jshargo/medical-interview-conversations huggingface dataset:
Patient: No, I haven't had any pain or anything like that. 

Doctor: OK, and are you otherwise healthy? Do you have any medical conditions?
Patient: Yeah, I have atrial fibrillation. And I do take Metoprolol for that. 

Doctor: OK, how long have you had A. fib?
Patient: It was like 4 years ago I think it was. It was having that like, felt like my heart was racing you were asking about earlier and they did an ECG and I was told I had atrial fibrillation. So yeah, I've been on a beta blocker for three years now. 

Doctor: OK, four years, and when was the last time you had an ECG?
Patient: Uh, maybe just a couple of months ago. I think every time that I come in to see my family doctor, they they do one. 

Doctor: OK, and the last time that it was done, was it normal?
Patient: I had an inguinal hernia repair about 15 years ago. 

Doctor: OK, any complications from that?
Patient: Um no. 

Doctor: OK, and then besides the Metoprolol, are you on any other medications? 

Patient: Oh yeah, I take a statin and baby aspirin. 

Doctor: OK, and is that for the A. fib as well, the aspirin? Or is that just for other cardiovascular issues or some sort of preventative measure?
Patient: Yeah, I heard it was good for people who have atrial fibrillation so I started taking it. 

Doctor: OK. and let's revisit your medications at the end of today's session. I just want to make sure that you're on the medications and I just want to make sure you're on the right dose.  Does that sound good?
Patient: Yeah, certainly.  DOCTOROK great. And ok, so we talked about your past medical history and medications. We will talk a little bit about any allergies that you have, if you have any.  I think it's like a sulfa allergy. I received an antibiotic like that many years ago and had a rash. 

Doctor: OK, OK and have you had any reason to suspect that you may have taken any sulfas recently?
Patient: No, I haven't had any antibiotics so no, really no changes. 

Doctor: OK, OK, good and are you up to date with all your immunizations? 

Patient: I am yeah. I've received the Zoster vaccine for shingles and also the one for pneumonia. 

Doctor: OK, good, good yeah, those two we definitely recommend if you're over 65. OK, and do you know of any family history of lung conditions or heart conditions?
Patient: No, I think my aunt had lung cancer but she smoked her entire life. 

Doctor: OK, OK and how about other cancers?
Patient: No other cancers. 

Doctor: And have you been in touch or do you think you've been in contact with any anyone sick recently? 

Patient: Well, I visited my mother at a long term care facility just this past weekend, so I guess about just over a week ago I visited there. 

Doctor: OK, and have there been any COVID outbreaks at the long term care?
Patient: Yeah, there has been, I thought I was like away from those areas but I have heard about outbreaks there. 

Doctor: OK, OK and any travel history?
Patient: No travel. 

Doctor: And do you smoke?
Patient: I used to smoke a pack of cigarettes a day, but I quit about, uh, about five years ago. I know four years ago it was when I found out I had atrial fibrillation. I quit. 

Doctor: OK, OK, well that's good. Good for you for quitting. How about marijuana?
Patient: No, I don't smoke it, but I'll use some edibles I buy from the Ontario stores a couple of times per week. Just the CBD stuff. 

Doctor: The CBD stuff OK. And how many milligrams? 

Patient: I'm not sure, I know it's their lowest dose though. 

Doctor: OK, OK if it's lowest dose, it might be 2.5 milligrams.
Patient: Sounds familiar. 

Doctor: OK good. Is there a particular reason you take these CBD edibles?
Patient: It helps me sleep. 

Doctor: OK, if it's specifically to help you sleep, we can actually try and see if there are other options for you. You know there are pills, like they are sleep aids. Or even things like melatonin that can help regulate your sleep so we can revisit other options for you if you're open to that as well.
Patient: OK for sure. Yeah I will. Um, yeah we can talk about that later. 

Doctor: OK, that sounds good and do you do any other recreational drugs?
Patient: I do not. 

Doctor: OK, how about alcohol? 

Patient: Uh, no, I don't drink anymore. 

Doctor: OK, and did you used to drink before?
Patient: Yes, I just stopped a few years ago, 

Doctor: OK, and what's your living situation like right now?
Patient: I live in a house with my wife. 

Doctor: In a house, OK. Any concerns for like old carpets, mold or asbestos in your house?
Patient: No, we've renovated it over the years. 

Doctor: OK, good and I apologize, but I would like to clarify three more symptoms with you. Did you say you felt like you had a fever earlier?
Patient: Um, maybe I've been feeling a little hot, but it's been really more the cough and shortness of breath that's been bugging me. 

Doctor: OK, well we can take a temperature today just to make sure. Have you been feeling like you have night sweats or chills? 

Patient: Um, not really. No, I haven't noticed that. 

Doctor: OK, and how about, um, any weight loss over the past few months?
Patient: No, it's been been stable. 

Doctor: OK, alright good, so that brings us to the end. Do you have any questions or concerns that you would like to clarify before we end the interview? 

Patient: No, nothing today.  I was just really hoping to get, uh, whatever this is sorted out. 

Doctor: Yeah, you know, um, right now it looks like, it sounds like it could be an upper respiratory viral illness, so that includes COVID.  So we will do a swab for you and then send it off to the lab for PCR results. In the meantime, because you have symptoms that overlap with COVID symptoms, we do encourage isolation for 14 days. Until your symptoms are gone, sorry,  until your symptoms are gone, even if they're gone, we do suggest isolating for 14 days just to make sure you're not a carrier or could spread COVID so we do encourage that, and that includes from your husband. If possible, we will get those results in a day or two. If they are positive, we will send your results to public health who will be in touch with you to do some contact tracing to see where you may have gotten it from. If it's not COVID, it could be other viral illnesses that are going around this time of year. And if your symptoms aren't getting better on their own, and there's reason to suspect you may have a bacterial infection or bacterial pneumonia, we will follow up with you and possibly prescribe antibiotics. How does that sound?
Patient: Yeah, that sounds like a great plan. 

Doctor: OK, great so um, I will see you at the next appointment.
Patient: Um, I've just had difficulties with breathing for the past, I want to say eight, nine months. And um, my wife just told me to come in. It's just, she was worried about it and uh, I thought I'd just come in and have it checked out. 

Doctor: Okay, so it's been going on for the last eight to nine months. Has it been getting worse at all?
Patient: Yeah, I would think so. I would say so, yeah. So, 

Doctor: Sorry, go on.
Patient: So, it was just um, I feel like I just get short of breath more easily now. 

Doctor: Okay, and is it short of breath with activities? Or are you getting short of breath with uh, sitting or resting as well? 

Patient: So when I'm, when I'm, with activity. 

Doctor: With activity, okay. And the cough that you're getting, is it a wet cough or a dry cough?
Patient: It's a dry cough. 

Doctor: Okay. And are you bringing up any material at all, like any um, yellow or green sputum? 

Patient: No, no. 

Doctor: Any blood?
Patient: Um, no, no blood. 

Doctor: No blood, okay. And with your shortness of breath, is it, are you having difficulty taking deep breaths, or do you find that you're taking more fast, shallow breaths?
Patient: Um, just, I guess, just uh, shallow breaths. 

Doctor: Okay, okay. And um, so this is over the last eight or nine months. Have you noticed any other symptoms at all, like chest pain, dizziness or fainting? No?
Patient: No. 

Doctor: Okay. And do your symptoms get, get worse at all when you're lying flat, like when you're sleeping? 

Patient: No. 

Doctor: No. And do you ever wake up gasping for air?
Patient: No. 

Doctor: Okay. Um, and have you tried anything that's helped you uh, relieve some of these symptoms? 

Patient: Sorry, could you say that again? 

Doctor: Uh, have you tried anything like over the counter, to help you relieve these symptoms?
Patient: No, no I haven't. 

Doctor: Um, have you traveled at all recently? 

Patient: No. 

Doctor: Have you been in contact with anyone that's been sick?
Patient: Um, no, not really. I, I did go out to the pharmacy to get my medications, but that's, that's the only time I actually interact with anyone outside of my home. 

Doctor: And what, what medications do you take? 

Patient: Um, I just take aspirin. 

Doctor: Aspirin, okay. Have you been diagnosed with any medical conditions?
Patient: I had a heart attack. 

Doctor: Oh okay, well when was that?
Patient: Last year. 

Doctor: Last year, well I'm so sorry and um, did they give you any medications to go on after that? 

Patient: Yeah yeah, yeah there, there were a couple of other medications as well. Something um, something, something -pril. And uh, I think there's uh, uh, rosuvastatin. 

Doctor: Okay, and do you still take those?
Patient: Yeah, I take those. Sometimes I forget that I do, I try to take them as much as I can. 

Doctor: Okay, and you also take the aspirin. Alright, have you noticed any fevers or chills?
Patient: No. 

Doctor: Nausea or vomiting? 

Patient: Nope. 

Doctor: And any chest pain?
Patient: Uh, no. 

Doctor: No, okay. Any increased fatigue? 

Patient: No. 

Doctor: Any diarrhea or constipation?
Patient: No. 

Doctor: Any numbness or tingling anywhere?
Patient: No. 

Doctor: Any confusion or memory, like memory loss? 

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

Doctor: Any trouble urinating?
Patient: Um, no. 

Doctor: Okay, have you noticed any swelling um, in your feet, ankles, legs at all? 

Patient: No. 

Doctor: Okay. Um, and how's your appetite been like?
Patient: Um, it's been, it's been the same. 

Doctor: Okay, and any um, significant weight changes? Have you lost any weight? 

Patient: No. 

Doctor: No. Um, any exposure to fumes or dust within your environment?
Patient: Um, not right now. When I was young, yeah. 

Doctor: Okay, now did you, so did you have exposure to fumes or dust?
Patient: Um, I used to work in a mine so. 

Doctor: A mine?
Patient: Yeah, lots of chemicals and things like that. 

Doctor: Okay. And any exposure to any pets or animals? 

Patient: Uh, no. 

Doctor: Besides your medical history of having a heart attack and some blood pressure, um, any other medical conditions?
Patient: Uh, I just have high blood pressure. 

Doctor: Okay, any allergies to any medications or any environmental allergies? 

Patient: No. 

Doctor: Okay. Um, any hospitalizations besides when you had a heart attack, previously?
Patient: No. 

Doctor: Any surgeries? 

Patient: No. 

Doctor: Okay. Did they tell you at all what the cause of your heart attack was?
Patient: Um, they just uh, they said it was my, my diet. 

Doctor: They said diet, okay. 

Patient: Yeah, something about cholesterol. 

Doctor: Did you require any stents, or did you have to get a bypass surgery or anything like that?
Patient: Uh, they put in, I think they put in stents. 

Doctor: Stents, okay. Um, any family history of any heart or lung conditions? 

Patient: Yeah, um, my um, mom had heart failure. 

Doctor: Okay, um, and how old was she when she had her heart failure?
Patient: She was young, she was uh, 55. 

Doctor: 55, okay. Um, and currently, right now, or sorry, do you have any family history of any cancers, any lung cancer or anything like that? 

Patient: No. 

Doctor: And currently do you work or are you retired?
Patient: I'm retired. 

Doctor: Okay. And what's your living situation like right now? Do you live with anyone?
Patient: I live with my wife. 

Doctor: Okay, and do you smoke? 

Patient: Uh, no. 

Doctor: Have you ever smoked?
Patient: I did when I was young. 

Doctor: How long would you say you smoked for?
Patient: Um, I'd say 45 years. 

Doctor: And how much would you smoke in an average day?
Patient: Um, about a pack a day. 

Doctor: Um, any recreational drugs like marijuana? 

Patient: No. 

Doctor: And do you drink alcohol?
Patient: Yeah I do. Um I'll, I'll drink a glass at night, every night. 

Doctor: And a glass of, what would you drink?
Patient: Oh just a, a glass of wine, white wine. 

Doctor: Okay, so those are all the questions I have for you today. Any questions for me?
Patient: No. 

Doctor: Okay, so yeah, there's definitely like the coughing and shortness of breath are definitely concerning, and they've been going on for a pretty long time. Do you ever have any night sweats or anything like that? 

Patient: No. 

Doctor: Okay. So there's a few things that we think about with the chronic shortness of breath and a cough. One could be just a COPD diagnosis with your long history of smoking. And this pulmonary function test, get an x-ray, chest x-ray as well. Um another thing that we need to look out for is uh, lung cancer. And since you have been smoking for a pretty long time, even though you may have quit, which is really great, but that long history of smoking, especially also with um, you working in a mine, those are some things that means we can test as well, and so we may require like a chest x-ray, and even um, a CT scan of your lungs as well. Um, so yeah, first we'll just do a couple tests, do a physical examination, get your vitals, do some blood work and do some of those tests and then we'll also get a COVID swab test done for you as well, just in case. Does that sound good?
Patient: Yeah. 

Doctor: Alright, so we'll be with you shortly.
Patient: So I've had a fever that I measured this morning and I had a cough.  I've had a cough these last several days. Yeah, today is Friday so it started Monday, so I guess like yeah the cough started four days ago. 

Doctor: OK, and the fever started four days ago as well? 

Patient: Well, I've been feeling hot this week, but I checked my temperature this morning and it was the first time I checked it and it was 38.5. 

Doctor: OK, so that's definitely a fever, so we can take your temperature today as well. Umm, so have your symptoms been the same or getting worse, or be getting better over the past few days?
Patient: They are getting worse. I've been starting to feel really fatigued and, uh, tired as well and the cough has gotten worse too. 

Doctor: OK, have you ever felt like this before? 

Patient: I mean, maybe a really long time ago when I was a kid or something like that. Maybe I had the flu, but nothing recently. 

Doctor: OK. And do you have a sore throat at all?
Patient: No sore throat. It does get a little scratchy with my cough but hasn't been sore. 

Doctor: OK, and do you have any issues swallowing food? 

Patient: No, but I haven't been as hungry. 

Doctor: OK, you haven't been as hungry. Um, have you had any changes to your taste?
Patient: No, I feel like I've been tasting my food OK. 

Doctor: OK, how about smell?
Patient: I feel like I've been able to smell. 

Doctor: OK, do you have a runny nose or a blocked nose? Do you feel congested? 

Patient: Maybe a little runny, but not too bad. 

Doctor: OK, how about your hearing or vision? Any changes there?
Patient: No, I haven't noticed anything. 

Doctor: OK, any pain or discharge from either your ears or eyes?
Patient: No, nothing like that. 

Doctor: OK, so let's go back to the cough. Um, are you producing any sputum?
Patient: No sputum. 

Doctor: OK, so it's a dry cough? 

Patient: Yeah it is. 

Doctor: OK, any blood associated with the cough?
Patient: I haven't seen any blood. 

Doctor: OK, do you feel wheezy at all? 

Patient: I haven't noticed any wheezing. 

Doctor: OK, how about shortness of breath?
Patient: Usually well, after some of my coughing fits, I can be a little bit shorter in breath, but otherwise they've been. 

Doctor: OK, any chest pain?
Patient: No, I haven't had any chest pain. 

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

Patient: No, I don't. 

Doctor: OK, and any night sweats or chills?
Patient: I have felt a little chilly at night, but I haven't had any night sweats. 

Doctor: OK, and how about weight loss? Have you had any weight loss over the past few months?
Patient: No, it's been about the same. Maybe down a few pounds over this week as I just haven't been eating as much. 

Doctor: OK, yeah. Umm, does anything make the cough better or worse?
Patient: Umm, no, I can't think of anything. 

Doctor: OK, and how have your bowel movements been? 

Patient: They've, I would say they've been normal. 

Doctor: OK, and any abdominal pain?
Patient: No pain, but I have been a little nauseous. 

Doctor: Nauseous, OK. Have you thrown up? 

Patient: No, I haven't vomited, but I've certainly felt like it a few times. 

Doctor: OK, and any triggers for your nausea?
Patient: Oh I can't think of anything. It just sort of came on. And it really went away on its own pretty quickly, but uh I don't know, maybe it was when I had my headache. 

Doctor: OK, when when did your headache start?
Patient: Um, so it's been on and off these last several days so I've been kind of resting a bit more too. 

Doctor: OK yeah, you said past several days, have you ever had headaches before that?
Patient: Yeah, I've had, I think they're called tension headaches. I get those every so often and will take Advil or something like that for them, and they usually go away. 

Doctor: OK. Do these headaches feel like the same headaches?
Patient: Yeah, they they feel about the same, kind of like a pressure or vice grip on my head. 

Doctor: OK, so it's not like the worst headache you've ever experienced?
Patient: No, I think it's just been a part of how I haven't been feeling well these these last few days. 

Doctor: OK, yeah. Do you feel fatigued or tired at all? 

Patient: Yeah, for sure. I haven't really had any changes, but just haven't been really getting my work done throughout the day because I have just been feeling so tired. 

Doctor: Yeah, umm, and do you feel any sort of body aches that go along with your fatigue?
Patient: Maybe a little. 

Doctor: OK. Umm, can you think of anything that may have caused your symptoms? You know, have you been in contact with anyone who's been sick recently?
Patient: I can't think of anybody I've been around who's been sick, but last weekend I went shopping in the mall so I went into quite a few stores. 

Doctor: OK, and you were wearing your mask? Everyone else was wearing their mask? 

Patient: Yeah, everybody far as I could tell. 

Doctor: OK, have you traveled anywhere recently?
Patient: Uh, no, I've just been home. 

Doctor: OK, I just want to ask you a few more questions. Any memory loss or confusion?
Patient: No. 

Doctor: Any dizziness or fainting spells?
Patient: Nothing like that, no. 

Doctor: OK. Are you otherwise healthy? 

Patient: Um, yeah I've well, I've been told I had high cholesterol so I've been taking Rosuvastatin for that the past few years. 

Doctor: OK, and is it helping with the cholesterol levels?
Patient: Yeah, the last time I was at the family DOCTOR: I was told they were at a good level. O 

Doctor: OK, good.
Patient: I'm sorry I'm pre-diabetic as well. 

Doctor: OK, when was the last time you had blood work done?
Patient: I think, uh six months ago. 

Doctor: OK, and that's when you were told you were pre-diabetic?
Patient: Yeah, I think my A1C was like 6.2% so uh, on the cusp. 

Doctor: OK, yeah, that's understandable. Um, have you made any sort of lifestyle changes to get your blood glucose under control? 

Patient: Well, I have been walking the dog more. he weather is getting better and trying to eat out less often. Yeah, I've been trying to lose weight, but it it's been yeah, relatively stable still.  DOCTOROK, we can review some options with you later on in the visit if you would like.  Yeah, certainly we can talk about that later. 

Doctor: OK, sounds good. Have you had any surgeries or hospitalizations in the past?
Patient: Yeah I had an inguinal hernia repaired about five years ago. 

Doctor: And are you on any medications?
Patient: Just Rosuvastatin right now. 

Doctor: OK, and any over the counter medications or herbal supplements?
Patient: Just a multi vitamin. 

Doctor: OK, umm, do you have any allergies?
Patient: Penicillin. I break out in hives. 

Doctor: OK, and did you need to be treated with any sort of antibiotics recently?
Patient: No, no, I haven't had any antibiotics for a long time. 

Doctor: OK, and are you up to date with all your immunizations?
Patient: I am, yeah, I get the flu shot every year. 

Doctor: OK, good. An yeah, that's really good. Um, do you know if you have any family history of any lung conditions or heart conditions?
Patient: No, I don't think so. 

Doctor: OK, how about cancers in the family?
Patient: I think my grandfather had bladder cancer, but, uh, I'm not sure. 

Doctor: OK, and I forget if I asked you earlier, but have you had any changes to your urinary habits, any changes in your urine itself or voiding frequency? 

Patient: No, I haven't had any changes there and I haven't noticed any like blood or color changes. No pain. 

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

Doctor: OK, how about marijuana? 

Patient: Nope. 

Doctor: Any other recreational drug?
Patient: No, I just have a few beers on the weekend. Like probably I don't know two or three on Saturday and Sunday. 

Doctor: OK, and where do you live? 

Patient: I live in a like duplex and rent the basement in a house nearby. 

Doctor: OK, do you live with anyone?
Patient: Yeah, I live with my girlfriend. 

Doctor: OK, and um, any concerns for you know old carpets or mold or asbestos in the duplex that you're living in? 

Patient: Not in our unit so I mean, maybe upstairs, but if it's anything like our place, then no. 

Doctor: OK. I think those were all the questions that I had for you. Did you have any questions or concerns that you wanted to bring up before we end the interview?
Patient: Uh, no, well  I guess I was just concerned about about COVID. 

Doctor: Yeah, you know that's the top on my list of differential diagnosis for you. So what we'll do is a COVID swab and that should come back in a day or so, but we do encourage isolation for 14 days and that includes from your girlfriend as well. So even if the COVID swab comes back negative, sometimes it can be false negative, so as long as you're having these symptoms, and these symptoms are common in COVID,  we do ask that you isolate for 14 days if the swab comes back positive. We will also notify public health so that they can get in touch with you and do some contact tracing to see where you may have gotten COVID from, but other than that, if it's not COVID, it could likely be another upper respiratory viral illness because of this time of year. A lot of different viruses are going around like common viruses or the flu, you know, so it could be one of those. And then if you're still sick or your symptoms change, we can reassess to make sure it's not a bacterial infection or bacterial pneumonia, in which case we can prescribe antibiotics. 

Patient: OK yeah, thank you for all that information. Sounds great. 

Doctor: OK, well take care then, alright.
Patient: Yeah, that sounds great. Thank you. 

Doctor: Can you tell me about what brought you in today? 

Patient: Yeah, I've had this cough for the past four or five days and it doesn't seem to be going away or getting better, so I thought I should get it checked out. 

Doctor: OK, are you here with your mom today?
Patient: I am. 

Doctor: Hi mum. Um OK. You got a cough you said I'm sorry, you said for five days?
Patient: For, yeah, four to five days ish, yeah? 

Doctor: OK. And, uh, has it you said it was a dry cough? Is that right?
Patient: Yeah, that's right. 

Doctor: OK, so at no point were you bringing up on gunk with your cough? 

Patient: Yeah. No, no, nothing like that. 

Doctor: OK. Since it started, do you think it's gotten worse or has it kind of stayed the same? Gotten any better?
Patient: It's kind of stayed the same. 

Doctor: OK. OK, uhm. Along with the cough have have you been having any other new symptoms?
Patient: Uh no. 

Doctor: OK, have you had a sore throat? 

Patient: No. 

Doctor: Do you feel like you can taste and smell things normally?
Patient: Yeah, I think so. 

Doctor: OK. OK, have you been having a runny nose?
Patient: Oh yes, I have had that for the past couple of days as well. 

Doctor: And is it a runny nose with kind of clear stuff? Is it watery or is it thick? Does it have a color to it a yucky the color?
Patient: It's pretty clear. 

Doctor: OK, OK. Uhm. And uh have you had any fevers? Your mom might be able to answer that one better. 

Patient: Yeah, um. He has had uh like he's had fevers in the past, but I I didn't really check this time. He didn't seem hot. He didn't have any chills. 

Doctor: OK, well that's good. Uhm. OK, have you had any back or muscle pain?
Patient: No. 

Doctor: OK. Have you had any chest pain? 

Patient: Uh no, no chest pain. 

Doctor: OK. Any, any nausea or vomiting?
Patient: Uh no, no nausea or vomiting. 

Doctor: Have you ever had any pain in your belly?
Patient: No, nope that no pain in my belly. 

Doctor: Any headaches? 

Patient: No, no headaches. 

Doctor: OK, have you been around anyone that's been sick?
Patient: No, not that not that I can remember. 

Doctor: OK. Uhm, have you traveled anywhere recently? 

Patient: Uh nope. 

Doctor: Are you going to school right now or staying home?
Patient: I’m going to school and they're doing these half days. 

Doctor: OK. OK uhm, and has anyone in your school been sick? 

Patient: Ah, Nope, not recently. 

Doctor: At least not that we know of. OK.
Patient: No. 

Doctor: OK, have you ever had anything like this before?
Patient: No. I've been pretty healthy otherwise. I've never had like I've never had like a dry cough like this. I've had runny nose in the past, but they never lasted this long. 

Doctor: OK, have you ever been in the hospital?
Patient: No. 

Doctor: OK. Did you see your family  for anything? Any health problems? 

Patient: No, no. 

Doctor: Do you take any medicines?
Patient: No. 

Doctor: OK. This may be a tricky one to answer, so Mom can definitely help us. Do you have any family history of respiratory problems? 

Patient: Um uh his grandparents had um asthma, but he's been worked up for that and he doesn't get short of breath or wheezing or anything like that with even with physical activity. So yeah, so he doesn't have that. 

Doctor: And what else?
Patient: Pardon me. 

Doctor: I said just some some asthma in the family.
Patient: Yeah. 

Doctor: OK. And so you live, you live with your mom. Do you live with anyone else in your family?
Patient: I have a four year old sister. 

Doctor: OK, do you live with your dad too? 

Patient: Yes. 

Doctor: Do you guys have any pets?
Patient: Um no, no pets. 

Doctor: And does anyone smoke in the home?
Patient: Nope, no. 

Doctor: OK, and what do you like to do for fun? 

Patient: Um I like playing with my friends, I like playing video games. 

Doctor: Oh cool. So what's your favorite game?
Patient: I am playing Rollercoaster Tycoon. 

Doctor: Oh cool, that sounds like fun. OK well, hopefully we can get you back to feeling healthy so you can continue to play lots of roller coaster Tycoon. So I’m going to go get the  that I'm working with. I'm, uh, I'm wondering, you know, he might want to do a chest X Ray and get a better look at what's going on there. Have you ever had an X Ray before?
Patient: I don't think so, no. 

Doctor: Do you know what an X Ray is?
Patient: A little bit, yeah. 

Doctor: Yeah it's like taking picture of your body on the inside. It's pretty cool so it gives us an idea of what's going on in the inside. Also, this really this part is kind of not so much fun, but I think we should probably do a covid swab because we're doing that with anyone that comes in with these symptoms lately and that's not a lot of fun. We gotta stick something up your nose, but I think that you're really brave and I think that you'll be just fine with it, OK?
Patient: OK. 

Doctor: So we're going to arrange for these things and then I will come back with the  that I'm working with and we'll kind of talk about where to go from here.
Patient: OK, that sounds good. 

Doctor: Thank you guys for chatting with me. 

Patient: Yeah, thank you. 

Doctor: Thanks.
Patient: Yeah, I've had, I've had a cough for a number of years now, but store these past like day, it's gotten a lot quite a bit worse and I've been really short of breath. 

Doctor: OK, and so how many days would you say you've been short of breath? 

Patient: Less than a day, maybe just really kind of started last night and has carried out throughout this morning. I, I called this morning to get an appointment. 

Doctor: OK, and it, was it brought on by any activities or were you doing anything at that time before it started?
Patient: No, last last night I was, well, I was just doing my regular kind of routine after dinner - cleaning up and just the cough started first. And over, the over the night it got worse. I could just couldn't catch my breath and that was similar this morning. 

Doctor: OK, so you've also had a cough.
Patient: Yeah I have. Yeah, uh, I've had a cough for a long time now, but it's been worse over this last day. 

Doctor: Yeah, is it like a wet cough or dry cough? 

Patient: It's wet, I I'm bring up sputum most of the time, but it's been, it's usually like white or clear and it's a lot more like, uh it's a lot more greenish, yellow and, yeah. 

Doctor: OK, and are you having any kind of fevers or chills anything like that?
Patient: Uhm yeah I, I did have some chills last night, so I'm not sure about a fever though. 

Doctor: OK. And are your symptoms at all, so you do have a shortness of breath, but any kind of chest pain at all?
Patient: I do have some chest pressure for sure. I just feels like I can't, can't ah, catch my breath. 

Doctor: OK, so is it mostly related to your breathing or do you have it at rest? Or do you have it with any exertion? 

Patient: Yeah, I think it, it's there kind of most of the time, like the chest pressure. I kind of feel it throughout my chest when when I'm breathing but, but also just kind of sitting here I can kind of feel it. 

Doctor: OK I see. And are all of your symptoms constant? Or do they come and go?
Patient: They've been constant and they've got been getting worse since since last night. 

Doctor: OK, and have you had this happen to you before?
Patient: It has, yeah, I, actually last last winter I was hospitalized for a COPD exacerbation for, for a few days. I I know I got some antibiotics and umm, I needed some oxygen. 

Doctor: I see and did you go home on home oxygen at all? Like do you use oxygen at home? 

Patient: No, I was told I didn't need any any yet, but if I didn't quit smoking I might in the future. 

Doctor: OK, and are you using any kind of puffers at all?
Patient: Yeah, I I do I I use I think it's called like Spiriva or something like that. I use that every day and there's another one that I'll use like if my symptoms are getting bad. My blue one. I did try that actually last night and it didn't, it helped a little bit, but, not not enough. 

Doctor: OK, so have you just tried like tried it one time last night? Have you tried it after that?
Patient: Yeah, we just tried it last night. 

Doctor: OK, so nothing today right? 

Patient: No, nothing today. 

Doctor: OK. Other than that, so you did have an admission before for this. And you have COPD. Do you have any other symptoms right now? Like runny nose, sore throat, any cold like symptoms?
Patient: No, no, I I I don't. 

Doctor: Did you have it before these symptoms started?
Patient: Uhm no, I've been feeling, I've been feeling OK. 

Doctor: OK. And have you traveled at all recently?
Patient: Uh, well, I did, I just go up to the trailer not too long ago to visit some family, but that's just an hour away. 

Doctor: OK. Anyone sick around you recently?
Patient: No, I don't, I don't think so. 

Doctor: And is there, are you having any headache or nausea or vomiting?
Patient: No, I haven't had anything like that. 

Doctor: OK. And besides the time you got hospitalized, have you had any exacerbations after that?
Patient: No, I just had that, had that happen, the one time, last year. 

Doctor: OK. And do you feel that your symptoms are similar, worse, or how do they compare to last time, if you remember?
Patient: Pretty similar. I think last time I was worse, but I waited longer last time and so that's why I was concerned and and wanted to come in early. 

Doctor: OK. OK, uh, alright, so uh, have you had any fevers at all or chills? 

Patient: Yeah, I've I've had some chills last night like I just couldn't get warm. I was loading up on blankets and it didn't seem to help. 

Doctor: OK so we'll get a temperature on you today as well. Do you feel that you're breathing faster at all?
Patient: Uh, not necessarily it, just it just harder to to, feel like I can't catch my breath. 

Doctor: OK, do you feel fatigued at all? 

Patient: Ah yeah, I I have a, I mean I have been feeling just tired this morning, but I think that's more to do with the fact that I just can't really do a whole lot of exertion because as soon as I move around I'm, I can't breathe. 

Doctor: I see. Uhm OK, and are you having any kind of diarrhea, constipation, or any urinary troubles at all?
Patient: No, I'm not. 

Doctor: OK. Any changes in your sleep or appetite?
Patient: That's been that's been normal. Been eating well. 

Doctor: OK. Any kind of confusion or any do you feel like yourself? 

Patient: Yeah, I do. 

Doctor: OK, any confusion at all that anyone's noticed?
Patient: No, I don't think so. I feel like that's been ok. 

Doctor: Any wheezing? 

Patient: Yeah I I have noticed some wheezing. It's usually I usually, uh well I've been told I have a wheeze, but I can actually hear it right now. 

Doctor: OK, yeah, we'll do like a full physical examination as well. And we'll get like your oxygenation level and everything like that. Umm, do you have any, besides COPD, so when were you diagnosed with you please?
Patient: About 10 years ago. 

Doctor: OK, do you have any other medical conditions? 

Patient: I do, yeah. I have a high blood pressure, type two diabetes and like and there's something wrong with my, with my kidneys as well. I think my EGFR is low or something like that. 

Doctor: Oh, I see, OK. And do you take any medications besides your puffers?
Patient: Yeah, I I do. I I take on an ACE inhibitor, Metformin, SGLT2 inhibitor and I'm also taking a, uh, a water pill as well 'cause I, over these last couple of years I've had some more swelling in my in my feet. 

Doctor: OK, I see. Do you have any swelling, increased swelling right now?
Patient: No, I that's been about this. Been pretty constant. 

Doctor: OK. And do you feel recently at all that you're short of breath when lying down, or do you have to wake up to take a deep breath? Anything like that? 

Patient: No, I haven't only brought issues like that. 

Doctor: OK, any any kind of dizziness or fainting episodes?
Patient: No, I haven't had anything like that. 

Doctor: OK, any increased sweating associated with your chest tight or pressure or anything like that? 

Patient: No, no, I haven't been sweaty. 

Doctor: OK. Yeah. And other than that, any previous surgeries in the past?
Patient: Uhm, I, yeah I had a Uterine prolapse, so I had surgery for that. I have five kids. 

Doctor: OK. Any, any complications after that surgery at all?
Patient: No, it helped, it actually fixed the leaking at the time I was having, so was happy with that. 

Doctor: That's good. Currently right now, do you work at all or are you retired?
Patient: I am retired. 

Doctor: OK, uh, and what is your living situation like right now?
Patient: Yes, we live in a house just outside of the city with my, with my husband. 

Doctor: OK. Any exposures to any dust, fumes, asbestos or anything like that in your home? 

Patient: No, I don't believe so. 

Doctor: OK. Uhm and do you currently smoke?
Patient: Uhm, I do, yeah. Currently, yeah, maybe half a pack to a pack per day. 

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

Patient: Oh, I started in my teens, so most of my life I've I've smoked. I grew up around it, it's just what my parents did and everybody smoked. 

Doctor: OK, uhm, and do you use any recreational drugs like marijuana?
Patient: No, I don't. 

Doctor: OK. And do you drink alcohol at all? 

Patient: Uh, very rarely, don't really drink it anymore. 

Doctor: OK. Alright, so yeah, those are some of the questions I had for you today. We'll do a full physical examination, get your vitals and get your oxygenation done right now. Do you have any questions at all?
Patient: No, that that makes sense. Thank you. 

Doctor: You're welcome and yeah so we'll, we'll also do some lab work as well. We'll get some blood work done. Want to make sure we don't miss any kind of infection. Umm, you're in, like your you can be having another COPD exacerbation. But we also want to make sure you don't have like pneumonia or anything like that so. We might have to do a chest x-ray as well, but for now I would say just sit tight. We'll get all your vitals done and then go on from there. Does that sound good?
Patient: Yeah, that sounds good. Thank you. 

Doctor: Alright, and if you feel at all you're very short of breath and we can give you some ventil in here as well. And then if you need like we can give you like systemic, core steroids as well to help some of your symptoms. But yeah, let's, let's do some of that, physical examinations first. 

Patient: OK, that sounds good. Thank you. 

Doctor: Welcome. Take care.
Patient: Hi Faiha, I've been very concerned lately. This past week I, first just started having this really bad headache and then my body, just completely all started hurting after completely rest, and then three days ago I just started having a lot of chills and I had a pretty high fever, just two days ago of almost like I think it was like 38 or 39, yeah, I was just very concerned and I came here today. 

Doctor: Yeah, it's good that you came in. Lets rewind a little bit and get a full history. So you said the, what started first, the fever or the headache?
Patient: So, the headache started first, so that was around four days ago. 

Doctor: OK 

Patient: And three days ago, like my body just started aching all over the place and then just two days ago I noticed that I had a fever and I've been getting a fever since then, as well, like even today, I was having chills. 

Doctor: OK, OK, and you said your highest recorded temperature was 39?
Patient: Like 38 to 39. 

Doctor: OK, so headache started four days ago. Is it persistent or constant or does it come and go?
Patient: It was pretty constant, the headache kind of got better yesterday but last few days it's just been constant headache Pretty much every day. 

Doctor: OK, OK. Does anything make it better or worse?
Patient: Just some rest and, uh, I tried to take some Tylenol to get rid of it, took some Advil as well. It did help a little bit, but it just kind of came back after the medication wore out. 

Doctor: How long does the headache last when you get it? 

Patient: If I don't take medications, it can last honestly, the whole day. 

Doctor: OK, yeah, um, and if you were to describe it, is it sharp, dull, achy?
Patient: It's just achy and it's kind of all over the front of my forehead. 

Doctor: OK.
Patient: Sometimes it's just like a throbbing pain. 

Doctor: OK, and, alright, and you said it's mostly at the front of your head. How about near the Crown of your head, temples? 

Patient: It can go to the temples sometimes, but mostly it's my forehead. 

Doctor: OK, OK, and severity-wise 1 to 10, 10 being the worst headache you've ever, worst pain you've ever felt. How bad is it?
Patient: Right now it's not that bad, probably like a two or three, but when it was, just a few days ago, it was like probably an 8 or 9. 

Doctor: Yeah, and then have you ever experienced something like this before? 

Patient: No, I'm not usually one to get headaches. My wife, she gets migraines, but like I rarely ever have headaches. 

Doctor: Yeah, OK, and then you mentioned the headache is getting a little bit better now?
Patient: Yeah, the headache has improved a bit, the body aches are still there and the fever is still there but like the headaches I feel have gone down. 

Doctor: OK, alright. Have you had any fainting spells or dizziness?
Patient: No, nothing like that. 

Doctor: Any confusion or memory loss?
Patient: No. 

Doctor: Any neck pain? 

Patient: Uhm, not neck pain but like just below my neck, like my back, upper back hurts as well. 

Doctor: OK, and, any weight loss recently?
Patient: Uhm, no, I don't, I don't think so. 

Doctor: Any excessive fatigue?
Patient: Yeah, I have been feeling pretty tired and just, uh, I haven't even gone to work this whole week, just kind of laying in bed honestly with all the pain and the fever and headaches, just yeah, it's exhausting. 

Doctor: OK, any changes in your hair, nails or skin, like rashes?
Patient: No, nothing that I've noticed. 

Doctor: How about changes in your vision or hearing? 

Patient: No. 

Doctor: No OK, how about a stuffy nose or runny nose?
Patient: Uh, I do feel a bit more stuffy like today, but there's no like runny nose or anything like that, but I do feel a bit more pressure and stuffiness in my face today. 

Doctor: OK, OK, how about changes in smell or taste?
Patient: Yeah, I think, just last night dinner, it was just kind of a funky like, different taste. I couldn't really tell, uh, everything was kind of a bit bland. Yeah, I think my taste buds are acting all weird too. 

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

Patient: Uh, no, no, I haven't been coughing or no shortness of breath at all. 

Doctor: OK and how about wheezing?
Patient: No, no wheezing? 

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

Doctor: How about feeling like your heart's racing?
Patient: No, nothing like that. 

Doctor: No, OK. Any swelling that you've noticed in your limbs? 

Patient: No. 

Doctor: No, ok. Any issues with your bowel movements or urine?
Patient: No, nothing. 

Doctor: OK, how about nausea or vomiting? 

Patient: uh no, no nausea or vomiting. 

Doctor: OK, and those were all the questions I had about your symptoms. Are you otherwise healthy or do you have any longstanding medical conditions?
Patient: Yeah, I have a couple conditions that I see my family DOCTOR: for. I do have diabetes, then I have high cholesterol. I also have this thing called fatty liver but that's that's about it, and a high blood pressure. 

Doctor: OK, when were you diagnosed with all of these things? 

Patient: Yeah, probably like, it all kind of went down in my 40s. I did gain a lot of weight at some point during my 40s and that's when all these things started happening. 

Doctor: OK, so you said diabetes, high blood pressure, fatty liver, and sorry, what was the other one?
Patient: High cholesterol. 

Doctor: High cholesterol, OK, are you on medications for all of these things? 

Patient: Yeah so I am on a statin medication for the cholesterol, then I'm on metformin, and then I'm on a blood pressure medication as well. I can't recall the name. Uh, so yeah, those are the medications that I'm on. 

Doctor: OK. And do you take your medications regularly as prescribed?
Patient: Yeah, I don't miss any doses. 

Doctor: OK, good. And, are you up to date with all your immunizations?
Patient: Yeah, I think so. 

Doctor: OK, good. Do you have any allergies?
Patient: No, no allergies. 

Doctor: How about family history of lung conditions or heart conditions? 

Patient: Yes, I have a pretty significant family history for heart conditions. My father passed away from a heart attack in his 50s. My mom has high blood pressure. Diabetes is also pretty big in my family as well. 

Doctor: OK, well I'm sorry to hear that. Any cancers in the family?
Patient: No, no cancers. 

Doctor: OK, do you smoke? 

Patient: I used to when I was in my 30s. I quit a pretty long time ago. 

Doctor: OK, how much did you smoke before that?
Patient: I probably smoked up until I was 35, so for probably like 10 years from 25 to 35 and probably smoked a pack a day at that time. 

Doctor: OK, yeah, and do you drink alcohol? 

Patient: I've been told like, not to for my liver, but I sometimes maybe have the rare red wine maybe once a month. 

Doctor: Once a month, OK, any other recreational drugs?
Patient: No, no recreational drugs. 

Doctor: OK, no recreational drugs, and where do you live right now? 

Patient: I just live with my wife in an apartment in the city, and yeah. 

Doctor: OK, any old carpet, dust, mold, anything that is concerning from that standpoint?
Patient: Nope. 

Doctor: No, and have you been in contact with anyone who's been sick recently?
Patient: Not that I know of. 

Doctor: Do you still go to work?
Patient: I just have like a desk job. I have my own room. It's not like, I don't see too many people and like, when I do I'm wearing a mask so I don't think so. 

Doctor: OK.
Patient: I have stopped going to work though like, just in case. 

Doctor: OK, good and have you traveled to anywhere recently? 

Patient: No, we've been pretty homebound. 

Doctor: Pretty homebound, OK, alright, well that's good and those are all the questions that I had for you. Did you have any questions for myself?
Patient: Yeah, I don't know, what do you think is causing all of this? 

Doctor: Yeah, it sounds like you have some sort of infection, so the first thing we need to rule out is covid, of course. So we'll do a swab and those swabs should come back to you in about 24 to 48 hours and until then, it's important that you do isolate and you isolate for 14 days at least, and that includes from other people at home. And if those swabs come back negative, you could possibly have like, another infection. But if your symptoms worsen, like you start getting neurological deficits like weakness or seizures or anything like that, you should come back to the ER and we'll get that checked out. And, so that's where we'll start for now, because your presentation is acute, we think it's likely infection related. 

Patient: OK, that sounds good to me and should I be staying in my own room or anything like that at home? 

Doctor: Yeah, if you can like, it's recommended that you try to isolate in your own room for the next 14 days because your symptoms do overlap with that of covid, yeah.
Patient: OK, sounds good.Thank you. 

Doctor: Yeah, no worries, take care.
Patient: So I've had this ankle pain for the past day, and and it doesn't seem to be getting better. My right ankle looks swollen and it's bruised and is pretty painful so I just wanted to come here to check, check it out, see if I need any thing done to it. 

Doctor: Yeah, absolutely, uh OK. So you said that this started yesterday. Was there any like trauma to the ankle or leg or did you have a fall or or some sort of injury?
Patient: Yeah so I play rugby and I might have, so I fell during a tackle motion type thing and I fell on that leg and my leg, my foot kind of in, pointed inwards as I fell an I kind of fell on um on my ankle kind of just above, above my lateral side of the foot, so where that bony prominence is. 

Doctor: OK, I see and and your foot kind of it turned inwards when you fell?
Patient: Yes, that's right. 

Doctor: OK, and was there pain immediately after the this incident? 

Patient: Yes. 

Doctor: OK, were you able to like walk off the field at all, or did you need to be carried? Or were you able to walk at any point after?
Patient: Um so I can walk um, but. It is very painful and I'm putting a lot of weight on my left foot so it's almost like I'm hopping on my left foot. 

Doctor: OK. And and is the pain. Actually, so where is the pain specifically located on your foot or ankle?
Patient: So it's um specifically, it's on the like lateral malleolus area. 

Doctor: OK, and how would you describe the pain in terms of its character or quality, like is it sharp burning, stinging?
Patient: It feels sharp. 

Doctor: OK, and do you feel the pain radiating anywhere else?
Patient: Oh no, it's pretty much in that area just in the ankle area. 

Doctor: OK, and has there been anything you've tried to make the pain better?