like two or three days. It doesn't seem to be getting better. In fact, it's getting worse and she just doesn't sound like herself anymore and she's not speaking as much. 

Doctor: OK, and when did this start?
Patient: OK, so she had a cough like four days ago, and she's still coughing a little bit, but not as much as she was before, but it's more her voice that I'm concerned about. It sounds very hoarse and harsh. 

Doctor: OK, and so how many days has she had the hoarse voice for? 

Patient: I'd say about two or three days now. 

Doctor: Two or three days, OK. And when she was coughing, you mentioned like previously was she coughing up any sputum or was it more of a dry cough?
Patient: It was more of a dry cough 

Doctor: And the cough has pretty much resolved by now? 

Patient: Yeah, she still gets them once in a while, but yeah, it's pretty much gone. 

Doctor: OK, and when she was coughing, did she at all bring up any kind of blood or any green or yellowish material?
Patient: No 

Doctor: No, OK. Did she have any fevers at all, recently? 

Patient: Uh, no, no fevers. 

Doctor: OK. And does she have any kind of, uh, along with a hoarse voice, does she have any pain with talking?
Patient: Yes, I think so. 

Doctor: OK, and does she have any pain with swallowing any foods or liquids? 

Patient: She's eating and drinking ok, but I suspect there is some pain. 

Doctor: OK, So how long has she, so she has a sore throat, how long has she had that for?
Patient: The sore throat? Uhm I would say for the past two or three days as well. 

Doctor: OK, and was there anything that, so she had kind of like a cough previously, but anything else, anyone sick around her, or anything you think might have precipitated some of her symptoms?
Patient: No, not that I know of. I don't think she's had any contacts with sick people recently. 

Doctor: OK. Are there any, have you tried any medications over the counter, that has helped her? 

Patient: Uhm, not over the counter medications, but like I tried to get her to like gargle with like salt water and all that kind of stuff, but that didn't seem to help. 

Doctor: OK. And have her symptoms been just constant or do they come and go?
Patient: They've been pretty constant. 

Doctor: OK, and you think her symptoms are getting worse? 

Patient: Uh, no, they've been pretty consistent, but maybe the harsh voice is getting worse. 

Doctor: OK. And other than the symptoms that you've mentioned, has she had any kind of shortness of breath, wheezing, chest pain or anything like that?
Patient: No, nothing like that. 

Doctor: OK, and no fevers, right? 

Patient: No 

Doctor: OK. Has she traveled at all recently outside of the country or outside of the province?
Patient: No, no, nothing like that. 

Doctor: OK, and any headaches at all? 

Patient: Uhm, no. 

Doctor: No, any nausea or vomiting?
Patient: Uh, no, nothing like that. 

Doctor: OK, any runny nose or congestion? 

Patient: No. 

Doctor: No, OK. And have you had a chance to at all, look into her mouth and throat? And if you have, have you noticed any kind of redness, swelling?
Patient: I haven't looked in there too much, like, just an inspection the other day, it looked a little bit red, but I didn't see any discharge. 

Doctor: OK, and have you noticed any kind of swelling around her neck, ears, like, around her lymph nodes?
Patient: Uhm, I haven't actually taken a look there. 

Doctor: OK, we can do that. Other than those symptoms, has she been experiencing any kind of like fatigue or have you notice her being just very tired?