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

Doctor: No, OK. And is the cough constant or does it come and go? 

Patient: It, it comes and goes. I would say sometimes it can be worse. Yeah, depending on on what I'm what I'm doing. I guess if I'm exercising or if it's if it's really cold outside, it might get worse. 

Doctor: OK. And do you feel that it's been getting worse at all, your cough?
Patient: Uh, not really, I think it's about the same. 

Doctor: OK, and anything that you did when you were in Mexico that might you think might have caused your cough? 

Patient: Uh, I don't know, maybe I, I was drinking a little bit too much and partying a little bit too much so might have got sick while I was there. 

Doctor: I see. Did you have any cold symptoms like runny nose, sore throat? Um, any anything like that when you were there or after you came back?
Patient: No, sometimes my eyes can get a little itchy, but no runny nose or sore throat. 

Doctor: OK, have you had any previous episodes that are similar to how you're feeling now? 

Patient: Uh, maybe years ago when I like when I was in elementary school, but nothing for the last few years. 

Doctor: OK, and how often are you coughing? Let's say in an average day?
Patient: Um, it's uh, it's pretty variable. I would say, so if I'm exercising it will it'll throw me into a coughing fit and and sometimes it's really bugging me at night too it'll affect me. It's impairing my sleep. 

Doctor: OK, and so exercise makes it worse. Anything that you do that helps you relieve the cough? 

Patient: Uhm, I actually I tried my sons inhaler and it seemed to actually help, but one of the days I just couldn't seem to stop the cough and I wanted to sleep so I gave it a try and it it seemed to actually help with the cough. 

Doctor: OK, and so your son has inhalers, does he have asthma?
Patient: Yeah he does. Yeah he was diagnosed with asthma a couple of years ago. 

Doctor: OK, and have you previously been diagnosed with asthma? 

Patient: Ah I think if they've said it before when I was young, but I haven't had any symptoms for for for years. 

Doctor: OK, and besides the cough, do you have any other symptoms, like any cold symptoms of runny nose, sore throat right now, or even like any chest pain?
Patient: No, nothing like that. 

Doctor: OK. And do you have any symptoms like a headache or nausea or vomiting? 

Patient: Uh, nope. No headache, nausea or vomiting. 

Doctor: OK. Is your cough at all worse during the day or at night? Or does it just is at around the same throughout the day?
Patient: I think the coughs worse at night. 

Doctor: OK. And do you ever feel that you're short of breath at all? 

Patient: Well, yeah, so it affects me if I'm outside and that that's actually usually when my eyes will get itchy too. 

Doctor: OK. And have you had any eczema in the past?
Patient: Uh, yeah I had, I had eczema when I was I was younger. I think that was in it when I was in elementary school as well. 

Doctor: OK. Have you had any fevers or chills recently?
Patient: No. 

Doctor: Any night sweats?
Patient: No. 

Doctor: Have you been feeling increasingly tired throughout the day?
Patient: Ah no, my energy's been been good I just get short of breath or or have these coughing fits if I, if I exert myself. 

Doctor: OK, have you noticed any swelling in your feet or hands?
Patient: No. 

Doctor: Any dizziness? 

Patient: No dizziness. 

Doctor: Do you ever feel your heart is racing when you get like these thumping like heart palpitations?
Patient: Uh, nothing like that. 

Doctor: OK, and you said no chest pain, right?
Patient: No chest pain. 

Doctor: OK. Have you noticed any changes in your bowel movements? Any constipation or diarrhea?
Patient: No diarrhea. 

Doctor: OK. Any changes in your urinary patterns? 

Patient: No, everything's been normal. 

Doctor: OK, so you mentioned like the coughs been keeping you up at night. How, how often are you waking up at night? Is it pretty frequent?
Patient: I would say about two or three nights a week over these last two weeks. It's been, it's been getting worse. 

Doctor: OK. And have you noticed any changes in your weight at all?
Patient: My weight's been about the same. 

Doctor: OK, any changes in your appetite? 

Patient: No, been eating well. 

Doctor: OK. Any recent exposures to anyone with tuberculosis that you know of?
Patient: No. 

Doctor: No, OK. Have you lost your sense of taste or smell recently? 

Patient: Neither of those. 

Doctor: OK. And have you been exposed to any fumes or dust in your surrounding area, or do you have any pets or animals at home?
Patient: Um, yeah, we have a, uh, two cats. And, but nothing at work. 

Doctor: OK. And how long you've had those cats for? 

Patient: We've had them for for almost a year. 

Doctor: OK. And other than eczema and remote history of perhaps asthma when you were younger, any other medical conditions like diabetes or high blood pressure that you've been diagnosed with?
Patient: No, I've been healthy that way. 

Doctor: OK. Any medications that you are on currently?
Patient: Uh, no medications. 

Doctor: OK, do you know of any allergies to any environmental exposures or any medications at all? 

Patient: Uhm yeah, I think I have, I'm allergic to pollen and some other environmental and allergies as well. 

Doctor: OK, and when you cough, have you ever noticed like wheezing noises at all?
Patient: Uh occasionally yeah, there, though I do notice a wheeze. 

Doctor: OK. And have you ever been hospitalized before?
Patient: No, I haven't. 

Doctor: Ok, any previous surgeries?
Patient: No surgeries. 

Doctor: OK. And has anyone around you been ill recently? 

Patient: Everybody's been healthy. 

Doctor: OK. And do you have any family history of cancers or anything related to the lungs at all?
Patient: Uh, no. I mean, my sister had eczema as well, but that's it. 

Doctor: OK, that's it. OK, uh, any heart attacks in your family? Any other medical conditions? 

Patient: Uh, no. Everyone's healthy. 

Doctor: OK and currently what is your living situation like?
Patient: Yeah, so I live in an apartment nearby with my boyfriend. 

Doctor: OK, and has there been any, have you moved there recently or how long have you lived there for?
Patient: Uh we've lived there for about four years now. 

Doctor: Four years, OK. And has anything changed recently? Has there been any mold or new carpets that you guys got anything new in the house?
Patient: Uhm, I don't, I don't think so. 

Doctor: OK. And do you currently work?
Patient: Yeah, I work as a a school teacher. 

Doctor: OK. And do you smoke at all?
Patient: No, I don't. 

Doctor: Have you ever smoked?
Patient: I did, yeah I, I smoked a pack a day up until just about a month ago. I made, it was a New Year's resolution to quit. 

Doctor: Oh wow, well congratulations, that's it's definitely very difficult to quit. And if you need at all, any help at all with your transition at all, we can always bring it up in any appointment. 

Patient: OK, thank you. 

Doctor: Yeah. And in terms of recreational drugs, do you use marijuana or cocaine or any other recreational drugs?
Patient: Um, yeah, maybe I'll I'll smoke like one or two joints a week. 

Doctor: OK. And do you drink alcohol? 

Patient: Uh, yeah, maybe a bottle of wine on the weekends. 

Doctor: OK. Uhm, so you go through like around a bottle every week?
Patient: Yeah, I would say about a bottle of wine on throughout the week, but usually don't really have any during the week, I'll usually, I guess, split the bottle between between Friday to Sunday sort of thing. 

Doctor: OK. And in terms of exercise, do you find that you're getting adequate exercise throughout the week?
Patient: I tried to, I tried to run and go for walks but always trying to be a little bit more active. 

Doctor: OK. Alright, so yeah those are all the questions I had for you today. Um, do you have any other questions for me?
Patient: Uhm, nope, that was it. 

Doctor: OK, so based on what we talked about, it seems that based on your past history and the coughing that you're having right now, one of the things that we definitely want to look at is if you do in fact have asthma. Um, it can also be like viral upper respiratory tract infection, but we will do some pulmonary function tests for you and see if the bronchodilators just like you use the inhaler from your son if that helps helps you with your symptoms and then we can go from there.
Patient: That sounds great. Thank you. 

Doctor: You're welcome. Well, take care.
Patient: Yeah, I'm just feeling, so, I do have COPD, but I just feel so much worse. I do have shortness of breath, but I think it's just been worse over the past three days. I'm having more difficulty climbing stairs, or even just going to the bathroom. 

Doctor: OK, and you said this started? 

Patient: Three days ago, three or four days ago. 

Doctor: And since that time has the shortness of breath been getting worse or staying the same?
Patient: Yeah, so initially it was just, it was just climbing stairs, you know, but then after that, I mean, this morning, I was just short of breath going to the bathroom. 

Doctor: OK, and have you had, uh, shortness of breath on exertion like this before?
Patient: Uhm, you know, sometimes. 

Doctor: OK.
Patient: I don't, do much anyway, because my CPD, you know, just makes things a little bit difficult, uh, yeah, I use my puffers. 

Doctor: OK, and have you had any, uh, episodes where you've woken up in the middle of the night and were really short of breath, you had to, uh, sit up? 

Patient: No, no, no. 

Doctor: OK, and are you able to lie flat?
Patient: Yes. 

Doctor: OK, and you mentioned you were bringing up sputum. Could you describe the color? 

Patient: Yeah, I don't know it's kinda yellow, uh, green. 

Doctor: Has that changed from before?
Patient: Yeah, yeah, so usually it's just sort of whiteish and foamy, and uh, yeah it's different. And it's more, you know, it's alot more, every time I'm coughing it's just like, spoonfuls, it's a lot more than usual. 

Doctor: OK, yeah, it sounds like a lot more and have you noticed any blood? 

Patient: No, no, no. 

Doctor: OK, and uh, so have you had a cough then?
Patient: Oh yeah, I've had a cough for the past 20 years. 

Doctor: OK, and is your cough worse at any particular time of the day, Or does it happen throughout the day?
Patient: Well, it's a bit worse when I'm smoking, but otherwise it's the same. 

Doctor: OK, and has your cough been worse these past couple of days as well?
Patient: No. 

Doctor: OK, and have you had any headaches? 

Patient: No. 

Doctor: How about any ear pain or eye pain?
Patient: No. 

Doctor: Any sore throat?
Patient: No. 

Doctor: OK, have you had a loss of smell or a loss of taste? 

Patient: No, I don't think so. 

Doctor: OK, and have you had any wheezing?
Patient: A little bit. It's been there for a while though. 

Doctor: OK, have you noticed any changes to the wheeze?
Patient: No, I don't think so. I don't know. I can't tell. 

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

Patient: No. 

Doctor: Have you had any lightheadedness or dizziness?
Patient: No. 

Doctor: OK, and have you had any heart palpitations? 

Patient: No. 

Doctor: Alright, and have you had any abdominal pain, nausea or vomiting?
Patient: No. 

Doctor: Alright, and any urinary problems?
Patient: No. 

Doctor: Any bowel problems? 

Patient: No. 

Doctor: OK, and have you had any changes to your skin or any rashes?
Patient: No, not really. 

Doctor: OK, and have you had any fevers or chills? 

Patient: I think I was feeling very chilly last night. My wife had to bring an extra blanket for me. 

Doctor: OK, have you had any night sweats?
Patient: No, I don't think so. 

Doctor: OK, and uh, have you checked your temperature? 

Patient: No, I didn't. 

Doctor: OK, we'll certainly check that today. And have you had any weight loss in the last several months?
Patient: I don't check my weight very often, but no, uh, yeah, my clothes still fit, they're all, they're fine. 

Doctor: OK, fair enough and, uh, have you noticed any, like, leg swelling or any swelling in your belly?
Patient: No. 

Doctor: OK, and in regards to your past health, you mentioned COPD, but have you been diagnosed with any other medical conditions? 

Patient: Yeah I have high blood pressure, and my cholesterol is also a little bit on the high side. 

Doctor: I see, OK and you use puffers. Do you use any other medications?
Patient: Yeah, I think my doc prescribed some pills, I don't know, I don't remember what they are, I just take them every day. 

Doctor: OK, we can get that information. Have you had any hospitalizations? 

Patient: Uhm, I've been to the ER a couple of times and this one time, it was similar to this time, when I was having difficulties breathing and had to stay for about five days or so. I think that was two years ago. 

Doctor: OK, and how are your symptoms feeling now when compared to, uh, that time?
Patient: I wasn't producing this green yellow thing that's coming out of my mouth right now. It was not that bad. It's just last time I was having difficulties breathing, so I decided to come in. But this time I just have this weird thing, I don't even feel like looking at it. 

Doctor: OK, yeah, for sure it sounds like there's something certainly going on here and Yeah, have you had any past surgeries?
Patient: I had, uh, I had a knee replacement. 

Doctor: OK, and, uh, can you tell me a little bit about your living situation, like who do you live with and whereabouts? 

Patient: Yeah, I live with my wife about ten minutes away from here. We live in an apartment, uh, yeah. 

Doctor: OK, are you working, are you retired?
Patient: I retired two years ago. I used to work at Chrysler, as a mechanic. 

Doctor: OK, and have you been around anybody who might be sick? 

Patient: No. 

Doctor: Alright, how about, have you traveled anywhere?
Patient: No, I've just been staying indoors. My wife's been staying with me. We're both pretty careful, we're worried about catching covid so we don't even go out for groceries, we just have those delivery guys come and bring us our groceries. 

Doctor: OK, and you smoke cigarettes, you mentioned, how much do you smoke per day? 

Patient: I smoke about a pack a day. 

Doctor: OK, and how long have you smoked for?
Patient: Let's see, about forty-five years. 

Doctor: OK, have you thought about quitting? 

Patient: Yeah, yeah, multiple doctors have told me to quit and it's just, I don't think I can quit. It's not gonna happen. I can't live without my cigarettes. 

Doctor: OK, the door is always open and certainly something we can talk about at anytime, uh, if you'd like to, but, uh, in the meantime, we'll leave it alone for now. I was wondering if you drink alcohol?
Patient: I drink a glass or two every weekend. 

Doctor: OK, and do use any other recreational drugs like marijuana, cocaine? 

Patient: No. 

Doctor: OK, and, any family history of heart or lung conditions?
Patient: Uhm, high blood pressure. 

Doctor: OK, has anybody in the family had lung cancer? 

Patient: No. 

Doctor: Alright, and, so you've been experiencing worsening sputum production that now has a green color to it, and now having a bit more, more short of breath, which sounds like COPD exacerbation, especially since it's a similar type of presentation as before. And so we'll order a chest X-ray, some blood gases and do a sputum culture and possibly start antibiotics, but, depending on the severity we may not not need to just yet. And then we'll also use some inhalers as well as inhaled steroid to help with the inflammation in the airways.
Patient: Sure. 

Doctor: Alright, we'll get that started.
Patient: Low back pain. 

Doctor: OK, and where exactly is uh is the back pain? 

Patient: So the pain's just right in the in the lower back. 

Doctor: Just in the lower back, OK. And when did this pain start?
Patient: It started yesterday, I was unloading groceries from my pickup truck when it suddenly started. 

Doctor: OK, so, and, did you kind of make any kind of movement? Or did you pick up something really heavy? 

Patient: I'm not sure. I just noticed the pain after um after that. 

Doctor: OK, and what kind of pain are you experiencing? Is it like a dull cramping pain or is it more like a sharp or stabbing pain?
Patient: It feels like it's stabbing just right in my lower back. 

Doctor: OK. And, um, on a scale of 1 to 10, uh 1 being like the least pain that you felt in your life, 10 being the worst, how much would you rate this pain?
Patient: If I'm sitting, uh completely still like like I am right now, it's a 2 out of 10. 

Doctor: OK. Um and when does it get worse?
Patient: Uh anytime I I move or bend my back or uh even cough it it worsens the pain significantly. 

Doctor: OK, and has this pain changed at all since yesterday?
Patient: No, it's been this same awful pain this whole time. 

Doctor: OK and have have you ever had this kind of pain before?
Patient: I've had back pain uh over the years, but nothing like this before. 

Doctor: OK. And does it, does the pain go anywhere or does it just stay in the lower back?
Patient: I also feel the pain uh into my right leg. 

Doctor: OK, and is it the same kind of aching or like stabbing pain that goes into your right leg? Or is it uh just like an aching pain?
Patient: Uh it's it's a, uh, an aching pain. 

Doctor: OK. And do you have any other symptoms besides the pain? Like are you experiencing any kind of weakness or any kind of, any other changes in your health?
Patient: Uh no it's just the uh the low back pain. 

Doctor: OK, and have you ever uh experienced any kind of trauma to your back? Like something has hit you or you've fall down, anything like that?
Patient: No, I can't remember any injuries like that in the past. 

Doctor: OK, any uh fevers or chills or night sweats? 

Patient: Um no fever, uh no chills, no night sweats. 

Doctor: OK, any uh symptoms of feeling very tired, fatigued, anything like that?
Patient: Uh no, I've been OK recently. 

Doctor: OK. Any changes to your skin at all? Uh I mean, any rashes? 

Patient: No. 

Doctor: OK, any pain in your joints at all?
Patient: Uh just the back pain. 

Doctor: OK. Uh any new coughs or any um symptoms and runny nose or anything like that? 

Patient: Uh no. 

Doctor: Any changes in your um bowel movements at all like diarrhea, constipation or anything?
Patient: Nothing like that, been regular. 

Doctor: OK, how about, uh, any urinary problems?
Patient: Uh no, nothing to report there. 

Doctor: OK, and how has your appetite been?
Patient: Uh appetite's been normal. 

Doctor: Any significant weight loss or weight gain recently? 

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

Doctor: OK, any recent infections that you know of?
Patient: No, I've been feeling well otherwise. 

Doctor: OK. Any uh tingling sensation or numbness uh in your back or lower limbs, in your legs?
Patient: Uh no numbness or tingling. 

Doctor: OK. Any muscle weakness at all? 

Patient: Uh no muscle weakness. 

Doctor: OK, have you been uh having any uh kind of erectile dysfunction?
Patient: Uh no concerns with uh erectile dysfunction. 

Doctor: OK, and any issues with uh incontinence, like uh having accidents at all, at night or during the day?
Patient: Uh no, I haven't had any problems with bowel or bladder incontinence. 

Doctor: OK, alright, and in terms of your past medical history, have you have you been diagnosed with any conditions like high blood pressure, diabetes?
Patient: Uh type 2 diabetes. 

Doctor: OK, and do you take any medications for it? 

Patient: Uh I, um insulin for diabetes. 

Doctor: OK, and any other medications at all?
Patient: Uh just been taking Tylenol for the the back pain. 

Doctor: And has that worked for you at all? Or has it not made a difference?
Patient: Uh maybe it's taking the edge off a little bit, but it hasn't done too much uh to help the pain. 

Doctor: OK, any allergies? 

Patient: Uh nope. 

Doctor: OK. Any previous surgeries?
Patient: Uh I had hemorrhoids removed three years ago. 

Doctor: OK. Um any hospitalizations before? 

Patient: Uh no, it was just day surgery, 

Doctor: OK, any family history of any um conditions uh or like any cancers?
Patient: Uh my father had prostate cancer. 

Doctor: OK. And currently right now, uh do you work?
Patient: Uh I'm a retired school teacher. 

Doctor: OK, and where do you live? 

Patient: I live alone um in a in a house uh not too far from here, actually. 

Doctor: OK. And do you do you drink at all?
Patient: Um occasionally uh maybe I'll have a glass of red wine on the weekend or something like that, but uh not too often. 

Doctor: OK, and do you smoke?
Patient: Uh, I've smoked um yeah, I smoke a pack of cigarettes uh per day. 

Doctor: OK, and for how long have you smoked uh cigarettes for?
Patient: Uh about 40 years. 

Doctor: 40 years, OK. And, uh, do you use any kind of recreational drugs? 

Patient: Uh never. 

Doctor: OK, and how is your diet like on like a regular basis?
Patient: I feel like it's uh pretty normal, mostly home cooked meals with some variety, vegetable, vegetables, other meats, and fish. I would say it's pretty balanced. 

Doctor: OK, alright, I just have a few more questions for you. Um are you currently sexually active? 

Patient: Yes, I am. 

Doctor: OK and who are you sexually active with, any new partners at all?
Patient: Uh no new partners, um just my girlfriend, uh. 

Doctor: And, uh, how many, I'm sorry, go ahead. 

Patient: Um just my my girlfriend recently. 

Doctor: OK, and have you been sexually active with more than one partner in the past, past year?
Patient: Yeah, so I just came in. I was a bit worried because I've been having this cough for around two years, which has been getting worse. But recently I've noticed that I see streaks of blood in the sputum that I'm producing. Before it just used to be like white but now I'm seeing over the last, I would say two months occasionally some streaks of blood. 

Doctor: OK, and the cough started two years ago. 

Patient: Yeah. 

Doctor: OK. And, it's been gradually getting worse over that time?
Patient: Yeah, I would say so. It's getting more frequent and worse in nature. 

Doctor: OK. And how much sputum are you bringing up an in a day?
Patient: Probably like a, a couple teaspoons. 

Doctor: OK, and uh, is are you seeing like bright red blood when you're when you're coughing it up?
Patient: Uh. In this it's kind of mixed into the sputum. I would say like, but it definitely is red. 

Doctor: OK. And how much blood would you say that you're you're bringing up would be teaspoons? Or a Cup? Or? 

Patient: No. It's just like a little streaks. It's not really significant, it doesn't feel like the whole production of the sputum, but just like little streaks that I've noticed. 

Doctor: OK and um is the cough worse, at any particular time of day?
Patient: Um, it definitely gets worse when I'm doing more activities and then also when I get like some viral infections. But other than that, it's pretty much always there. 

Doctor: OK, anything that that makes it worse? You said some viral infections. Have you had a viral infection recently? 

Patient: Yeah, like in the last two years, I've probably had two or three viral infections, just just just cold cold symptoms. 

Doctor: Has there been anything that you've tried to make the cough better?
Patient: I've tried the Tylenol Cold, hasn't really worked. Tried just other over the counter medications, haven't really worked. 

Doctor: OK. And prior to two years ago um, were you experiencing any similar symptoms like, uh, like this cough or bringing up blood before? 

Patient: In the past, I've always had a somewhat of a cough like I have COPD. So I've always had a little bit of a cough here and there, but over the last two years I feel that it's been getting much worse. 

Doctor: OK, have you been diagnosed with chronic bronchitis before?
Patient: Yeah I think so. 

Doctor: OK. Um and so with with this cough and now blood tinged sputum, have you been experiencing any other symptoms? 

Patient: Um, I do feel sometimes I get like more tired than I used to throughout the day. 

Doctor: OK.
Patient: Um, sometimes I also feel more breathless on when I'm exerting myself more. 

Doctor: OK, and have you been having any fevers or chills? 

Patient: No, no I haven't. 

Doctor: How about any night sweats?
Patient: No. 

Doctor: Have you lost any weight?
Patient: Yeah, I've actually lost a significant amount of weight. I would say within the last 1 and a 1/2 months probably lost like 8 to 10 pounds. 

Doctor: OK, have you been trying to lose weight? 

Patient: No, not really I've just been sitting around like I can barely walk that much anymore too. I used to be able to walk at least 400 meters around the block, but now I can barely even go to the kitchen. 

Doctor: OK, is this because of the shortness of breath when you are are exerting?
Patient: Yeah, that and I just start coughing so much that I just have to sit down. 

Doctor: OK. Um, and have you been having any headaches?
Patient: No headaches. 

Doctor: Alright, and how about and how is your appetite been?
Patient: Um, I think it's been pretty much the same. Sometimes when I'm coughing a lot, I don't feel like eating, but other than that it's been around the same. 

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

Doctor: Any runny nose or sore throat?
Patient: No. 

Doctor: OK. And then how about a loss of smell or a loss of taste?
Patient: No, nothing like that. 

Doctor: OK, have you been having any chest pain?
Patient: No. 

Doctor: Any heart palpitations? 

Patient: Nope. 

Doctor: Any wheezing when you're breathing?
Patient: Sometimes I would say like when when, it gets worse when I'm exerting myself more, I I can get some wheezing. 

Doctor: OK, and have you noticed any swelling in your feet or ankles?
Patient: No, nothing like that. 

Doctor: Alright. And have you woken up at night extremely short of breath? 

Patient: No, I'm pretty fine during the night. 

Doctor: Alright And, uh, have you been having any abdominal pain?
Patient: No. 

Doctor: Any urinary problems? 

Patient: Uh no. 

Doctor: Any bowel problems like diarrhea or constipation?
Patient: No, nothing like that. 

Doctor: Alright, any skin rashes? 

Patient: Nope. 

Doctor: Any joint pains or or muscle pains?
Patient: No. 

Doctor: Any weakness?
Patient: Not weakness, I'll just say more fatigue. 

Doctor: Alright so I know you told me a COPD, but do you have any other medical diagnosis?
Patient: Yeah, I have high blood pressure as well. 

Doctor: Alright. 

Patient: I think I have high cholesterol too. 

Doctor: I see, OK. Do you take any medications regularly?
Patient: Yeah, so for the cholesterol taking Rosuvastatin and I forget what I'm taking for the blood pressure, but it's pretty well under control. 

Doctor: OK, do you use any inhalers for COPD?
Patient: I used to. I used to have I think like 3 different inhalers but haven't had to use them for more than 10 years now. 

Doctor: OK, and what was the reason for not needing them anymore? 

Patient: I just didn't have any symptoms for a pretty long time and my doc said like if I don't really need them then I could just stop. 

Doctor: OK, and have you had any recent hospitalizations?
Patient: No. 

Doctor: Any allergies to medications?
Patient: Nope. 

Doctor: Any surgeries that you had in the past? 

Patient: No surgeries. 

Doctor: OK, And are your vaccinations up to date?
Patient: Yup. 

Doctor: OK, and could you tell me a little bit about your social situation or living situation?
Patient: Yeah, so currently I'm just living by myself in an apartment. I've been there for more than 10 years now. Um, I am retired so I'm not working anymore. But yeah, that's that's me. 

Doctor: OK, great um. What did you do previously for for work? Did you have any exposures for two chemicals or dusts or asbestos? Things like of that nature?
Patient: Oh yes, I worked in the steel factory for most of my working life. I think yeah, there might have been some exposures to chemicals and dust particles. Asbestos I don't think there was exposure, but definitely I may have lived in places that had asbestos. I mean, yeah. 

Doctor: OK, how long have you been living where you you've been now?
Patient: So this this is like the one I'm living in is a new place, but before that, I lived in another apartment for around five years and that was a pretty old building. 

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

Doctor: OK um. And do you smoke cigarettes? 

Patient: Yeah, I smoke, I'd say around 20 cigarettes a day right now. 

Doctor: Alright, and did you smoke more previously?
Patient: Yeah, I think I've been smoking for almost like 40 years now and I used to smoke up to 30 cigarettes a day. 

Doctor: OK, do you smoke cannabis? 

Patient: No. 

Doctor: Alright. Do you drink alcohol?
Patient: Um just maybe a couple times a month. Nothing, nothing throughout the week. 

Doctor: OK, so do you use any recreational drugs like IV drugs or opioids or cocaine?
Patient: No, nothing like that. 

Doctor: Alright. And anybody in the family have any similar symptoms before like coughing up blood or?
Patient: No. Not that I know of. My father passed away from a heart attack when he was in his 60s. And I think my mother had a, um like I think one of the like, an arthritis. But yeah, like, but I think that was just like the one that you get with old age. 

Doctor: OK, like osteoarthritis?
Patient: Yeah that that was the one. 

Doctor: OK. Any cancers in the family?
Patient: Um, not that, one of my uncles had like um bladder cancer, but that's that's that's about it. 

Doctor: OK, and have you have you traveled anywhere recently or been around any sick contacts? Possibly people anybody who's had tuberculosis or any infections? 

Patient: No, I've been pretty much to myself over the last few months, so not really. 

Doctor: OK um. Was there anything that you're worried that this could be?
Patient: Um Yeah, just the blood I kind of got scared maybe I thought like you know what if it's a cancer? One of my friends had lung cancer and I I know I've been smoking for most of my life, so that's something I was worried about. 

Doctor: Um, I can certainly see that the concern and I understand where you're coming from. I think it would be very reasonable to investigate that today. So we'll start with a chest CT along with some lab work and we will get a CBC and some electrolytes, also get an ECG as well to just check your heart and we will see what what the investigations show
Patient: Sounds good. 

Doctor: OK, and um, other things that um to think about this could be, uh, also like to COPD I know it's been going on a long time, but possibly could have a pneumonia that's been lingering on, particularly if it's a fungal type of infection and as well as things like you mentioned you possibly unsure if you've had an asbestos exposure in the past and stuff like that can possibly lead to scarring of the lung, and so all of these factors will be looked into.
Patient: Hi I'm coming in because I've had this like on and off runny nose and stuffy nose for the past week. Um and I just came to make sure it's not something serious like Covid. 

Doctor: OK, yeah no I completely understand why you might be worried um with everything going on. So just to get an idea of the timeline, so when did this start? 

Patient: So it started about I'd say, seven days ago. 

Doctor: Seven days ago, OK. And was it just a runny nose that started or did you have any other symptoms?
Patient: So at first I felt kind of stuffy um and then now it's more runny. Um and no other symptoms. 

Doctor: And are you coughing at all?
Patient: No. 

Doctor: Are you bringing up any discharge from like your nose, or are you coughing any material up? 

Patient: No, no. I mean there's some discharge from my nose, like it's runny, but it's it's not yellow or anything, it's clear. 

Doctor: OK, and do you think this issue has gone worse over the last seven days or is it improving at all?
Patient: Um I don't think it's improving. It's changed 'cause it used to be stuffy, now it's more of a runny nose. Um but yeah, it seems to be runny, like it's the same amount of runniness for the past couple of days. 

Doctor: And are you having any symptoms of loss of smell at all?
Patient: No, no loss of smell. 

Doctor: How about loss of taste?
Patient: No. 

Doctor: Um were you uh with anyone around you sick at all before those seven days? 

Patient: Uh I don't think so, I visited my sister and she has a nephew who goes to daycare, but my nephew's been OK, no, no runny nose or stuffy nose. 

Doctor: Uhm, and is it just a constant issue that goes on throughout the day or is it worse at night, during the day, how would you describe it?
Patient: Um it's it's pretty constant throughout the day. It's just it just feels bad at night because it um makes it hard for me to fall asleep. 

Doctor: OK, uh have you tried any medications at all over the counter that would help?
Patient: Um I tried some antihistamines because I do have seasonal allergies. Uh but they don't seem to be helping. 

Doctor: Um any anything that makes your symptoms worse at all, like any exertion or any kind of uh position? 

Patient: No. 

Doctor: Um do you have any shortness of breath or chest pain at all?
Patient: Uh no. 

Doctor: Any sore throat or muscle aches? 

Patient: No. 

Doctor: Any uh headaches?
Patient: Nope. 

Doctor: Have you traveled at all recently? 

Patient: No. 

Doctor: Have you had any nausea or vomiting?
Patient: Uh no. 

Doctor: Any fevers or chills?
Patient: No. 

Doctor: Any night sweats or fatigue? 

Patient: No. 

Doctor: OK. Um any kind of sensation that your heart is racing?
Patient: Uh no, nothing like that. 

Doctor: Any changes in your bowel movements like any constipation or diarrhea? 

Patient: No. 

Doctor: Any changes in your urinary pattern?
Patient: No. 

Doctor: Uh any issues with your sleep or appetite? 

Patient: No. 

Doctor: Have you lost any weight, significant weight, uh recently in the last few months?
Patient: No. 

Doctor: And uh do you have any exposure to like fumes, dust, or like uh carpet, pets, or animals? Anything that you might have an allergic reaction to?
Patient: Uh no nothing like that. 

Doctor: OK and currently are you sexually active? 

Patient: I am. 

Doctor: And um can you just tell me a little a little bit of a detail like about like a partner? Uh and if you've had any new partners recently at all?
Patient: No, I've been with the same partner for the past five years. 

Doctor: OK, and uh do you have any history of any STI's? 

Patient: No. 

Doctor: OK nice, um, in terms of your uh past medical history, do you have any um diagnoses or anything any medical conditions at all?
Patient: Uhm no, no nothing, nothing long standing. 

Doctor: Um anything you take medications for? 

Patient: No. 

Doctor: Are you allergic to any medications?
Patient: Uh not medications. 

Doctor: Uh any environmental allergies?
Patient: Just yeah, some seasonal allergies. 

Doctor: OK. Any previous hospitalizations or surgeries? 

Patient: Um I was hospitalized for um Like an appendectomy when I was younger. Um but that's about it. 

Doctor: And when was that?
Patient: That was when I was 18. 

Doctor: And any complications after that?
Patient: No. 

Doctor: And uh in terms of your family history, does anyone have any lung conditions, heart conditions, or any cancers?
Patient: Uh nope, nothing like that. 

Doctor: And currently uh do you work? 

Patient: I do. I work from home though. 

Doctor: OK. And how would you describe your living situation right now?
Patient: Um I live in an apartment with um my partner and we have a dog. 

Doctor: Um and currently, uh do you smoke at all?
Patient: Uh no. 

Doctor: Do you use any recreational drugs like marijuana?
Patient: No. 

Doctor: How about uh any alcohol?
Patient: Uh I drink like a glass of wine every other day. 

Doctor: OK. Um yeah, so those were some of the questions I had for you. I know it's a bit concerning because of the pandemic going on and um a runny nose can be a symptom uh of Covid as well, but uh it can also be a symptom of just the common cold or any other virus. Um but since you're having, uh you're symptomatic right now, we will definitely get like a Covid swab test done for you.
Patient: OK. 

Doctor: And if you start having any, just monitor for your symptoms. Um you should have the test back within 48 hours. Until then, uh at least for 14 days you should try to isolate in your own room, wear a mask around uh your partner, uh and not go outside, so just self isolate. 

Patient: OK. 

Doctor: And and then you will get the test results back in a, hopefully in a few days. So do you have any questions at all?
Patient: Uh no, thank you, that was good. 

Doctor: Take care, bye
Patient: My child has been having a sore throat and chills yesterday as well. 

Doctor: OK, so you mentioned the sore throat started three to four days ago and the chills started yesterday. And is he having any issues swallowing food or fluids? 

Patient: Yeah, it seems like appetite's gone down, like a lot of pain in his throat, especially when swallowing solid foods. 

Doctor: Have you taken a look into his throat? Is it red? Do you see any yellow streaking white stuff, anything like that?
Patient: I definitely did take a look yesterday and definitely saw a lot of redness. I don't know if I saw any white or yellow streaks, but definitely looks very red in there. 

Doctor: OK, do his tonsils look enlarged?
Patient: Uh, everything looks swollen in there, I don't know what's what, but it does look very angry in there. 

Doctor: OK, OK. And has he had a stuffy nose or runny nose?
Patient: No, not really, no. 

Doctor: Any loss of taste or smell?
Patient: No, nothing like that. 

Doctor: OK, how about changes in vision or hearing? Any changes in her nails or skin like rashes?
Patient: No, no rashes. 

Doctor: OK. Have you taken his temperature at home? 

Patient: No, I think he might have had a fever yesterday, but we didn't really take a temperature. 

Doctor: OK. And, any fatigue or exhaustion?
Patient: Energy's pretty much the same, just really complaining a lot about the throat. 

Doctor: OK, OK, have you noticed any swelling in in the neck area?
Patient: Uhm, I think there might be like a few lumps near his neck, so I don't know if that's swelling, but definitely there is. There's a few that I felt over the last few days. 

Doctor: OK, coughing?
Patient: No, hasn't been coughing at all 

Doctor: OK, um, and how about shortness of breath or wheezing?
Patient: No, nothing like that. 

Doctor: Chest pain? 

Patient: No. 

Doctor: Feeling like his heart is racing?
Patient: No. 

Doctor: Swelling in his limbs? 

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

Doctor: OK, dizziness or fainting spells?
Patient: He was complaining of a headache a few days ago, but it kind of went away on its own. 

Doctor: OK. So the headache's gone completely now. 

Patient: Yeah, yeah. 

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

Doctor: Joint pain or muscle aches? 

Patient: No. 

Doctor: OK, how about his bowel movements? Have those been normal?
Patient: No, no, he hasn't told me anything about that. 

Doctor: Any appetite changes?
Patient: Yeah, just with the trouble swallowing I'm trying to make sure that he gets like liquids because over the last few days he can't tolerate like solid foods at all. 

Doctor: Yeah, how about a weight loss over the past few weeks? 

Patient: No, not really. t's just been over the last few days that he hasn't been eating like himself. 

Doctor: OK. Alright and has he been healthy otherwise?
Patient: Yeah, otherwise he's a very healthy child. We have rarely gone to a DOCTOR: for him before, so yeah, nothing. Nothing else with him. 

Doctor: OK, have you tried anything for his sore throat? Anything over the counter? 

Patient: We did try, uh, like Tylenol cold. It helped with this headache, but it didn't really help with his sore throat 

Doctor: OK, and has he ever experienced anything like this in the past?
Patient: No, not that I know of. 

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

Doctor: Any medications that he's on? 

Patient: No, no medication. 

Doctor: OK, is he up to date with all his immunizations?
Patient: Yeah, all his immunizations are up to date. 

Doctor: OK, any allergies? 

Patient: No, not that I know. 

Doctor: OK, family history of lung conditions or heart conditions?
Patient: No, no lung or heart conditions. His father does have diabetes though. 

Doctor: OK, how old was he when he was diagnosed with diabetes? 

Patient: I think probably in his late 30s with type 2 diabetes. 

Doctor: Type 2, OK and then any sick contacts recently that he may have had?
Patient: I don't think at home at least, uh, but maybe at school, like you never know who they are in contact with, so I'm wondering if he just picked it up somewhere from school. 

Doctor: OK.
Patient: Yeah, yeah, they're all wearing masks right now, but I don't know if he picked something something up from his classmates. 

Doctor: Yeah for sure. OK, and then any travel to anywhere recently?
Patient: No, we've been at home, haven't left even to go to like a different city, have been in London the whole time. 

Doctor: OK, yeah, and who does he live with at home? 

Patient: So he lives with myself and his dad. 

Doctor: Any siblings?
Patient: No, he's an only child. 

Doctor: OK, any reason to believe you have old carpets, mold, asbestos, anything that could be triggering his symptoms?
Patient: You know we don't have any pets. We don't have any like old carpets, it's a fairly new apartment, so I don't think any of that should be an issue. 

Doctor: Okay, well, I think those are all the questions that I had for him. Anything that you wanted to add or anything that I missed today?
Patient: Uh, no, I think those are everything I wanted to talk about but I just was wondering if he needs to get tested or like if there's anything we can do today for him. 

Doctor: Yeah, so he does seem to be checking off some of the criteria for strep throat. So just to make sure, because he does have a score of right now at least three or four, or maybe even five, definitely over four, we can prescribe him some antibiotics. But we will do a rapid strep test first in the clinic here today just to rule out in or rule that out. If it comes back positive and I guess even if it isn't positive because he checked off a lot of the boxes for strep throat, we will give him a prescription for penicillin or amoxicillin for 10 days. And then you can take that if his symptoms don't go away in a day or two. Because his symptoms also overlap with COVID, we will. do a swab for that as well and you should hear back within 24 to 48 hours and then you should isolate for 14 days. Does that sound good? 

Patient: Yeah, that sounds good. 

Doctor: OK, great thank you.
Patient: So yeah I've been having for the last two days, uh, it just started randomly. I had to miss work, Just a headache started at the beginning and then I noticed the same day, so this was two days ago. A headache started and my body just started aching throughout the day and yesterday I just developed, I think it was a fever, I didn't really get a chance to check, like, but I was very chilly yesterday and now I have this cough as well. 

Doctor: OK, so just to confirm, so the, the symptoms at first started with a headache and, and fatigue, and that started two days ago?
Patient: Yeah, like with fatigue, like also just the, my muscles were aching. 

Doctor: OK, and any particular muscles that were achy or is this more of a, uhm, general kind of whole body feeling?
Patient: Just a general whole body feeling. 

Doctor: OK. Uh, and in terms of the headache, could you describe, uhm, could you describe the headache?
Patient: Yes, it's just kind of like at the front like near my forehead, on, on kind of like both sides more. It just feels like, like pressure in there. 

Doctor: OK, have you had headaches like this before? 

Patient: Uh, no, not really. 

Doctor: OK. Uhm, is the headache on one side or, or the other or on both sides?
Patient: I think it's like both sides. 

Doctor: And is the headache like pulsating or is it more, continuous kind of constant pain? 

Patient: I think it's more continuous constant. 

Doctor: Alright, and have you had any sensitivity to light or sound that, that's made the headache a lot worse?
Patient: No, it's, it's kind of just there, it's about the same as when it was when it started. 

Doctor: OK, have you had any nausea and vomiting associated with that, the headache or anything else? 

Patient: Uh, no. 

Doctor: OK. And so, and then, last question for the headache piece. Does it feel like it was a like kind of sudden onset, worst headache of your life sensation?
Patient: Uh, no, it's still like, like I can still cope with it, like, if I wanted to I would have gone into work. But it was the muscle aches that really started bothering me. 

Doctor: OK. And so you had a cough as well, when did this start, and is it a dry or wet cough?
Patient: It's a dry cough and it started yesterday, probably in the morning when I woke up. 

Doctor: OK, and has the cough been getting any better or worse? 

Patient: Uhm, since yesterday I would sayit's probably a bit worse now. 

Doctor: Alright, and it's dry, but have you seen any blood that's come up?
Patient: No, no, no blood. 

Doctor: And have you had any shortness of breath?
Patient: No. 

Doctor: OK. And have you had any flu like symptoms or infectious symptoms like a red eyes, runny eyes, runny nose, or a sore throat?
Patient: No, I don't have any of those symptoms. 

Doctor: OK, you mentioned you felt feverish. Do you feel hot now?
Patient: Not right now, but I did have, last night just, was just very chilly and Uh, I had to just wrap myself up in a couple blankets. 

Doctor: OK. Did you have any night sweats? 

Patient: No, I, I didn't have any night sweats. 

Doctor: Alright, and have you had any chest pain?
Patient: No, no chest pain. 

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

Doctor: OK. And have you had any wheeze?
Patient: No wheezing. 

Doctor: OK. Uhm, and have you noticed any swelling to any of your extremities? Like your ankles?
Patient: Uh, no. Nope. 

Doctor: OK. And have you had any belly pain?
Patient: No belly pain. 

Doctor: Any urinary problems like pain or, or frequency going to the bathroom?
Patient: No. 

Doctor: And any diarrhea? 

Patient: No diarrhea. 

Doctor: Alright, and have you noticed any rashes or, or changes to your skin?
Patient: No, not at all. 

Doctor: Alright, and I don't know, you've had muscle aches, have you had any joint pains?
Patient: Uh, no, no musc, sorry no joint pain. It's mainly just like in, I would say in around my upper back like my upper arms and kind of like my thighs and glutes areas 

Doctor: OK. And how has your energy been these last couple of days?
Patient: Yesterday I felt a bit drained. I just kind of like stayed in bed the whole day. 

Doctor: OK, and have you tried any medications for the, for the headache or any of your symptoms so far?
Patient: I, I took a Tylenol. I actually took a couple Tylenols, uh, when the headache and pain started. It did help a bit for a couple hours, but it just kind of came back. 

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

Patient: Uhm, Just uh, like I had type 2 diabetes, that's it. 

Doctor: OK, and are you using medications for your diabetes?
Patient: Yeah, I've been on Metformin. 

Doctor: OK, have you used insulin before?
Patient: No, no, I've never had to use insulin. It's pretty stable, like my family doctors even considering taking me off the metformin. 

Doctor: OK, no, that's great. And that reminds me, actually, how has your weight been over the last several months? Have you had any weight changes? 

Patient: Not really, like I, I, I think over the last two years I've just been very focused on my fitness, so I feel like I've probably lost around 30 pounds over the last year. Last one to two, yeah, year, but like I, I've been exercising a lot like uhm, gym every day, it's, it's been, it's been a journey. 

Doctor: no that's great though, good for you. I encourage you to keep that up for sure. OK, and so do you take any other medications, other, over the counter or prescribed?
Patient: Uhm, just a multi vitamins. 

Doctor: Alright, and do you have any allergies to medications? 

Patient: No, not that I know of. 

Doctor: All right. So have you had any hospitalizations or surgeries?