jshargo/medical-interview-conversations2 huggingface dataset:
user: Yeah. 

assistant: 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? 

user: Right, yeah exactly. 

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

assistant: OK, so what I'm going to do is bring all this information to your family doctor and we can come back together and talk to you about the next steps. 

user: Awesome, thank you. 

assistant: Thanks for coming in.
user: 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. 

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

assistant: OK, let's talk about the headache first that came on four days ago. Has it been persistent or does it come and go?
user: It's been pretty persistent. Besides, when I take some Tylenol. 

assistant: OK, and does anything make it better or worse? 

user: Just a Tylenol, nothing really, yeah, it's pretty constant, 

assistant: 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?
user: It's kind of like my forehead in the top of my head on both sides. 

assistant: OK and does it radiate your neck or anywhere else? 

user: No, I think it’s, it doesn't go to my neck or anywhere else. 

assistant: OK, and do you have neck stiffness or neck pain with that?
user: No, not really. 

assistant: And one to ten, ten being the worst pain you've ever had, how bad is it? 

user: Uh the headache, probably like 7. 

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

assistant: OK, OK, and have you ever had a headache like this in the past?
user: Not really, I don't really get too many headaches 

assistant: 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?
user: It's the cough is around the same as well. 

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

user: It's mostly a dry cough. 

assistant: OK, so no sputum or blood?
user: No, no. 

assistant: OK, good. Alright, and are you short of breath at all?
user: Uhm, no, not really, 

assistant: No OK. And how about wheezing? 

user: Uhm no, no wheezing. 

assistant: OK. Only saying an. And any chest pain?
user: No. 

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

assistant: Any fevers or chills? 

user: No. 

assistant: No OK, uhm how about fatigue?
user: 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. 

assistant: Um OK, and how about rashes? 

user: No. 

assistant: No, OK changes in your vision or hearing?
user: No. 

assistant: Uh itchy eyes, discharge anything like that? 

user: No, nothing like that. 

assistant: About a stuffy or runny nose?
user: No, nothing like that. 

assistant: OK, how about changes in your smell or taste? 

user: Uhm smell I feel like a little bit. I've been kind of losing my smell over the last I would say one day. 

assistant: OK, OK. Alright, and any dizziness or fainting spells?
user: No, nothing like that. 

assistant: Confusion or memory loss?
user: No. 

assistant: Uhm alright and joint pains or muscle aches? 

user: Uh no. 

assistant: Alright. You mentioned you also have had diarrhea. When did that start?
user: 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. . 

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

assistant: OK, do you feel dehydrated? 

user: No, I've been trying to keep hydrated. 

assistant: OK, good, any changes in your appetite?
user: Uh no. 

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

assistant: OK. And are you throwing up any blood? 

user: No. 

assistant: What color is it?
user: Uhm it's usually I feel like whatever I eat. Yeah, contents, food contents. 

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

assistant: OK, alright any feelings of like, feeling like you're bloated or gassy? 

user: Uhm, no. Nothing like that. 

assistant: OK, any constipation?
user: No. 

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

assistant: OK. And are you up to date with her immunizations? 

user: Yep. 

assistant: Uhm, do you have any allergies?
user: No, not that I know. 

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

assistant: OK, do you smoke? 

user: No. 

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

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

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

assistant: OK, any like old carpets, dust, mold, asbestos, pets, anything that could be triggering your symptoms?
user: No, not really. 

assistant: OK and have you been in contact with anyone sick recently? 

user: 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. 

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

assistant: OK, OK. An any travel recently?
user: No. 

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

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

assistant: 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? 

user: Yeah, that sounds good. Thank you. 

assistant: OK. Great, no problem.
user: 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. 

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

user: 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. 

assistant: Um Do you feel that uh do you feel that your, uh, difficulty with breathing is worse when you're exerting yourself?
user: 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. 

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

user: Uh no, nothing like that. 

assistant: 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?
user: No, nothing like that. 

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

user: 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. 

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

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

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

assistant: OK, uhm do you have any other symptoms? Do you have any fevers or chills?
user: 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. 

assistant: And have you had any unintentional weight loss? 

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

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

assistant: OK.
user: So I don't think that's anything new. 

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

user: No. 

assistant: Any abdominal pain?
user: No, not that I've noticed. 

assistant: OK. Any headaches?
user: Um no, nothing like that. 

assistant: Uhm, OK. Uh have you had any falls in the past or in the past couple of months or years? 

user: No, no, I've been lucky. 

assistant: Good. Any confusion?
user: Nope. 

assistant: Uh any time when you've lost consciousness? 

user: Not that I know of, no. 

assistant: OK. Um and any medical conditions that you've been diagnosed with?
user: 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. 

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

assistant: Anything else?
user: Um I do take uh just pain medications like Advil. 

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

user: 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. 

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

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

user: Uh mot that I know of, no. 

assistant: OK, any um I guess social history, who do you currently live with?
user: 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. 

assistant: 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?
user: No, I'm I'm fairly independent in those matters. 

assistant: OK, do you require any assistance uh with walking any cane or walker or wheelchair, anything like that? 

user: No, not yet. 

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

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

user: 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. 

assistant: OK. Have you ever been diagnosed with any lung conditions?
user: Uh no. 

assistant: OK, have you um had any marijuana or any recreational drugs? 

user: Uh no, nothing like that. 

assistant: Alcohol?
user: Nope. 

assistant: OK, uhm, alright, um you mentioned that the cough started 5 to six months ago. Have you had a cough before that?
user: 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. 

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

assistant: 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? 

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

assistant: 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.
user: 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. 

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

user: Um 52. 

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

assistant: OK, and is it a constant pain? Is it always there?
user: 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. 

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

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

user: 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. 

assistant: OK um do, did anything trigger this a week back? Any trauma to the chest area? Anything like that?
user: 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. 

assistant: OK, the cough is it still there? 

user: Yeah, it's um. I still have a cough. 

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

assistant: OK, how about sputum? 

user: Um, no sputum. 

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

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

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

user: I I would say maybe 100 meters. But before I was able to run uh like I was running a few days per week so. So this is not like me. 

assistant: OK and the chest pain. Is it sharp or is a dull crampy? What does it feel like?
user: I say it's sharp. 

assistant: OK, have you ever experienced this before? 

user: No, nothing like like this before at all. I I have never had any, any problems like this before? 

assistant: OK um, and has it changed since it started a week back or has have your symptoms been pretty much the same?
user: They've been pretty much the the the same. 

assistant: OK, OK Um, do you have anything like COPD, Congestive heart failure, anything like that?
user: No, I've never had any heart problems, uh in the past. I've been healthy up to this point though, nothing I see a doctor regularly for. 

assistant: OK, OK. This you mentioned, no fevers, no chills. And no night sweats too I guess? 

user: Yeah, no night sweats. 

assistant: OK, and how about weight loss? Any weight loss?
user: No weight loss 

assistant: No, OK. Um, have you experienced any changes in your vision? 

user: Yeah no, my visions been been, been fine. 

assistant: OK hearing?
user: Hearing has been OK. 

assistant: OK, how about smell?
user: No changes in smell. 

assistant: No, um have you had a stuffy nose or runny nose in the past week or so. 

user: No, it's just that the dry cough. 

assistant: OK, dry cough. Any changes in your skin like rashes?
user: no rashes. 

assistant: OK, and you mentioned some chest pain. Any palpitations like you feel like your hearts racing? 

user: Uh, actually I did feel like that a little bit. Especially when I was moving a little bit more, I felt like my heart was racing. 

assistant: OK, um, any calf pain.
user: Um yeah my left, my left leg's actually a little bit sore. 

assistant: OK, any swelling in the area? 

user: um uh nope, I don't see any swelling there. 

assistant: OK, no?
user: Um, Yeah, we'll say that there is swelling. 

assistant: Oh, OK. And, and you mentioned shortness some shortness of breath on exertion, how about when you're laying down?
user: Not when I'm laying down. 

assistant: No OK, and not when you're OK, not when you're laying down, OK. Um alright and in terms of like
user: Yeah, all that's been normal. 

assistant: OK, any headaches? 

user: Um no headaches. 

assistant: no, no confusion?
user: No confusion. 

assistant: OK, how about dizziness or fainting spells? 

user: Um, No fainting spells. 

assistant: OK, OK, and have you already received any sort of imaging or pulmonary function tests or anything like that for this recently?
user: Oh no. I I I haven't. 

assistant: OK and are you otherwise healthy? Do you have any past medical history of any conditions really?
user: No, like I've been um previously healthy, but I I guess I did have a hysterectomy a few weeks ago. I know it was, I I didn't bring it up before 'cause it's just a day procedure, but I was definitely spending a lot more time um relaxing at home after that, a few weeks ago. 

assistant: OK, OK, so you haven't been moving around as much. I guess since the hysterectomy?
user: yeah exactly it's starting to it was starting to get, the pain was starting to improve but it was keeping me on the couch a lot of days. 

assistant: OK, yeah. Um, are you on any medications? 

user: Um no I try, I've tried some Tylenol and Advil for the pain throughout this week, and it didn't really help much. But other than that, don't take any any medications, nothing for blood pressure or anything like that. 

assistant: OK, and sorry. What was the hysterectomy for?
user: Um I I was having a lot of bleeding. 

assistant: OK, so were they thinking it was like a cancer or something? 

user: Um I think it was um. It was from Fibroids. 

assistant: OK, OK and then,  So you mentioned no medications, any allergies?
user: Um no allergies to medications . 

assistant: no. And are you up to date with any with all your immunizations? 

user: Um, I am yeah. 

assistant: you are OK. Any family history of lung conditions?
user: No lung conditions. 

assistant: But how about heart? 

user: Yeah, it's just my mom had a heart attack when she was 56. 

assistant: OK, OK. I'm sorry to hear that. And. Any history of family history of something called pulmonary embolism or DVTS.
user: Uh, no, I haven't heard of a heard of pulmonary embolism before. 

assistant: OK, so it's basically blood clots in your lung. And then DVT's are deep vein thrombosis. So also blood clots but in different parts of your body. 

user: OK. 

assistant: Yeah, anything like that that you know of?
user: Uh no, I I have might have heard of something like that happening in my mom actually, it might have been related to her heart attack, but I'm not specifically sure. 

assistant: OK, sure. Um an then do you smoke? 

user: Um I I smoke, I may be about half a pack of cigarettes per day. I've smoked ever since I was a teenager. I've tried to quit multiple times I I was smoking about a pack per day before, so I have cut it down, but still something that I'm working on. 

assistant: OK good, I'm glad you're trying to cut down. Um, we have resources available if you're interested
user: No, I don't. 

assistant: OK. Any use of other recreational drugs?
user: No, no. 

assistant: OK. And how about alcohol? Do you drink alcohol?
user: Uh may be a glass of wine on the weekends, but other than that no. 

assistant: OK. I mean, have you had any sick contacts recently? People around you? People you live with at work.
user: I can't think of any anybody who's been sick no. 

assistant: OK, OK, and and what do you do for work Jenn?
user: I work as an administrator at at a bank. 

assistant: OK, OK. I'm and I have you traveled anywhere recently?
user: Um, no I I can't remember the last vacation. 

assistant: OK, alright, and so those are all the questions that I had for you. Did you have anything that you wanted to add? Anything that I hadn't touched on? 

user: Um No, I think you covered everything. Thank you. 

assistant: OK yeah, no worries. So I guess at this point we would do a physical exam. Just take a listen to your lungs and your chest. After that, so right now it sounds like it could be something vascular you know, like a pulmonary embolism like we talked about. That's kind of high on my list of things to
user: Um I just uh I have, I have a cough that I've had for a couple of days and like normally if I had a cough or cold, I would just like stay home and rest, but just because you know there's like Covid I I wanted to make sure, like I wanted to get checked out. 

assistant: Yeah, of course that that was a great idea. Thanks for coming in. Um how long have you had this cough for?
user: Uh it's like 2 days. Like maybe three days ago, I started to feel like my throat was dry and I was like, oh, maybe I need to drink more water or something and then the next day I started like actually coughing. 

assistant: OK, is it a dry cough or a wet cough? 

user: Yeah it's really dry. 

assistant: Really dry, OK. So no sputum, no blood that you're bringing up?
user: No, nothing like that. It's just kind of annoying. 

assistant: Yeah, um do you have any wheeziness associated with your coughing?
user: I don't think so. 

assistant: No, OK. No shortness of breath? 

user: No, no, I've been, I feel like I've been tired, but I don't think it's been actually hard to breathe. I just feel overall like really tired. 

assistant: OK, OK, and have you tried anything for the cough, like um over the counter cough syrup or anything like that?
user: Uh like I have, I've just been drinking tea and just like tea with honey just to like make it feel better. I I didn't like take any medicine. 

assistant: OK, and do you, have you noticed that there are any triggers for your cough, like the cold, or dust, or any like environmental triggers? 

user: I mean, I've been, just because of Covid and stuff, I've been staying home ever since I had it. Uh so, I don't, I can't think of anything, but I don't think so. 

assistant: OK, and do you find that it's constantly there or um is it worse during a particular time of day, like morning, afternoon, or evening?
user: It's kind of just been there all the time right now. 

assistant: OK, and um is it getting worse, do you think?
user: I think so. I think like today is worse than yesterday, and the day before that, it just felt like dry and then and then like the next day I started coughing, so yeah. 

assistant: OK, and have you ever experienced anything like this in the past?
user: I mean, I've had coughs before, um this one feels like particularly dry, but uh like it, it's not too different than like when I'm just like, like had a cough in other years. 

assistant: OK, OK. Um and you mentioned that your throat was also dry. Do you have a sore throat?
user: Maybe a little bit this morning, yeah, like at first it just felt dry like I was thinking like, oh it's like you know I need to take a sip of water or something and now it just feels, now it's starting to think, I feel a little bit sore, I think. 

assistant: OK, um is it hard for you to swallow foods or fluids?
user: Oh sorry, could you repeat that? I just missed the last part. 

assistant: Oh no worries. Is it hard for you to swallow food or fluids?
user: Uh no, it's not hard. It's not hard to swallow things. 

assistant: OK um, and then have you had a runny nose or a stuffy nose?
user: No, not particularly. 

assistant: No, OK. How about any changes to your hearing or vision?
user: No. 

assistant: No, how about changes in smell or taste?
user: Uh, no, that's like a Covid thing, right? Like I was hoping because I could still, I could still like taste my coffee this morning, I was hoping that that means I don't have Covid, but yeah, I don't really know. 

assistant: I mean yeah, some people have it, some people don't. Um I guess people with Covid present in different ways, yeah yeah, do you have a fever at all? 

user: Um like when I came in here, when the nurse took my temperature, she said I had um, like she said I had a fever. Uh I don't have a thermometer at home, um but like I've been feeling really hot so would probably, I've probably been having it for a couple of days. 

assistant: OK, OK, we can take, yeah we can take your temperature. Sorry, did you say you already took your temperature today and?
user: The nurse took it, yeah, I don't know what it was, but the nurse kept coming in and she said it was a little high like I don't know if it was like a fever but I've been feeling hot, so. 

assistant: OK OK yeah so yeah we'll double check to make sure that um you either do or don't have a fever. Um have you experienced any chills or night sweats over the past few days?
user: Uh, no. 

assistant: No, OK. OK, how about um any weight loss?
user: No, like I don't weigh myself regularly, but I don't think so. 

assistant: OK, um any changes to your hair or uh nails or skin, like rashes? 

user: Uh no. 

assistant: No, OK. How about um chest pain?
user: Uh, no. 

assistant: No chest pain, OK. Um swelling in your limbs?
user: Uh, no. 

assistant: No, do you ever feel like your heart's racing? 

user: Uh, no. 

assistant: No, OK. Um how about um, how about any dizziness or or fainting spells?
user: Um, no, like I've been just tired. 

assistant: Just tired, OK.
user: Yeah I don't, I don't, I haven't fainted or anything. 

assistant: OK, any headaches?
user: No. 

assistant: No, OK. Uh how about confusion or memory loss? 

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

assistant: OK, um any changes to your bowel habits?
user: Um, no. 

assistant: No, OK. So no constipation or diarrhea or blood in your stool?
user: Yeah, exactly. 

assistant: OK, any changes to your urine? 

user: No. 

assistant: OK. Any nausea or vomiting?
user: No. 

assistant: No, OK. And um no abdominal aches?
user: No. 

assistant: No, OK. Um are you otherwise healthy?
user: Um like I have um, I have uh Like some um Like digestive problems generally, like I haven't had any changes to that, but they think it might be like Crohn's or something. Um but other than that, no. 

assistant: Um you said you had digestive problems. Did you say it might be Crohn's? 

user: Yeah, like I, I've been seeing my family doctor and they they said they thought it might be, um but we don't really know, just like in general, I guess they've been calling it IBS. 

assistant: Oh, I see, OK. Um, OK.
user: I wish I knew exactly, but they just said, yeah, they don't really know. 

assistant: OK.
user: But there haven't been any changes right now. 

assistant: Oh yeah, I see, OK. Um have you ever had any hospitalizations or surgeries? 

user: No. 

assistant: No, OK. Um are you on any medications?
user: No. 

assistant: OK, and how about um any allergies?
user: Um, just uh pineapple, like not any medications or anything. 

assistant: Pineapple, OK. Um are you up to date with all your immunizations?
user: Uh yeah yeah. 

assistant: OK. Um any family history of lung conditions or heart conditions? 

user: Um, like my my uncle had a heart attack. 

assistant: OK.
user: I don't, like, not my parents. 

assistant: OK, I see. Um any cancers in the family? 

user: Uh, no. 

assistant: OK. Um and do you smoke?
user: No. 

assistant: No, OK. How about marijuana? 

user: No. 

assistant: No, OK, um any other recreational drugs?
user: Um no, no 

assistant: OK, how about alcohol?
user: Uh, like I drink, I don't know maybe I'll drink like a bottle of wine on like a weekend, like over a whole weekend or something so like, I don't know maybe like 3 or 4 drinks over the weekend. 

assistant: Three or four drinks a weekend, OK.
user: Yeah, something like that. 

assistant: Sure, OK.
user: I'm not at all like. 

assistant: OK, so occasionally?
user: Yeah. 

assistant: OK. And where do you live?
user: Uh I live in town here. 

assistant: OK, do you live in a house, in an apartment? 

user: Um my fiancé and I live in a townhouse. 

assistant: In a townhouse, OK, um, any um concerns for like old carpets or mold or asbestos, anything like that?
user: Uh no, it's like a new a new building. 

assistant: OK, OK, and do you think you may have been in contact with anyone who's been sick recently? 

user: Well, so um, I work uh in like, I work in an office that's attached to a factory um and I, so like I have to actually be there, I haven't been able to work from home. Um and there was someone else in my office that I think was coughing in that, like last week and I I don't know, I questioned it but I I didn't actually get to talk to them and ask them, or like I don't know if they were actually sick or something. So, I might have been, and we wear masks and everything, like we're really good, but I don't know, I feel like the offices aren't like super, like the air flow's not that great. 

assistant: Yeah.
user: So yeah, I think that's another reason I was concerned, that I I feel like some people might have been sick and I didn't really know the whole story. 

assistant: Right, OK, so potentially, from from the workplace then, OK. 

user: Yeah. 

assistant: And, OK, um have you traveled anywhere recently?
user: No. 

assistant: No, OK. Well those were all the questions that I had for you today, was there um anything that I missed that you wanted to discuss today? 

user: Uh not that I can think of. 

assistant: No, OK. So right now it seems like, if I'm going through my differential diagnosis list for you, at the top is, the thing that we have to rule out is Covid, so we'll take a swab and send it off for those PCR results and you'll hear back either tomorrow or the day after, about the results. But in the mean time, and I guess even if the test is negative, um and you're still having symptoms, please do isolate for 14 days. Um and if your symptoms get worse, um like you know, you're having trouble breathing, uh your fever, your temperature is off the charts, um or you're having any sort of neurological symptom, please do um go to the ER and seek out help. Um if it's not Covid, it could be another viral illness that's going around at, during this time of year, um, and usually the treatment for that kind of stuff is supportive, so make sure you're staying well hydrated, you're eating nutritious foods, uh you're getting good sleep. Um and if not, and your symptoms, you know you're having a productive cough, um you're really short of breath, uh we can test you to see if you have some sort of bacterial pneumonia, and those are usually treated with antibiotics, so that's kind of the plan right now. Um so we'll just start with that Covid swab for now. How does that sound?
user: Yeah, that that sounds great. That's really what it, like, I I don't feel super sick, I just really wanna know if I have Covid or not. 

assistant: Yeah for sure and I, and I think it's good that you came in. 

user: Awesome. 

assistant: Alright, thank you.
user: Hi, I've I've had um this pain in my left knee that's been going on now for the last uh three or four months um but it's gotten a bit a bit worse, it used to only really bug me while I was doing activity, and now its started to uh hurt even more um afterwards as well, so I'm getting the pain at at rest. and so I wanted to come and get that checked out. 

assistant: OK yeah, for sure. Um and you said it started a few weeks ago? 

user: Uh well, I think it first started a few months ago, but in the past couple of weeks it has started to um kinda like last longer and and happen at rest as well. 

assistant: Yeah, and so does anything make it worse or better? I assume doing any sort of physical activity makes it worse and rest makes it better, but how about anything other than that?
user: Uhm not really, yeah, it's mostly just the the activity, if I'm going upstairs or um downstairs or uh during running is really where it hurts the most and that's what's bugged me the um yeah, the most, running. 

assistant: OK, OK, and if you were to describe the quality of this pain, would you say sharp, dull, achy, crampy?
user: Uh it's a sharp pain, uh almost like every time my foot hits the ground I get like a sharp stabbing pain and while I'm at at rest it feels a bit more dull, while, yeah, yeah while I'm at rest. 

assistant: OK, OK, and 1 to 10, 10 being the worst pain ever, how bad is this pain? 

user: A six. 

assistant: OK, alright, and have you ever experienced this type of pain before?
user: Uh I did have something similar like many years ago. I used to be a rower uh in undergrad and I got some similar pains before, and I mean with some stretching and um other I don't know kind of strengthening stuff, it it kind of helped but I didn't go see anybody for it at that time because it it kind of went away after a little while, 

assistant: OK, OK, um and you said you were, are you still rowing? 

user: No, no, the only activity that I'm doing now is is running. 

assistant: Running, OK and from when it started to now, in the past couple of weeks has it changed like dramatically, um is it affecting your day to day life?
user: Uh a little bit, yeah, like even now, just walking I can I can feel it. Um the pain's not as severe but like as when I'm running but I can, I'm starting to notice it uh daily. 

assistant: OK, alright, and um are you otherwise healthy? Do you have any um symptoms like fevers or chills?
user: No, nothing like that. 

assistant: No, any weight loss? 

user: Uh no weight loss. 

assistant: No, any rashes?
user: Uh no rashes. 

assistant: No, uh changes to your uh vision, hearing, taste or smell? 

user: Uh no changes there. 

assistant: OK. How about a cough, shortness of breath, or um wheezing?
user: Nothing like that. 

assistant: OK. How about uh chest pain, heart palpitations?
user: No, I haven't had anything like that. 

assistant: OK. Um any changes to your bowel movements? 

user: No, I haven't had any diarrhea, or yeah, everything's been normal there. 

assistant: OK, nausea or vomiting?
user: Nope. 

assistant: No, um how about abdominal pain?
user: No, I haven't had any uh any abdominal pain, nothing like that. 

assistant: OK, any changes to your urine?
user: No, uh no I haven't had any issues with that. 

assistant: OK, how about uh headaches? 

user: No, I haven't had any headaches. 

assistant: OK. Um any pain elsewhere on your body?
user: Uh nope, I've, it's just my, yeah just my knee. 

assistant: OK, any numbness or tingling in the area? 

user: No, I haven't had anything like that, it's just the uh sharp pain. 

assistant: OK. How about confusion or memory loss?
user: No, I haven't had that. 

assistant: OK. Um any um muscle aches around the knee, like so just above your knee where your quads are or just below?
user: Um no, nothing, nothing like that. 

assistant: OK, and are you otherwise healthy? Do you have any longstanding medical conditions? 

user: Um yeah, I'm otherwise healthy, I it's nothing that I see the doctor for, I've never been diagnosed with anything. 

assistant: OK. Um how about hospitalizations or surgeries in the past?
user: Um nothing like that. no. 

assistant: No, OK. Um any medications that you're on?
user: Um nope, I I don't take anything just well, no medications, but I do take a like a multivitamin. 

assistant: OK, um are you up to date with all your immunizations?
user: I am yeah, I'll get the flu shot each year. 

assistant: OK, how about allergies? Do you have any? 

user: Um, no, I I don't. 

assistant: No, OK. Um any family history of musculoskeletal issues?
user: Uh nope, I don't think so. 

assistant: How about um heart or lung conditions? 

user: Uh I think my dad has like high blood pressure um and high cholesterol, but uh nobody's had a heart attack or, and no cancer. 

assistant: OK, um how about autoimmune conditions?
user: Uh no, I don't think so. 

assistant: No, OK. Um any um, do you do you do any smoking? 

user: Uh no, I've tried uh like smoking marijuana in the past, but didn't really like it, so I've stayed away from that. 

assistant: OK, how about um other recreational drugs?
user: Uh no, no, I I I haven't used anything like that before. 

assistant: OK, um and then where do you live right now? And who do you live with?
user: So um right now I just live on my own, actually I'm um just finishing up my my my Masters um and just live in a small apartment. 

assistant: OK alright. And have you been in contact with anyone sick recently?
user: No, I don't believe so. 

assistant: OK. Um how about um travel? 

user: Uh no, I've just been yeah finishing up the the thesis and running. 

assistant: OK, alright, um those were all the questions I had for you, um we'll move on to the physical exam component of this. Um so if you can take a look at both your knees, um do you see any visible redness or swelling in the area?
user: Uh no no swelling or yeah, nothing visible that I can see. 

assistant: OK, so no bruises?
user: Uh no, no no bruises 

assistant: OK. Do you notice any like muscle atrophy, any deformities or skin changes otherwise? 

user: No, everything looks looks normal. 

assistant: OK, and if you can just um place your hand just kinda at the top of your, on top of your kneecap on both sides, do you notice any temperature changes from your, uh between your right knee to your left knee?
user: No, no temperature changes, they they feel the same. 

assistant: OK. Um and then when you palpate your knee cap as well as um yeah, just if you could palpate just at the center of your kneecap, do you feel any pain there?
user: No pain over the kneecap, that feels fine. 

assistant: OK. How about when you palpate kind of like the medial ligaments of your kneecap, do you feel any pain there?
user: No, everything on the medial side feels feels normal and fine. 

assistant: How about when you palpate the lateral ligaments of your kneecap? 

user: Yeah, the ligaments feel feel OK, on the lateral side though I I do get some pain along the um like above the joint line. 

assistant: Above the joint line?
user: Yeah. 

assistant: OK, OK, and how about when you palpate uh that big muscle group on your thighs like the quadriceps? 

user: That feels OK, no pain in the muscles. 

assistant: OK, how about like the patellar tendon?
user: Uh no pain there. 

assistant: OK. And then when you go lower below your kneecap, um when you palpate like the top part where the proximal parts of your tibia and fibula are, do you feel any pain there? 

user: Uh, yeah, no pain there. 

assistant: OK, and now let's do some um movements with your leg. Um are you sitting down?
user: Uh, yeah, I am. 

assistant: OK, I'm gonna get you to stand up from a sitting position, does that, is that painful?
user: It is, yeah it's, I get a sharp pain if, when doing that. 

assistant: OK yeah, uhm how about when you um sit back down, does that hurt? 

user: Um yeah, that hurts too. 

assistant: That hurts too, OK. Um and then how about when you flex your knee inwards, um so that your heel is touching your bum like does that hurt?
user: Uh like I, I'll get up, uh no that doesn't hurt, that feels OK. 

assistant: OK, how about when you extend your knee back out, straighten it all the way? 

user: Yeah, that feels OK too if I'm just sitting and doing that, I can um, I can do that OK. 

assistant: OK. Um how about when you, so you're standing and then you uh you abduct your hip so you basically, um you flex your hip but laterally and you kind of bring it upwards so that it's almost, so that your your, the action is like you're uh trying to touch the ceiling.
user: OK yeah I um, it, if, it does feel, it feels like it's kind of pulling um like it feels tight when I do that uh like on that side, it's, I don't get the same sharp pain, but it's uncomfortable. 

assistant: OK, uhm, so I'm gonna try a special test, it's called the Ober test. So can I get you to lie on the side um with the injured knee? 

user: Yep. 

assistant: OK, and then I'm gonna get you to flex your knee at 90 degrees and um abduct and extend the hip uh while your thighs maintain in line with your trunk. Um so I'm gonna get you to adduct your thigh, so bring it back towards you, the the median, um as far as possible.
user: Oh yeah, I can't really, it's kind of like stuck out there. It feels really tight if I'm trying to like bring it, bring it back down, my leg almost like floats up if I just leave it there. 

assistant: OK, so that is a positive Ober test. Um OK, so what it sounds like is you, it sounds like you have something called um iliotibial um band syndrome, so ITB syndrome, and basically that happens in um athletes, so depending on your like position, like how much you're using those joints um and like repetitive actions um of like knee flexion extension um kind of triggers that. And to treat it, uh we can try some conservative um things first, so the first thing would be um for you um to have some sort of activity modification to prevent aggravating that joint even more, so you're doing a lot of running, so maybe uh switching to things like swimming um for the time being can help with that. And then other things include ice or heating pads, uh taping and stretching, um and then if the pain is, if the pain uh persists, you can try some like ibuprofen for temporary relief. Um we can talk about other treatments as well, like physiotherapy because um it'll be important to kind of strengthen those muscles around that joint as well as um increase your range of motion, so we can do, we can put in a referral for that. Um and if none of those work, we can also discuss um some other things like ultrasound therapy or like muscle stimulation, um shockwave therapy, and then eventually if none of those other things work, we can discuss surgical management but uh it's rare that it ever gets to that point. Does that sound OK?
user: Sure, I'm I'm just having a lot of chest pain and and so I thought I should get it checked out. 

assistant: OK, before we start, could you remind me of your gender and age? 

user: Sure 39, I'm a male. 

assistant: OK, and so when did this chest pain start?
user: It started last night, but it's becoming sharper. 

assistant: OK, and where is this pain located?
user: It's located on the left side of my chest. 

assistant: OK, and, so how long has it been going on for then if it started last night? 

user: So I guess it would be a couple of hours now, maybe like 8. 

assistant: OK. Has it been constant throughout that time, or uh, or changing?
user: I would say it's been pretty constant, yeah. 

assistant: OK, and how would you describe the pain? People will use words sometimes like sharp, burning, achy.
user: I'd say it's pretty sharp, yeah. 

assistant: Sharp OK. Uh, anything that you have done tried since last night that's made the pain better?
user: Um not laying down helps. 

assistant: OK, so do you find laying down makes the pain worse?
user: Yes, definitely. 

assistant: OK, do you find that the pain is radiating anywhere? 

user: No. 

assistant: OK, and is there anything else that makes the pain worse besides laying down?
user: Not that I've noticed, no. 

assistant: OK, so not like taking a deep breath or anything like that?
user: Maybe taking a deep breath. Yeah. 

assistant: OK. And when the pain started, could you tell me uh, could you think of anything that you were doing at the time? 

user: I mean, I was moving some furniture around, but, that I've done that before. 

assistant: OK, so you didn't feel like you hurt yourself when you were doing that?
user: No. 

assistant: OK, and in regards to how severe the pain is on a scale of 1 to 10, 10 being the worst pain you've ever felt, how severe would you say the pain is?
user: I'd say it's like a seven or eight. It's pretty bad. 

assistant: OK, and with the pain, do you have any other associated symptoms?
user: I feel a little lightheaded and I'm having some trouble breathing. 

assistant: OK. Have you had any loss of consciousness? 

user: No. 

assistant: OK. Uh, have you been experiencing any like racing of the heart?
user: Um, a little bit, yeah. 

assistant: OK. And have you been sweaty at all? 

user: Just from the from having issues breathing. 

assistant: OK, have you been having issues breathing since the pain started?
user: Yes. 

assistant: OK. Um recently have you had any periods of time where you like have been immobilized or or, you haven't been like able to move around a lot? 

user: No no. 

assistant: OK. And have you been feeling sick at all? Any infectious symptoms?
user: No. 

assistant: OK, have you had any nausea or vomiting? 

user: No. 

assistant: Any fevers or chills?
user: No. 

assistant: OK, how about any abdominal pain? 

user: No. 

assistant: Any urinary problems?
user: No. 

assistant: Or bowel problems?
user: No. 

assistant: OK, have you had a cough?
user: No. 

assistant: OK. You haven't brought up any blood?
user: No. 

assistant: OK, have you had a wheeze with your difficulty breathing?
user: No, not that I've heard. 

assistant: OK, any changes to the breath sounds at all like any noisy breathing?
user: No. Well, I guess if when I'm really having trouble breathing, yeah. 

assistant: OK. Has anything like this ever happened to you before?
user: No. 

assistant: No, OK. And have you had any night sweats? 

user: No. 

assistant: Alright, and then how about any rashes or skin changes?
user: No rashes, but I guess like my neck seems to be a little swollen. 

assistant: OK, do you have any neck pain?
user: No. 

assistant: OK, have you had any like accidents like a car accident or anything where you really jerked your neck? 

user: No. 

assistant: OK. Um any any trauma at all to the chest or or back?
user: No. 

assistant: OK, so just in regards to past medical history, do you have any prior medical conditions? 

user: No. 

assistant: OK, any recent hospitalizations?
user: No. 

assistant: OK, any prior surgeries? 

user: No. 

assistant: OK, do you take any medications regularly? Are they prescribed or over the counter?
user: No. 

assistant: Alright, how about any allergies to medications? 

user: None. 

assistant: Alright, any immunizations or are they up to date?
user: They are all up to date. 

assistant: Excellent. Alright, and could you tell me a little bit about your living situation currently? 

user: Sure, I live in an apartment by myself. I, uh, yep, that's about it. 

assistant: OK, and how do you support yourself financially?
user: I'm an accountant. 

assistant: OK, sounds like a pretty stressful job or that it can be. Do you smoke cigarettes?
user: I do. 

assistant: OK, and how much do you smoke?
user: I smoke about a pack a day. 

assistant: OK, how long have you been smoking for? 

user: For the past 10 to 15 years. 

assistant: OK, and do you smoke cannabis?
user: Uh sometimes. 

assistant: Uh, how much marijuana would you smoke per per week?