jshargo/medical-interview-conversations huggingface dataset:
Patient: I've tried some ibuprofen and some ice that seems to help temporarily, but it doesn't help with like like it's not permanent. 

Doctor: OK, and. Has there been anything that's made it worse?
Patient: Um just putting weight or like trying to bear any weight on that ankle has made it worse. 

Doctor: OK, and what would you say the severity of the pain is on a scale of 10 to one, with 10 being the worst pain you've ever felt.
Patient: I would say it's like a 7 or 8. 

Doctor: OK, and have you ever had a pain like this before to the ankle or ever injured your foot before?
Patient: No, nothing like this. 

Doctor: OK. And have you had any any headaches?
Patient: Uh no headaches. 

Doctor: Had any fevers or chills? 

Patient: No 

Doctor: How about night sweats?
Patient: No. 

Doctor: Have you had any unexpected weight loss? 

Patient: No. 

Doctor: OK, and have you had any sensory changes like changes your vision, hearing or even your sense of smell or sense of taste?
Patient: No, nothing like that. 

Doctor: OK, and have you had any neurological symptoms such as like numbness or tingling?
Patient: No. 

Doctor: OK, now have you noticed any sensory loss over your leg or ankle?
Patient: No, no, no no sensory loss. 

Doctor: OK. And have you had any muscle weakness? 

Patient: No. 

Doctor: OK. and, and have you had any infectious symptoms, like having like a runny nose or feeling congested or maybe even a sore throat?
Patient: No. 

Doctor: Alright, and have you had a cough? 

Patient: No cough. 

Doctor: How about shortness of breath?
Patient: No. 

Doctor: Alright, have you had any chest pain or feeling like your heart's racing?
Patient: No. 

Doctor: Have you had any dizziness or lightheadedness? 

Patient: No. 

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

Doctor: How about any loss of appetite?
Patient: No. 

Doctor: Have you had any abdominal pain? 

Patient: No. 

Doctor: Have you any diarrhea, constipation, or or blood in the stool?
Patient: No. 

Doctor: OK, and have you had any changes to urinary patterns?
Patient: No. 

Doctor: OK, and have you had any changes to your energy recently? 

Patient: No, no changes to my energy. 

Doctor: Alright, and in the past, have you been diagnosed with any medical conditions or any reason to see a  regularly?
Patient: Uh no I've been pretty healthy otherwise. 

Doctor: OK, so do you take any medications regularly, either over the counter or prescribed? 

Patient: No. 

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

Doctor: OK, and are your immunizations up to date?
Patient: I think so. I gave them the most recent ones I've received in high school. 

Doctor: OK, OK that's good and have you had any surgeries before or any reasons for hospitalizations? 

Patient: Um no I've never, yeah I've never been hospitalized. 

Doctor: OK, uh and. Alright, could you tell me a little bit about your living situation right now, like who you're living with and whereabouts?
Patient: I live with both my parents as well as two of my siblings. They are younger. We live in a house downtown. 

Doctor: OK and are you currently in school?
Patient: I am. I'm in grade 11. 

Doctor: OK, awesome and then how's that been going so far? 

Patient: Going pretty well. 

Doctor: OK. And have you been around anybody who's been sick recently?
Patient: No, no one's been sick. 

Doctor: OK, and how about have you traveling anywhere?
Patient: No, we haven't been doing any of that so since COVID. 

Doctor: OK, and and I know sometimes people at like in high school and certainly in your age group may experience with things like smoking. Smoking tobacco or cigarettes, drinking alcohol or using marijuana. Have you used any of those, those substances?
Patient: No. 

Doctor: OK. And and are you currently sexually active? 

Patient: Um I am. 

Doctor: OK, and could you tell me about your partners or or partner?
Patient: Um yeah, she's been my girlfriend for the past two years. And we use protection. 

Doctor: OK, great. And any concerns for any sexually transmitted infection at this time?
Patient: No. 

Doctor: OK. And in the family, has there been any history of musculoskeletal or neurological problems?
Patient: Uh, no, nothing like that. 

Doctor: OK, and how about any autoimmune conditions? 

Patient: No. 

Doctor: OK, and so I next wanted to move to the physical exam component and ask you to have a look at your ankles. And are you seeing any swelling or redness or discolouration?
Patient: So I there's a. Like there's a bruise about 4 centimeters wide and it appear swollen, but just by right ankle. 

Doctor: Just your right ankle, OK. And is there any temperature changes like warmth when you touch it? 

Patient: Uh slightly warm yeah. 

Doctor: OK. And are you seeing any muscle atrophy or deformities of the of the ankle or foot.
Patient: No. 

Doctor: OK. Uhm and, uh if you press on areas of your of your ankle and foot, do you feel pain at the lateral malleolus or the medial malleolus? 

Patient: Uh, there's a lot of pain on the lateral malleolus. 

Doctor: OK. Um and do you feel pain if you press on the top of your foot like a?
Patient: Um on the, no no pain at the top of my foot. 

Doctor: OK, and how about on the like outside or lateral aspect of your foot you'll feel a kind of, it's a bony prominence that that sticks out at the base of the 5th or you're kind of last metatarsals is there any pain there? 

Patient: No, no pain there. 

Doctor: OK, and then how about any pains on that like medial side of your foot?
Patient: On the medial side, no. 

Doctor: OK, and then when it comes to moving the foot, are you able to point your toes on your foot up towards your face?
Patient: Up towards my face that's hard. 

Doctor: OK, so dorsiflexion is limited. And how about pushing your foot down like you're pressing on the gas pedal? 

Patient: I can do that, but it's still painful just to move the ankle. 

Doctor: OK, so planter flexion is is painful as well. And then any issues with moving your toes?
Patient: No. 

Doctor: OK, and then you mentioned that with walking you're having a limp currently?
Patient: Yes. 

Doctor: OK, so we have an antalgic gates with an inability to bear weight as well. OK, so the that was everything that I wanted to ask and check today and based on these features it is starting like it could be either an ankle fracture or an ankle sprain. But because of the pin-point tenderness or that you're finding on the lateral side as well as some of the the inability to bear weight as you're describing it'll be important to get an X-Ray to make sure that there's not a fracture. Um and yeah, and if there is then it will be important to have some sort of air boot or casting so that to make sure that we're offloading the area for the bones to heal, but we'll see what the X-Ray shows.
Patient: OK, that sounds great, thank you. 

Doctor: Thank you.
Patient: Hi, I've I've had this pain on the outside of my uh right elbow now it's it I first started knowing, noticing it several months ago, but recently it's just been more painful. 

Doctor: OK, so you said several months ago. Um did anything happen several months ago? Was there any sort of trigger, trauma, anything like that to that area?
Patient: No, there wasn't any any trauma or any triggers that that I noticed, I was just um feeling it, uh, a bit more at the end of of work. Um yeah, I was just having it uh, feeling the pain a bit more at the end of work. 

Doctor: OK, does uh anything make it better or worse, the pain?
Patient: Um yeah, if I, really if I'm just resting the elbow um it makes it better, and I've tried uh things like ibuprofen um which has helped with the pain, I'll I'll do that for um hoping I can get through work sometimes if the pain is bad enough. 

Doctor: Right, OK. Um and if you were to describe the quality of the pain, is it sharp, throbby, achy?
Patient: Uh it's um kind of uh, well, it's achy and then sometimes depending on the movement it can get, it can be sharp as well. 

Doctor: It can be sharp, OK. OK, um and what sorts of movements make it worse? 

Patient: Um, so like, really it's mostly the movements at my wrist, if I'm bending my wrist down, uh I can I can feel it, or um if I'm having to pick things up or hold heavy objects at work, I do a lot of repetitive uh things at at work, I work on a line. 

Doctor: OK, OK. And 1 to 10, 10 being the worst pain you've ever felt, how bad is this pain?
Patient: It is about a four. 

Doctor: About a four, OK. And have you ever experienced this type of pain before? 

Patient: Uh, no I haven't. 

Doctor: No, OK, and do you feel like your pain is getting worse over the past several months, or is it the same, getting better?
Patient: Uh it's been getting worse. 

Doctor: It's been getting worse, OK. OK, um have you tried any like topical ointments or anything like that for it?
Patient: Uh I did, I yeah, I tried some um some stuff that you can get at the um drugstore and it did help take the edge off a little bit. 

Doctor: OK. Um alright and are you still able to move that arm, your right arm, um as well as your hand?
Patient: I am, yeah, I I have full range of motion of both the elbow and uh hand. 

Doctor: OK and it's not like preventing you from doing everyday tasks? 

Patient: Uh, no. I I've been been able to manage so far at work, but um it is starting to become an issue um yeah, with my job. 

Doctor: OK. Um alright, and then do you have any sorts of aches or pains uh in any other joint or muscle groups?
Patient: No, it's just right there on the outside of my right elbow, and it's really annoying 'cause I'm right handed as well, so um yeah, it's causing problems there. 

Doctor: Right, um and is the pain radiating upwards or downwards? 

Patient: Uh no, I kinda just feel it right over that that one spot. 

Doctor: OK, any numbness or tingling in that arm?
Patient: No, no, no numbness or tingling. 

Doctor: Yeah, um OK, and then how about um like your arm feeling like it's cold? 

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

Doctor: OK, alright, um and then otherwise do you have any other symptoms?
Patient: Um no I, it's just been the elbow pain. 

Doctor: OK, so no weight loss?
Patient: No, my weights been stable over these last few months. 

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

Doctor: OK, any fatigue? 

Patient: No, my energy's been good. 

Doctor: OK. How about um rashes?
Patient: Uh no rashes. 

Doctor: OK. Changes to your senses like vision, hearing, smell, smell or taste?
Patient: No changes there. 

Doctor: OK any coughing, shortness of breath, or wheezing? 

Patient: No. 

Doctor: OK. Chest pain, any heart palpitations, or uh dizziness?
Patient: Nothing like that. 

Doctor: OK, changes to your bowel movements?
Patient: No. 

Doctor: No, no no nausea or vomiting? 

Patient: No, I haven't had any nausea or vomiting. 

Doctor: OK. Changes to your urine?
Patient: No, I haven't had any urinary uh symptoms. 

Doctor: OK. Memory loss or confusion?
Patient: No. 

Doctor: OK, so if you look at that right elbow, um do you notice any redness or swelling? 

Patient: Uh no, I don't. 

Doctor: No, OK. Does it seem misaligned or like asymmetrical compared to your other elbow?
Patient: No, it looks, it looks the same. 

Doctor: Looks the same, OK so no um skin changes or deformities there?
Patient: Uh no. 

Doctor: No, OK, alright and now I'm going to get you to um just palpate uh that lateral or yeah, the lateral aspect of that elbow and you let me know if you feel pain when you push, push on that.
Patient: Uh there is pain at the lateral uh lateral elbow. 

Doctor: How about the medial aspect? 

Patient: No pain. 

Doctor: No pain, OK, and how about when you palpate your um forearm and your biceps?
Patient: Uh no no pain. 

Doctor: OK, alright and then do you feel like it's hot, that area?
Patient: No. 

Doctor: No, OK now I am going to get you to um extend your wrist. 

Patient: OK. 

Doctor: And then keep your elbow in full extension as well. Does that hurt?
Patient: Uh it does, yeah. 

Doctor: Yeah, OK, how about when you flex your wrist with the elbow still in full extension? 

Patient: Uh it does, yeah that hurts as well. 

Doctor: OK, how about when you flex your elbow?
Patient: Uh no, that that doesn't cause any pain. 

Doctor: OK. How about when you extend your shoulder all the way up? 

Patient: No, nothing there, that feels fine. 

Doctor: OK, and then flexing your uh, or sorry abducting your shoulder?
Patient: That feels normal. 

Doctor: OK, alright, and then how about when you pronate and supinate your forearms?
Patient: Uh, pronation um? 

Doctor: So like twist your um arm inwards so that your palm is facing the floor.
Patient: No, that doesn't really cause any pain, pronation and supination. 

Doctor: OK, alright. Um alright, and then are you otherwise healthy or do you have any longstanding medical conditions? 

Patient: Um I'm uh healthy. 

Doctor: You're healthy, OK. And then UM do you have, have you had any hospitalizations or surgeries in the past?
Patient: I had a surgery for um a C-section for uh my, my son, um but that's that's it. 

Doctor: OK. OK, and um how long ago was that?
Patient: That was about uh 17 years ago. 

Doctor: OK. And was that an emergency C-section?
Patient: Uh no, it was not. 

Doctor: OK um and then are you on any medications?
Patient: Um no, I've just been taking uh Tylenol and Advil um for the pain. 

Doctor: OK, alright um immunizations wise, are you up to date?
Patient: Uh I I am, yes. 

Doctor: OK. Do you have any allergies? 

Patient: Uh no allergies. 

Doctor: OK, family history of any uh skeletal or muscular um issues?
Patient: Um no, nothing like that in the family. 

Doctor: OK, neurological issues in the family? 

Patient: Um no neurological issues in the family. 

Doctor: OK, how about um autoimmune conditions?
Patient: Uh no, nothing like that. 

Doctor: OK and then um do you smoke? 

Patient: Uh no, I haven't smoked before. 

Doctor: OK, uh do you do um marijuana.
Patient: No, I I don't use that. 

Doctor: OK. Um Alcohol? 

Patient: Um uh yeah, I'll have a glass of wine every once in awhile, but maybe just one, one a week. 

Doctor: OK, and have you been around sick contacts recently?
Patient: Um no, I haven't been around anybody who's been sick. 

Doctor: OK. Any recent travel? 

Patient: Uh nope, I've been at home. 

Doctor: OK. Um I think those are all the questions that I had for you, um did you have any questions of your own for myself?
Patient: Yeah I've had, a fever and a cough that started just like four days ago. 

Doctor: OK, when did you, when did you start having your, so the cough started four days ago, what about the fever? 

Patient: I think, like, last night was when I checked, it was high, like over thirty eight. 

Doctor: I see, OK. And, did you check your fever before that? The night before?
Patient: Yeah, I just checked it last night. I felt hot previously, but, I don't know, I thought I was going to just get better, but this morning still, well, feeling a bit a little bit worse. 

Doctor: OK, and the cough that started four days ago, has it been a dry cough or wet cough?
Patient: It's been dry. 

Doctor: OK, so there's been no sputum or any, or blood? 

Patient: No sputum or blood 

Doctor: OK. Has it gotten worse over the past four days?
Patient: Uh, a little bit, yeah.  D; And, other than the fever and the cough, do you have any fatigue?  Uhm, yes. 

Doctor: We do, OK. Any muscle aches?
Patient: Uh, no. 

Doctor: OK, Sore throat?
Patient: No. 

Doctor: Any difficulties breathing? 

Patient: No. 

Doctor: Any wheezing?
Patient: No. 

Doctor: Any chest pain or pressure?
Patient: No. 

Doctor: OK, any runny nose? 

Patient: Yeah, my nose has been a little bit runny. 

Doctor: OK, that started over the past four days as well?
Patient: Yeah. 

Doctor: OK, what about pain in your belly? 

Patient: No pain. 

Doctor: OK, any diarrhea or Constipation?
Patient: Uhm, no. 

Doctor: Any nausea or vomitting?
Patient: No. 

Doctor: Any urinary symptoms? 

Patient: No. 

Doctor: OK, any rash that you've noticed on your skin?
Patient: No. 

Doctor: Any changes in your sense of taste or your sense of smell?
Patient: Uh, yeah, I haven't been able to smell as well. 

Doctor: You feel like you have a runny nose, but is it sort of congested?
Patient: Not really, it,  yeah, just kind of running, and yeah, I haven't been able to smell very well. 

Doctor: OK, and do you have any past medical, any conditions, medical conditions? 

Patient: Uh, depression and anxiety. 

Doctor: And have you had any surgeries in the past or hospitalizations?
Patient: Uhm, no 

Doctor: OK, are you taking any medications, including over the counter pills?
Patient: I do take a multi-vitamin. 

Doctor: And, uh. 

Patient: sorry I do take, um, I take, uh, an SSRI, Citalopram as well. 

Doctor: OK, that's good. OK, any allergies?
Patient: No allergies 

Doctor: OK, specifically allergies to medications?
Patient: Uhm,  yeah no, no medications, I don't think so. 

Doctor: Good, ok, and do you currently smoke or have you ever smoked in the past? 

Patient: Uhm, I smoked when I was in high school very briefly, but I haven't smoked anything in the last twenty years. 

Doctor: Alright, do you consume marijuana?
Patient: Uh, we'll use edibles every once in a while. I buy them from the, like, I guess government store, OCS. 

Doctor: I see, OK, any recreational drugs? 

Patient: No, 

Doctor: OK, and do you currently live alone or do you live with others?
Patient: I live with others, I live with my girlfriend, and a dog. 

Doctor: OK, and has she been sick or have you been in contact with anyone who's been sick recently?
Patient: Uh, she just came back from a work trip. I've been working from home but she was, uhm, in Saskatchewan, and just got back last week. 

Doctor: OK, and has she had any symptoms?
Patient: She's been fatigued since coming back, but I mean, we thought that was maybe just from the travels, but, maybe not. 

Doctor: Has she been quarantining, or are you both spending time together?
Patient: Well, we've been, I mean, trying to distance in the home, but I mean, we've been living together in an apartment so. 

Doctor: Fair enough, fair enough. OK, have you had any travels?
Patient: No, I've been working from home. 

Doctor: OK, alright, and uh, any, you don't have any asthma or COPD or any lung conditions, right? 

Patient: Right, I don't have anything like that. 

Doctor: OK, and, any conditions that run in your family?
Patient: Uhm, no, nothing that runs in the family. 

Doctor: Alright, OK, so if I understand correctly, you've been feeling tired and you've had a cough and a runny nose and changes in your sense of smell for the past three or four days and you also were feeling a little bit hot and yesterday you noticed that you had spiked a high fever. Is there anything that I'm missing?
Patient: No, I think that covers all the symptoms. 

Doctor: And you might have potentially had, some exposure through your girlfriend potentially, so it's possible that, well, it's possible that you just have a cold, but it's also,  we'll still have to rule out covid as a cause, and so we'll have to do a covid swab and go from there and we'll check your temperature here as well. Just, uh, I think something that I forgot to ask, have you taken any medications that has helped you with your symptoms? 

Patient: Uh no, I haven't taken anything. 

Doctor: OK, alright, well, thank you, I'll go talk to my attending and we'll come back and discuss this further with you.
Patient: Hey, I'm I'm the mom of, of the patient. He's he's a kid, he has had, he just had a cough and stuffy nose for the past three days. 

Doctor: OK, and so did they both start around the same time or one started before the other?
Patient: They started the same time. He's also had like these, these, his eyes have been like kind of red and watery as well. 

Doctor: OK, and is he, what kind of cough is he having a dry cough or wet cough? 

Patient: It's a dry cough. 

Doctor: Dry cough, OK and and so with the congestion is he also having any kind of nasal drainage?
Patient: Yeah, it's it's like watery. 

Doctor: Watery OK so now are you noticing any kind of yellow or greenish material?
Patient: No. 

Doctor: OK, and he hasn't, is he coughing up any blood at all at any point? 

Patient: No no no. 

Doctor: And so this started just recently three days ago. Was he in contact with anyone that's been sick recently?
Patient: I don't think so, but he has been like playing outside quite a bit. And sometimes he's just playing with the neighbours kids. 

Doctor: OK. Has this happened before? 

Patient: Yeah it has, but I guess what I'm concerned about is the rash that he has now that he's never had before. 

Doctor: OK, and where is the rash, exactly?
Patient: It's on his face. It started this morning. 

Doctor: OK, and can you describe the rash for me like it's color, shapes, and what kind of looks like?
Patient: Small really small dots like kind of, uhm, like I'd say like brown in color. Like brownish dark reddish. 

Doctor: OK, let's just are they just located on his face?
Patient: Yeah, like it was on his face and it's kind of a little bit on his neck. 

Doctor: OK, uh and is he scratching at them at all? 

Patient: Yeah. 

Doctor: OK, Um, OK and so they just started today. Have you had these rashes before at all?
Patient: No, no he hasn't. 

Doctor: OK, anything new at all that he has either eaten or any new clothing or new laundry detergent or soap, so anything at all? 

Patient: No no. 

Doctor: OK. OK, And has he had any fevers or chills anything like that?
Patient: Uh, he has been feeling a little bit warm. I didn't really check his temperature. 

Doctor: And. And busy so, it started three days ago. Anything happened before 3 days at all that might have caused the symptoms?
Patient: I don't think so. As I said, he has been playing around with others so could have caught something? 

Doctor: OK, And OK, any kind of ah, have you tried anything that has helped him at all? Any medications? 

Patient: Uhm? I haven't tried anything yet, no. 

Doctor: OK, and how often is he coughing? Is he coughing throughout the day or is it more so with exerting himself?
Patient: Um, it's just kind of all through the day. It's actually gotten a little bit better. Uhm, the cough has gotten better. But what I'm concerned about is the, the rash? 

Doctor: OK cough's gotten better yeah. Does he have visit rush it so is it mainly just on his forehead or also on his cheeks?
Patient: It's on his cheeks on his chin. It's kind of on his neck. It's kind of like this blotchy reddish, brownish like little dots. Kind of, it's not like, it's not raised, it's like flat. 

Doctor: OK, and uh. Is it kind of just a bit like a bright red rash that's kind of covering the cheeks or little little dots everywhere? 

Patient: Kind of little dots. 

Doctor: OK, any anything on his nose?
Patient: Yeah, yeah, it's on his nose as well. 

Doctor: OK, um, OK, but no fevers, right?
Patient: He, I guess he might have had a fever. He was feeling warm. 

Doctor: OK. And any other symptoms like shortness of breath, sore throat, anything like that?
Patient: No, no, nothing like that. 

Doctor: OK. And otherwise, any other symptoms like just not like behavioural changes, not being himself, being more irritable at all?
Patient: So yeah, he's just been tired. He hasn't been doing anything, he's just been lying in bed. Hasn't eaten. 

Doctor: OK. Any at all, is he having any nausea or vomiting?
Patient: No. 

Doctor: Any diarrhea or constipation? 

Patient: No. 

Doctor: Any changes in his urination?
Patient: No. 

Doctor: Any changes in his sleep or appetite?
Patient: No. Well, he has been eating little less, but nothing like nothing else. 

Doctor: OK. And has he been complaining at all of any abdominal pain or anything like that?
Patient: No. 

Doctor: OK. Otherwise that has he been healthy or if he had any medical conditions diagnosed? 

Patient: He's been healthy. 

Doctor: OK. And and any previous surgeries or hospitalizations?
Patient: No. 

Doctor: Any medications that he takes regularly?
Patient: No. 

Doctor: And any family history of any lung or heart conditions? 

Patient: No. 

Doctor: Concurrently, or like during your pregnancy with him, any complications at all?
Patient: No. 

Doctor: And did, was he meeting his milestones that developmentally in terms of, also with growth and height and everything like that? 

Patient: Yeah, he seems to be doing OK come when he's doing as well as his other brother, his two brothers. 

Doctor: OK, and does he go to school at all? What grade is he in?
Patient: He's going to school. Um, online. 

Doctor: Online right now? OK, yeah. And any issues at school at all. Any complaints that we've been told?
Patient: No. 

Doctor: OK. Great, so, uh and how is the houses or your living situation like? 

Patient: It's, uh, things are good, so it's him, his two older brothers, my husband and me. 

Doctor: OK, and has anyone been sick recently or had similar symptoms?
Patient: No. 

Doctor: OK. Alright. Has anyone in the family ever had any diagnosis of asthma, eczema, allergic rhinitis?
Patient: No. 

Doctor: No, nothing like that, OK. Alright, so yeah those are all the questions I had for you today. Do you have any questions or concerns? 

Patient: No. 

Doctor: OK. So yeah, so, we'll, we'll be doing a couple we'll do a physical examination, I want to see examined with the rash looks like and there's many things that can cause a rash. There's uh viral infections that can cause some of the symptoms. The symptoms he's having mainly seen viral with a dry cough and runny nose. And then you can we have a rash as well. One thing I forgot to ask actually is is he fully immunized?
Patient: Um, he I guess he didn't get all his immunizations done earlier. He did get them a little bit later so we came from Syria as refugees. But I I'm thinking he got all his immunizations when he, uh, came to, when we moved to Canada. 

Doctor: OK, and is he complaining of joint or muscle aches at all?
Patient: No. 

Doctor: No, nothing like that, OK. Alright, so yeah, we'll do it like a full physical examination, and if it's more just a viral, it'll be something that we'll just have to monitor and do supportive care for. But if it's anything else we might need to do further investigations. OK, and we'll just do a COVID swab for him today as well as some of the symptoms overlap with COVID symptoms and you will get the results back in 24 hours to 48 hours and then further instruction from public health.
Patient: Yeah, so this chest pain has just been coming on for the last couple of weeks now. 

Doctor: OK, uhm. So 2 weeks, and can you tell me kind of where you're feeling that pain? 

Patient: Um yeah, I'm I'm just feeling this chest discomfort, sort of over on the left side. 

Doctor: The left side, OK. Does does it stay just in one spot or does it kind of spread anywhere else?
Patient: No, I don't really feel it anywhere else. Yeah, I just feel it in that one spot on the left side. 

Doctor: OK, does it feel dull and achy, or does it feel more sharp?
Patient: It feels pretty sharp. 

Doctor: OK, and is it constant like on all the time, or do you feel like it kind of comes and goes? 

Patient: It comes and goes. I would say I it might last for um 20-30 minutes at a time and then it goes away. 

Doctor: OK, and over the last two weeks since you said it started, has it gotten any worse?
Patient: Uh, no. It's been about the same. 

Doctor: About the same, OK, and has it gotten more frequent, these like 20 to 30 minute episodes? 

Patient: No, it's happened about two or three times during the 2 weeks. 

Doctor: And if you were to rate it on a scale of zero to 10, zero being no pain and 10 being like the worst pain you've ever felt, where would it fall?
Patient: I would say a 4 out of 10. 

Doctor: OK. Uh, can you think of anything that that you've done differently recently that could have brought it on or is there any kind of common factor between the times that you had the pain?
Patient: Um,  I don't know I've separated from my husband 2 two years ago which has been really stressful but other than that I mean I can't really think of any changes to my health or anything like that recently. 

Doctor: OK, but do you feel like you have been more stressed out in general? 

Patient: Uh, yeah the last couple of years have been a lot more stressful because of those issues in my personal life. 

Doctor: OK, I'm sorry to hear that, but I'm glad that you're coming in and we can hopefully get to the bottom of this. Not that I think that's necessarily the source of your pain, and we definitely want to look into everything, but it is really helpful to know that. So when you've had these episodes, have you taken anything to help with the pain or done anything that's that you felt it made it go away?
Patient: Uhm, I've tried some Advil, some Tylenol and actually some Tums as well, and it hasn't really helped. 

Doctor: OK, do you think it's worse when you're moving around, if you're if you're kind of doing more exercise, or is it kind of just the same no matter what you're doing when you get the episodes?
Patient: Oh, it actually I I feel like it happens most of the time when I'm either at work or or driving. 

Doctor: OK. OK, and before this two week period, have you ever had anything like this before?
Patient: No, I haven't had anything like this happen before. 

Doctor: Do you have any chronic conditions that you see your family  for?
Patient: No, previously healthy. 

Doctor: And just jumping back to these pain episodes when you have them, do you experience anything else? Do you get any nausea or vomiting?
Patient: No. 

Doctor: OK, do you get any, do you have any difficulty breathing during these times?
Patient: No, I haven't. 

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

Doctor: OK, have you been in contact with anyone that's been sick recently? 

Patient: Uhm, no, I haven't. 

Doctor: And have you traveled anywhere outside of Canada?
Patient: No, I've been home. 

Doctor: OK so you have, you said you have been previously healthy, nothing that you've been seeing your family  for on a regular basis. Do you take any medications?
Patient: Uhm, I do not, no medications, just the Tylenol and Advil I tried for the pain. 

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

Doctor: And is there any history of heart problems in your family? 

Patient: Yeah, my father had a heart attack when he was 60 just last year and it's actually one of the reasons what concerns me about the chest pain that I thought I was having. 

Doctor: For sure, it always feels very concerning when when you have these these symptoms and that and you know people in your life that have had issues like similar issues in the past. I don't know that this is related to that. I I personally don't think so at this point, but we're definitely going to do everything to look into it and and rule out something that would be scary like that. I'm going to ask you few more questions about your lifestyle in general. Do you smoke cigarettes?
Patient: Yeah, I smoke about half a pack to a pack per day. I've been trying to quit and I was smoking more one pack per day, but so it is down a little bit, but, It's still something I'm trying to work on. 

Doctor: Congratulations, that's a really tough thing to do so, good for you. That's that's really exciting. Step in the right direction, right? Do you drink alcohol? 

Patient: Um, I do, but, uh, I'll have maybe one or two glasses of wine on the weekend. 

Doctor: Do you use any other substances?
Patient: Uh no. 

Doctor: I know that you said you don't see your family  for anything regularly, but I just want to check a couple of specific things like have you ever been told you have high blood pressure?
Patient: No, I've never been told I've I've had high blood pressure. 

Doctor: And have you ever been told you have like high cholesterol? 

Patient: I haven't, but I've actually never been tested either. 

Doctor: OK, and do you exercise regularly?
Patient: Yeah, actually, I'll either do some running or cycling, probably three or four days per week and I haven't had any chest pain or or problems exercising. 

Doctor: OK, that's good to hear. And have you ever had problems with heartburn?
Patient: Uh. I don't think so, no. 

Doctor: OK. OK, so just to kind of summarize what we've talked about, over the last two weeks, you started having these 20 to 30 minute episodes of chest pain that's on the left side, it feels more sharp, is that correct? 

Patient: Yeah. 

Doctor: And it's kind of constant when it comes on, there's nothing really that makes it better or worse, it just kind of goes away on its own after half an hour or so, it has kind of stayed the same over over the last two weeks, hasn't really gotten worse or better, it hasn't gone away either?
Patient: Right, yeah exactly. 

Doctor: You never had anything like that before and you have been, it sounds like experiencing some stress in your life, it definitely can play into that as well. OK, is there anything else that you wanted to to tell me about that I didn't ask you today? 

Patient: Uh, no, I think that's um, yeah, I think that's all that I wanted to talk about today. 

Doctor: OK, so what I'm going to do is bring all this information to your family  and we can come back together and talk to you about the next steps.
Patient: Hi I just came in today I have been having, just been feeling really sick over the last three or four days. It started with just like a headache and cough four days ago and then I started getting some nausea and vomiting few days back as well as diarrhea. 

Doctor: OK, so the headache and cough started first you said right?
Patient: Yeah. 

Doctor: OK, let's talk about the headache first that came on four days ago. Has it been persistent or does it come and go? 

Patient: It's been pretty persistent. Besides, when I take some Tylenol. 

Doctor: OK, and does anything make it better or worse?
Patient: Just a Tylenol, nothing really, yeah, it's pretty constant, 

Doctor: OK, and have a an and sorry where exactly is it is it on it's like at the top of your head, temples, forehead?
Patient: It's kind of like my forehead in the top of my head on both sides. 

Doctor: OK and does it radiate your neck or anywhere else?
Patient: No, I think it’s, it doesn't go to my neck or anywhere else. 

Doctor: OK, and do you have neck stiffness or neck pain with that? 

Patient: No, not really. 

Doctor: And one to ten, ten being the worst pain you've ever had, how bad is it?
Patient: Uh the headache, probably like 7. 

Doctor: OK. Uhm and timeline wise, has it gotten worse over the past four days?
Patient: It's kind of stayed around the same, actually. 

Doctor: OK, OK, and have you ever had a headache like this in the past? 

Patient: Not really, I don't really get too many headaches 

Doctor: OK so this isn't you. Alright And let's go on to the cough. The cough started around the same time you said, has that gotten better or worse over the past four days?
Patient: It's the cough is around the same as well. 

Doctor: OK, and is it a dry cough or are you breaking up any flem? 

Patient: It's mostly a dry cough. 

Doctor: OK, so no sputum or blood?
Patient: No, no. 

Doctor: OK, good. Alright, and are you short of breath at all? 

Patient: Uhm, no, not really, 

Doctor: No OK. And how about wheezing?
Patient: Uhm no, no wheezing. 

Doctor: OK. Only saying an. And any chest pain? 

Patient: No. 

Doctor: No OK. And have you had any weight loss over the past few months?
Patient: No, I haven't. 

Doctor: Any fevers or chills?
Patient: No. 

Doctor: No OK, uhm how about fatigue?
Patient: I guess just a little bit tired over the last few days, but I don't know that's just just from the diarrhea and just being sick. 

Doctor: Um OK, and how about rashes?
Patient: No. 

Doctor: No, OK changes in your vision or hearing? 

Patient: No. 

Doctor: Uh itchy eyes, discharge anything like that?
Patient: No, nothing like that. 

Doctor: About a stuffy or runny nose? 

Patient: No, nothing like that. 

Doctor: OK, how about changes in your smell or taste?
Patient: Uhm smell I feel like a little bit. I've been kind of losing my smell over the last I would say one day. 

Doctor: OK, OK. Alright, and any dizziness or fainting spells? 

Patient: No, nothing like that. 

Doctor: Confusion or memory loss?
Patient: No. 

Doctor: Uhm alright and joint pains or muscle aches? 

Patient: Uh no. 

Doctor: Alright. You mentioned you also have had diarrhea. When did that start?
Patient: So probably like 2 days ago I started getting some liquid stools and I just had to go like probably five or six times a day. . 

Doctor: OK. Alright. And uhm are you noticing any blood in there?
Patient: No, I haven't seen any blood. 

Doctor: OK, do you feel dehydrated?
Patient: No, I've been trying to keep hydrated. 

Doctor: OK, good, any changes in your appetite?
Patient: Uh no. 

Doctor: No, any nausea or vomiting?
Patient: Yeah, I was having some. I'm having some nausea today, but I had some vomiting yesterday. I vomited two times. 

Doctor: OK. And are you throwing up any blood?
Patient: No. 

Doctor: What color is it? 

Patient: Uhm it's usually I feel like whatever I eat. Yeah, contents, food contents. 

Doctor: OK, do you think anything triggered that episode of vomiting?
Patient: No, I haven't really ate anything new, I'm just in my house, yeah I I don't know what triggered it. 

Doctor: OK, alright any feelings of like, feeling like you're bloated or gassy?
Patient: Uhm, no. Nothing like that. 

Doctor: OK, any constipation? 

Patient: No. 

Doctor: OK. Alright, and are you otherwise healthy or do you have any longstanding medical conditions?
Patient: No, I'm I'm pretty healthy. I don't really. I don't really even take any medications. 

Doctor: OK. And are you up to date with her immunizations?
Patient: Yep. 

Doctor: Uhm, do you have any allergies? 

Patient: No, not that I know. 

Doctor: No, any family history of lung or heart conditions?
Patient: Uh, no, not that I know of. 

Doctor: OK, do you smoke? 

Patient: No. 

Doctor: No, OK. How  about marijuana or yeah, how about marijuana? Do you either take edibles or smoke it?
Patient: I’ve tried a couple times but it was not really my thing. 

Doctor: OK. And how about other recreational drugs like cocaine, heroin and opioids?
Patient: No, nothing like that. 

Doctor: OK. Uhm and where do you currently live?
Patient: I live just in an apartment just in the city. So yeah, just by myself though. 

Doctor: OK, any like old carpets, dust, mold, asbestos, pets, anything that could be triggering your symptoms? 

Patient: No, not really. 

Doctor: OK and have you been in contact with anyone sick recently?
Patient: No, I've been. And kind of. At home, the only places I maybe have been in contact with someone is maybe at work. In like the lunch room and things like that. 

Doctor: OK. OK and sorry, where do you work?
Patient: I work at a car dealership. 

Doctor: OK, OK. An any travel recently? 

Patient: No. 

Doctor: OK, has anyone at your work been sick as well?
Patient: No, I haven't really noticed anyone being sick. 

Doctor: OK, OK, well those were the questions that I had for you. Did you have any questions of your own for me?
Patient: No, I I was just wondering what this can be. 

Doctor: Um yeah, so the first thing we want to rule out as covid because a lot of your symptoms overlap with those of covid, so we'll take a swab and you should get those results in about 24 to 48 hours. In the meantime, you should isolate for 14 days. And if your results are positive, public health will be in touch with you to do some contact tracing. But if it's not covid, it could be another viral illness that's going around this time of year that could be causing similar symptoms as well, but either way the management kind of is supportive, so making sure you're well hydrated, eating nutritious food, sleeping well, taking antipyretics like Tylenol for fever's if you get any. And you can also take Tylenol or anseads for muscle ache, joint pains, anything like that. Does that sound OK?
Patient: Hi uh so I just came in today uh I've kind of put it off for a bit, but I've been having this cough uh for the last five to six months and it seems to be getting worse and over the last month I've also been becoming more short of breath, so I just wanted to come and check if I need to do anything. 

Doctor: Yeah, that that it's it's really good that you decided to come in. Um how bad is your shortness of breath? 

Patient: Um, so usually like I I would be able to walk a few blocks, um no problem, but now I have to take a break and catch my breath and even going up and down stairs has been tough. 

Doctor: Um Do you feel that uh do you feel that your, uh, difficulty with breathing is worse when you're exerting yourself?
Patient: Um, yeah, it's definitely worse, but I also just like normally even when I'm resting, I feel like I have to um take in like much deeper breaths. 

Doctor: Do you ever wake up in the middle of the night gasping for air? 

Patient: Uh no, nothing like that. 

Doctor: Do you feel like you have to raise your head or have multiple pillows to sleep at night so you don't feel short of breath?
Patient: No, nothing like that. 

Doctor: OK. Uhm and this cough that you've had for the past five or six months, did you say it's getting worse? 

Patient: Um yeah it it's, both the shortness of breath and the cough are getting worse and also just I've been having some even some discomfort and pain when taking those deep breaths now too. So, and that's been happening for probably the last couple weeks. 

Doctor: I see. Um is it a dry cough that you have or or do you bring up any gunk or any mucus?
Patient: Um it's mainly just a like a like a dry cough. 

Doctor: Have you ever coughed up any blood or anything like that? 

Patient: No, I haven't, I don't think I've seen any blood. 

Doctor: OK, uhm do you have any other symptoms? Do you have any fevers or chills?
Patient: Um not fevers, but I I have been getting night sweats um for the last couple weeks to maybe even a month or once or twice a week, I just wake up completely drenched. 

Doctor: And have you had any unintentional weight loss? 

Patient: Yeah, now that you mention it, I probably lost 15 pounds in the last two months. 

Doctor: OK. Uhm, have you had any muscle aches or joint pains all over your body? Do you feel achy?
Patient: Yeah, but I've probably felt like that for the last five years, um so I have uh osteoarthritis. 

Doctor: OK.
Patient: So I don't think that's anything new. 

Doctor: Um have you had any changes in your bowel movements or any urinary symptoms? 

Patient: No. 

Doctor: Any abdominal pain?
Patient: No, not that I've noticed. 

Doctor: OK. Any headaches?
Patient: Um no, nothing like that. 

Doctor: Uhm, OK. Uh have you had any falls in the past or in the past couple of months or years?
Patient: No, no, I've been lucky. 

Doctor: Good. Any confusion? 

Patient: Nope. 

Doctor: Uh any time when you've lost consciousness?
Patient: Not that I know of, no. 

Doctor: OK. Um and any medical conditions that you've been diagnosed with?
Patient: Um, so I have osteoarthritis. And then I also have um this condition with my prostate, uh BPH. And um I also take medications for my blood pressure. 

Doctor: Um what medications do you take?
Patient: Um I take um this medication called uh Lisinopril. 

Doctor: Anything else?
Patient: Um I do take uh just pain medications like Advil. 

Doctor: Um OK. Do you take anything to protect your stomach when you're taking the Advil, any other medications? 

Patient: Yeah, I was given um this other medication for, for, to take with my Advil like, but it's only when I'm taking Advil like every day. Um and, um I haven't really been taking that, um I probably took, the last time I took it was probably a month ago. 

Doctor: OK, OK. That's good. Um are you taking anything for your uh BPH?
Patient: Oh yeah, sorry. So I'm taking uh this medication called Tamsulosin. 

Doctor: OK, alright, any allergies, to medications or otherwise? 

Patient: Uh mot that I know of, no. 

Doctor: OK, any um I guess social history, who do you currently live with?
Patient: Uh I live alone right now in my apartment I, um but I have pretty good support from my kids, they just live a few blocks away and come visit me. 

Doctor: That's good. That's really good. And uh do you, are you able to um take care of yourself or do you need help with things like um finances and groceries and cleaning?
Patient: No, I'm I'm fairly independent in those matters. 

Doctor: OK, do you require any assistance uh with walking any cane or walker or wheelchair, anything like that?
Patient: No, not yet. 

Doctor: OK good good. Do you smoke at all or did you ever smoke in the past?
Patient: Yeah, I've been smoking for my whole life. 

Doctor: How long and how much and for how many years? 

Patient: Um probably for almost, I guess 50 years or maybe even more, maybe like 55 years and uh I've been smoking, at one point I even smoked up to like two two packs a day, but now, like for the last, at least 20, 30 years, it's been like one pack a day. 

Doctor: OK. Have you ever been diagnosed with any lung conditions?
Patient: Uh no. 

Doctor: OK, have you um had any marijuana or any recreational drugs?
Patient: Uh no, nothing like that. 

Doctor: Alcohol? 

Patient: Nope. 

Doctor: OK, uhm, alright, um you mentioned that the cough started 5 to six months ago. Have you had a cough before that?
Patient: Um, it's here and there, like maybe just when I wake up sometimes, but this is kind of uh more frequent and, I I do feel just kind of this discomfort in my chest when I take these deep breaths as well. Um yeah so, I I don't really know what's going on. 

Doctor: Um do you go to your family  for your uh health checkups?
Patient: I haven't been for a while, for the last few months, but yeah, I generally do go to my family doctor. 

Doctor: You do, OK. Um have you been, uh, sometimes for people who have been smoking for a long time, they do uh these scans of the lungs, uhm, have you been getting those? 

Patient: No, I don't remember the last time I had one. 

Doctor: OK Alright. Um OK, those are all the questions I had for you. Uhm, we'll we'll do a physical exam and uh do your vitals um and see if you uh, do some labs, and then go from there.
Patient: I so I've just had this pain in my chest for just over a week now and it's caused me to have trouble breathing. 

Doctor: OK, um how old are you, Jen? 

Patient: Um 52. 

Doctor: OK when did this pain start? You said a week back?
Patient: Uh, yeah, just about that I I think maybe 8 days ago. 

Doctor: OK, and is it a constant pain? Is it always there? 

Patient: Ahh it it is, but it's definitely worse that um, it's the breathing that's been bothering me a lot more. When I take a deep breath that the pain is a lot worse. 

Doctor: OK, OK um. And when you do get that, get that pain. How long does it last?
Patient: Um I would say, uh. Around 15-20 minutes. It's it goes away over overtime. 

Doctor: OK, and the shortness of breath do you have that at rest as well? 

Patient: Uh no if I if I take a break or sit down to rest then I can usually catch my breath. But if even if I'm doing a little bit of exertion like walking a few a few blocks or something like that I'm finding it, I'm I'm short of breath. 

Doctor: OK um do, did anything trigger this a week back? Any trauma to the chest area? Anything like that?
Patient: Uh, No, no one else has been sick. I I had a cough about a week ago so I thought it might be a chest infection, but I'm not feverish, so I'm not sure. 

Doctor: OK, the cough is it still there?
Patient: Yeah, it's um. I still have a cough. 

Doctor: OK, and are you coughing up any blood?
Patient: No, I haven't. I haven't noticed any any blood. 

Doctor: OK, how about sputum?
Patient: Um, no sputum. 

Doctor: No, OK. And do you feel like you're wheezing?
Patient: Oh no wheezing. 

Doctor: No wheezing, OK. Um, the shortness of breath 1 to 10, 10 being the worst, the most severe. How bad is your shortness of breath? 

Patient: I would say when I'm exerting myself, it could get up to like a 7 or 8. 

Doctor: OK, and you mentioned how, how far can you walk before you need to rest.