jshargo/medical-interview-conversations2 huggingface dataset:
user: Uh, I don't know if it's difficulty breathing, but I have noticed sometimes she's like breathing faster than normal, like taking a lot more breaths. 

assistant: I see, OK. Uh, is she having troubles with drooling or your trouble speaking? 

user: Uh, no. I haven't noticed that. 

assistant: OK, and does her voice sound normal to you?
user: Yeah, I think her note, her voice hasn't really changed that much. 

assistant: OK, um, with the noticing the faster rate of breathing is the breathing noisy at all? 

user: Uh, no, like she's not wheezing or anything. 

assistant: OK, and do you notice any like retraction of the skin between her ribs when breathing.
user: Uh so like, uhm, like what do you mean by that? 

assistant: Like just so when she's breathing in and out. Is she generating a lot of force and effort to really kind of suck in and blow out so you can kind of see impressions over the ribs. 

user: Uh no, I I don't think I've noticed that, no. 

assistant: OK. And, and, have you noticed any blueish discolouration around her lips or mouth?
user: Uh, no. 

assistant: OK, and any urinary problems? 

user: Uh, no, she's peeing fine. 

assistant: OK. And how has she been sleeping the last few days?
user: She hasn't really been sleeping in between the crying and like just being so irritable. I think she's just very uncomfortable when she's trying to get to sleep, so I would say not, like maybe a couple hours for the last few nights. 

assistant: OK. Any evidence of seizure or limb jerking?
user: Uh no, not that I've noticed. 

assistant: No, OK. And and have you notice an her being like really lethargic at all? 

user: Uh, she's not herself and she's still like pretty active, like she's, she just seems really unhappy and irritated. But no, she still has energy. 

assistant: OK. And uh, is she drinking yeah, a lot more fluids or or a lot less? How is she tolerating oral intake?
user: I would say I think she's more on the dryer side like she, her mouth is very dry. Her lips are like all cracked, and she it seems that she's drinking less water too. 

assistant: I see, OK. And, uh, how many wet diapers would you say in the last 24 hours? 

user: Um? Yeah, it's difficult to say. I think I like yesterday changed four to five times. They were all diarrhea, so not really sure, but maybe around 5. 

assistant: OK, and have you guys traveled anywhere recently?
user: No. No, we've been here. 

assistant: OK, so next just some questions about past medical history. Uh, has she had any medical problems in the past? 

user: The only thing I could think of was after she was born, she had to be given the light treatment for like jaundice, but after that no other problems. 

assistant: OK. And any prior surgeries?
user: No. 

assistant: Any previous hospitalizations?
user: No, just the light treatment, but other than that nothing. 

assistant: OK, and throughout pregnancy were there any complications?
user: No, my pregnancy was completely normal. No complications during the pregnancy. 

assistant: OK, so no gestational diabetes or hypertension?
user: Uh, no. 

assistant: OK and uh, were you sick at all at any point with infectious symptoms?
user: No, everything came back clear. All the tests were normal. 

assistant: OK, and um. Any allergies to medications?
user: No allergies. 

assistant: OK, and is she currently taking any medications? 

user: No, just tried the Tylenol but it didn't really seem to work. 

assistant: OK, and has she been around anybody sick recently?
user: Just her big brother who goes to daycare was also like a bit sick with a cough and some runny nose for the last four days. But, uhm, he didn't have a fever and he seemed to recover pretty fast but seems she may have caught it from him. 

assistant: OK, and anybody in the family um, have any similar symptoms right now? I guess besides her brother?
user: No, just just her and her brother. 

assistant: OK. And, and in regards to birth, birth history, was it a vaginal delivery or C-section?
user: It was a normal vaginal delivery at 38 weeks there were no problems after the delivery or before the delivery. 

assistant: OK, and uh are her immunizations up to date?
user: Yeah uh, all our immunizations are up to date. 

assistant: OK, and um, in regards to growth and development, have you had any concerns? 

user: Uh, no, we've been getting her checked regularly. It seems that she's been growing well and developing well. 

assistant: OK, and who is the primary caregiver for at home?
user: Primary caregiver, right now I'm staying home with her and her brother goes to daycare. So yeah, it would be me. 

assistant: OK. Uh, and could you tell me about her eating habits and typical appetite? 

user: Uh, so now like she is able to eat like everything like vegetables, fruits, breads and meat, but over the last few days she has been just irritable with everything. So even eating food has just not been great for the last few days. 

assistant: OK, and when was her last checkup?
user: Hi so I just like for I don't know like three or four days I’ve been having this really dry cough and my throat feels really scratchy. I just feel kinda crappy overall. And my head’s pounding 

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

assistant: OK, and you say I've been feeling that for three to four days now.
user: Yeah, yeah exactly 

assistant: What did you first notice? 

user: I first noticed that my throat was kind of scratchy and then I started coughing, but it's really like dry. 

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

assistant: Any flem? 

user: no nothing. 

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

assistant: You felt hot at home, OK,
user: yeah, 

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

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

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

assistant: No worries and then aside from that, any nausea? Any vomiting? 

user: No, not that. No, nothing like that. 

assistant: Any diarrhea?
user: No no. 

assistant: Any aches in your joints anywhere? 

user: No. I mean, I'm I'm tired, but I don't think they're not like hurting. 

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

assistant: Oh no, no, it's perfectly valid. We called that Malays in general. Just feeling a little bit off. Alright so this is going to talk about you for a little bit, but first, we'll get to that later. So any issues that you've seen a doctor for before?
user: I have I have allergies. Usually in like the spring in the fall. 

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

assistant: OK. 

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

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

assistant: It's just like a little stuffy.
user: Yeah, yeah, exactly. 

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

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

assistant: OK, sounds good. So you've seen an allergist. Any other doctors that you've seen in your life?
user: My family doctor. I don’t really go very often. 

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

assistant: OK, any surgeries in your life?
user: Uh, no, no. 

assistant: No. Are you takin any medications right now? 

user: I take. Claritin for allergies but I haven't like right now. I just have it with me just in case. I take birth control. 

assistant: What type of birth control do you take?
user: Deyo 

assistant: OK and you take that regularly?
user: Yeah, it's just like the pill. It's like the one that goes for three months. 

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

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

user: No. 

assistant: OK, any family history of asthma?
user: Like my cousin. 

assistant: OK, what about your parents, brothers, sisters?
user: No, nothing like that. 

assistant: Do you know what eczema is? 

user: Like, I've heard of it. 

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

assistant: OK . Dad has allergies. OK, mother and father still alive? 

user: Yeah. 

assistant: Healthy?
user: Yeah. 

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

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

user: Yeah I have a little brother. 

assistant: How old’s he?
user: Like 14 now. 

assistant: Has anyone in the family been sick recently?
user: I think my brother we had like a cold a few weeks ago 

assistant: He had a cold. 

user: Yeah. 

assistant: OK.
user: But like we are doing our school from home now so. 

assistant: Got it. 

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

assistant: OK, so sorry, do you live on a farm?
user: Yeah, 

assistant: OK, in London?
user: Like just outside. 

assistant: OK. Any travel or anywhere recently? 

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

assistant: So last last two weeks you haven't left the country?
user: No. 

assistant: Nothing like that. 

user: I wish. 

assistant: You keep any animals on the farm?
user: We have like a dog, but it's not like an animal farm 

assistant: Got it. OK, another questions, are you sexually active? 

user: Uh no. 

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

assistant: OK. So chances of being pregnant very low. 

user: Oh Oh yeah yeah, it's been like a year. 

assistant: Got it got it alright, do you smoke? Cigarettes?
user: No. 

assistant: Do you drink alcohol? 

user: Like before Covid, when I saw my friends like sometimes a little bit but like not really anymore. 

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

assistant: Got it. Any other drugs? Marijuana, cocaine? 

user: Like I tried marijuana once at a party like a couple years ago, but like I had, I never did it again. 

assistant: Got it so none of the harder drugs, cocaine, heroin?
user: No. 

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

user: No. 

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

assistant: OK. Alright perfect Thank you very much. You have any more questions?
user: No, I don't know. I don't have any more questions. I just like I can go home soon like lay down. 

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

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

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

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

assistant: No, OK. Um do you feel that the shortness of breath has gotten kind of worse over time? 

user: Yeah, I think so. 

assistant: And what about the cough? Did that start at the same time as the as the difficulty with breathing?
user: Um it started before the difficulty with breathing. 

assistant: Can you, uh is it a dry cough or a wet cough? 

user: Um it was it was a dry cough at first, but now I'm seeing some phlegm um and it looks kind of yellow. 

assistant: Have you seen any blood in the phlegm?
user: No. 

assistant: Uhm and, uh, are you hearing any wheezing sounds? 

user: Yeah, a little bit. 

assistant: OK. Um how uh, has the cough sort of improved or gotten worse over time?
user: Um it's it's gotten worse. 

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

assistant: And have you been checking your fever this past week, or was that the first time you, um, checked it?
user: It's the first time I checked it. I I've felt hot though in the past and I've felt like I had chills. 

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

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

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

user: No this has never happened before. 

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

assistant: OK, any changes in your vision or your uh hearing that has that has uh been very sudden or that has happened over the past week? 

user: No. 

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

assistant: Sense of taste? 

user: No. 

assistant: OK uhm and uh any runny nose or congestion?
user: Um a little bit of a runny nose, yeah. 

assistant: And what's that discharge like? What colour? 

user: It's also yellow. 

assistant: Um any uh sore throat?
user: Uhm no, no sore throat. 

assistant: OK. And um any chest pain? 

user: Yeah, it hurt hurts when I try to take a deep breath in. 

assistant: When did that start?
user: That started about the same time as my shortness of breath. 

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

assistant: OK. Do you get any chest pain otherwise um in this week when you're not trying to take a deep breath?
user: No, there's no chest pain at rest. 

assistant: Where is your chest pain? 

user: It kind of feels like central to my chest um uh yeah, just in the chest area, it doesn't radiate to anywhere else. 

assistant: OK OK. Does it get better right away after you um sort of stop taking that deep, stop doing deep breathing?
user: Uh no otherwise it doesn't hurt. 

assistant: It doesn't hurt, OK good. Um alright, and any uh belly pain? 

user: Uh no. 

assistant: Any nausea or vomiting?
user: No. 

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

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

assistant: No, OK. Any pains in your joints or muscles? 

user: Uh no. 

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

assistant: Um any um any weight loss recently?
user: Uh no. 

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

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

user: No. 

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

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

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

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

assistant: Have you ever had any um COPD?
user: No. 

assistant: Ever been diagnosed with asthma?
user: No 

assistant: Heart attack or any heart related problems?
user: No. 

assistant: OK, OK. Um has, have you had any hospitalizations in the past? 

user: Um no. Actually sorry, I have, for the DVT. 

assistant: Yeah, yeah, yeah, I see. Any surgeries?
user: Uh no, no surgeries. 

assistant: OK. Um what what caused your DVT? Do you remember or do you know? 

user: Uh I was, I was flying somewhere. I was well, I was flying back from somewhere and I got off the plane and um I guess they found uh blood clots. 

assistant: I see, I see. OK. Any allergies to medications, environmental allergies, food allergies, anything?
user: Uh no, I don't think so. 

assistant: OK. And I forgot to ask in terms of medications, are you taking anything over the counter? Any herbal pills, any vitamins, etc. 

user: Just some um calcium, vitamin D. 

assistant: Well, that's great.
user: Yeah. 

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

assistant: OK, and are you, um, is there anybody else in the house? Any pets, animals? 

user: Uh no, we don't have any pets or animals. 

assistant: And uh are you able to take care of things like uh dressing, uh changing, going to the bathroom on your own? Do you need help?
user: Uh no, I am pretty independent. 

assistant: What about things like groceries or taking care of finances? 

user: Uh no, I'm pretty independent in in that aspect as well. 

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

assistant: That's good. Um and any, do you think any exposures to anyone who could possibly be sick? For you or your husband? 

user: Um I mean we we do laundry at a laundromat. Um but other than that, no. 

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

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

assistant: Oh that's very true. Yep, Yep uh so. 

user: OK. 

assistant: Well, you will be in the hospital, so yes you do. We will be we will be doing a Covid test, but that's a really good point um uh because your symptoms do overlap with Covid symptoms um we will also uh have you in an isolated room away from other patients until your Covid swabs are back and we know whether um, yeah, we'll follow the guidelines um put forth by the public health.
user: Yeah, so over this past five days I've had um worsening shortness of breath and uh some discomfort in my chest um and this cough that that's been getting worse as well. 

assistant: OK, so it's just been for the past uh past week or five days? 

user: Yeah, I mean I've had um a cough and uh in the in the in the past, and and and shortness of breath in the past. But yeah, just over these past five days it's been there um at all, like it's been there all day and it's been getting uh worse as well. 

assistant: OK, and what is the cough like? Is it wet or dry?
user: Yeah, I'm bringing up sputum uh pretty much um like every time I'm coughing up I'm bringing up some yellowish or greenish uh sputum. 

assistant: OK, and have you noticed at all any blood?
user: No, no, no blood. 

assistant: No blood, OK, um and how much sputum are you bringing up like uh every time you cough? 

user: I I would say its um would would be the like just the little inside of my uh palm each time. 

assistant: OK, and uh is this uh, and then what about the shortness of breath, is it uh are you having trouble taking deep breaths or do you find yourself breathing faster? Like how would you describe it?
user: It's um yeah, I'm just really feeling like I just can't, uh catch my breath even with um some small things around the apartment uh that normally I can do, it's any type of exertion, I just can't catch my breath. I'm OK right now just sitting here though. 

assistant: OK yeah, so at rest you're fine but like when you exert yourself, it gets worse.
user: Yeah, well I'm I still have this like uh chest discomfort. Um so while while sitting here, it doesn't feel um like my breathing is normal. 

assistant: OK, and when do you get that chest discomfort? Is it when you're breathing in or breathing out or it, can it be just due to exercise? 

user: It's it's kind of just always, it's just kind of been there over these past uh like four or five days. 

assistant: OK, and how would you describe uh, is it pain at all or is it like sharp stabbing or pressure like pain?
user: Um no, nothing like that. I kind of I just I feel congested I guess. 

assistant: OK, um so just discomfort. Do you do your symptoms get worse at all when you're laying down flat? 

user: No. 

assistant: No, OK. Uh, do you wake up at night gasping, gasping for air?
user: No, I haven't done that before. 

assistant: OK, um have you had any fevers or chills?
user: Yeah, uh now that you mentioned, I do think I I feel a bit feverish. Um uh yeah, and I I've noticed that actually over the last uh couple of days. 

assistant: Oh, have you had a chance to take your temperature at all? 

user: No, I just felt feverish. 

assistant: OK, um do you have any other symptoms like um sore throat, runny nose, anything like that?
user: No, I don't. 

assistant: OK, um have you traveled at all recently? 

user: No, I I I I've been been home. 

assistant: OK, have you tried anything to help you with your symptoms?
user: Yeah, I I did try uh, using an inhaler. I have um a couple up those and um usually that that helps, but hasn't really been able to um help much this time. 

assistant: OK, um how often are you having to use it? 

user: Um so uh I I used it um I I took three or four puffs this morning and um and that was about it. I was using it last night as well, uh but typically I will use it maybe two or three times a week. 

assistant: OK. Um and have you had any headaches or changes in your vision or anything like that?
user: No, I haven't noticed anything like that. 

assistant: OK. Any nausea or vomiting? 

user: No. 

assistant: Um any increased fatigue?
user: I, I mean, I haven't been able to do as much with uh being so short of breath, but my energy has been been OK. 

assistant: OK, and how about um, do you have any sensation of palpitations or your heart is racing at all? 

user: No, I haven't felt anything like that. 

assistant: OK. Um and any kind of diarrhea or constipation?
user: No. 

assistant: OK. Any issues with urination?
user: No, uh no problems there. 

assistant: Uh any changes in your sleep or appetite?
user: Um no, that that's been pretty good. 

assistant: OK, any night sweats? 

user: Uh no, I haven't had any night sweats. 

assistant: OK. Um any kind of uh significant weight change recently?
user: Um I I I might have, uh no, I think my weight's been about the same. 

assistant: OK, um any exposure to anyone sick around you recently?
user: No, I don't think so. Um but I I've had I've had a couple of uh chest colds over the last year that I needed um antibiotics for uh and it, they they went away after that, I got that, those from a walk in clinic. 

assistant: Sorry, you got antibiotics from the walk in clinic? 

user: Yeah, the last time was uh probably about about four months ago. 

assistant: OK.
user: So I haven't been around anybody sick recently, but um but I mean I I've had similar symptoms um before, I feel like this time might be just a bit worse though. 

assistant: OK. Um and do you have any past medical history? Uh any conditions you've been diagnosed with? 

user: Um yeah, so I I have been I've been diagnosed with COPD uh as well as uh, high blood pressure and uh GERD. 

assistant: OK, and when were you diagnosed with COPD?
user: Uh about three years ago. 

assistant: Three years ago, OK. Do you take any medications for any of these conditions?
user: Yeah, so I have a medication uh Ventolin, I take Symbicort daily um which is like a steroid type medication. And then um I take an ACE inhibitor I think for blood pressure and just Tums or something like that if my reflux is bad. 

assistant: OK. Um and do you have any allergies to any medications?
user: Um, no. 

assistant: No, OK. Any past hospitalizations or surgeries? 

user: Um, no. 

assistant: OK, any family history of any medical conditions, any lung or heart conditions?
user: Uh nothing like that, no. 

assistant: OK. Um and any cancers in the family? 

user: Um, no. 

assistant: OK. Um and any, currently right now, what's your living situation like?
user: Yeah, so um I'm living with um with just my uh daughter in a in an apartment. 

assistant: OK. Um and currently do you work?
user: Yeah, so I I've been working at the um at the grocery store. Uh yeah, I've been at the grocery store. 

assistant: OK, and do you smoke currently? 

user: I do, yeah. Uh I smoke about a pack a day. Um and I I've smoked for, now well, probably like 30 or 40 years. I used to smoke more. 

assistant: OK. Um you have cut down, that's good. Um yeah, definitely the more you cut down, and if you need to talk about quitting, there's a lot of resources that we can go through. Um do you use anything else besides uh cigarettes, like any marijuana or any other drugs?
user: Uh no, no, just just cigarettes. 

assistant: OK, um and any alcohol?
user: Uh yeah, I mean I'll have some uh wine with dinner on the weekends, but that's about it. 

assistant: OK. Alright, so those are all the questions I had for you. Do you have any questions? 

user: No, that was, uh, about it I was uh I was wondering if you think I I have an infection or is this uh COPD acting up, or what's going on? 

assistant: Yeah, so definitely with your history of COPD and um these symptoms, it can just be an exacerbation of your COPD and that can happen sometimes when you have COPD and then you get a either viral or bacterial infection and that makes your symptoms worse, and you've also had a fever, so we'll do like a full physical examination, get your vitals, everything, but uh and then we'll give you some uh like nebulized like um for your home puffers too, but all just in the hospital and monitor your response to them. Uh and then we'll also get like your, some of your blood work and chest X-ray just to see if there's any like pneumonia. And lastly we'll just get like a Covid swab done since some of these symptoms also overlap with Covid symptoms. Um and yeah so we'll, so that's what we'll do um and I'll let the emergency department know that you're on your way. I think you'll need to get all those tests there, and then they'll decide whether or not you need any kind of admission or you can just go home on antibiotics um from there, OK?
user: OK, that sounds good. Thank you. 

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

assistant: OK, so yeah, let's break this down. The cough, when did that start?
user: The cough, I think it started uh probably like around 10 days ago. 

assistant: 10 days ago, OK, and how about the shortness of breath? 

user: That just started in the last uh I think 3 days. 

assistant: OK, and then the the bowel bowel changes, when did that start?
user: Yes, I think it also started in like, I would say, for the last three days I've been getting uh diarrhea. 

assistant: OK OK, so let's go back to the cough, is it constant or um is it triggered by certain things like the cold air, dust, um you know, um, certain times of the day, like morning, evening? 

user: Um, I would say it's pretty pretty constant since the last like 10 days, uh it's, there's no real pattern to it, and I've mostly just been inside my house. I don't think there are any triggers or I don't own any pets or anything like that, no new rugs, like uh, no no new changes really in my house. 

assistant: OK, OK and um have you tried anything to make it better?
user: Um, no, not really. I I've done some uh home remedies like trying to do one of those steam steam masks and see if that helps, but it didn't really do anything. 

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

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

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

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

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

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

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

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

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

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

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

user: Uh no, not really. 

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

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

assistant: OK. Dizziness or fainting spells? 

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

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

assistant: Uh no, probably weight gain. 

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

assistant: OK, any changes in your vision or hearing?
user: Uh no, no, that that's all been fine. 

assistant: How about um loss of smell or taste? 

user: No, I haven't had uh, I think my taste and smell are still pretty good. No, no issues there. 

assistant: OK, um have you had a runny nose or stuffy nose?
user: No, no, no no congestion really. 

assistant: OK, and um have you had a sore throat at all? 

user: No, no sore throat. 

assistant: OK. Um any issues swallowing food?
user: No. 

assistant: No, changes in your appetite? 

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

assistant: OK. How about nausea or vomiting?
user: No, nothing like that. 

assistant: OK um constipation? 

user: No, diarrhea. 

assistant: Diarrhea, right. Um how often are you having a bowel movement right now?
user: I would say uh like I've been going, probably more than eight times a day, probably in the last few days like 10 times a day. 

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

assistant: OK. Any solids at all? Like is it semi solid at all?
user: Um maybe a little bit, but mostly it's just liquid. 

assistant: OK, um any blood in the stool? 

user: No, I've been checking uh no, I didn't notice any blood or change in colour. It's mainly just um liquid diarrhea. 

assistant: OK, any changes in your urine?
user: No. 

assistant: No, OK, um any confusion or memory loss? 

user: No, not that I know of. 

assistant: OK, um how about muscle aches or joint pains?
user: No, nothing like that. 

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

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

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

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

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

assistant: OK, um and do you have any allergies?
user: No, not not really. 

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

user: Yep. 

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

assistant: OK, OK. Um any family history of heart conditions or lung conditions that you know of?
user: Um yeah, so my family, like diabetes is pretty big, it runs in the family and uh my father in his 60s uh like died from a heart attack. Um other than that, not anything else I can think of, no. 

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

assistant: OK, do you smoke?
user: I used to, I I quit probably five years ago, but before that I used to smoke probably a pack a day for more than 20 years. 

assistant: Oh OK, well good job for cutting down and quitting, um. 

user: Yeah. 

assistant: Yeah, um do you do marijuana at all?
user: No, no no no drugs. 

assistant: Any other recreational drugs? You said no, right?
user: Yeah no, no, I don't do any drugs. 

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

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

assistant: OK, um is she also sick or is she OK?
user: No, she's been completely fine, and I've been kind of isolating myself from her over the last week. 

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

user: Mhmm. 

assistant: Yeah OK, do, can you think of any other sick contacts that you may have had over the past one or two weeks or even three weeks?
user: Um I go to the grocery store, then I go to work, I haven't noticed anyone being sick at work, but you know, you never know like who comes in asymptomatic and like they might be carrying it, with this virus like mainly I'm worried about covid and you know just how fast that's spreading everywhere. 

assistant: Yeah, for sure. Um yeah, for sure, have you traveled to anywhere recently? 

user: No, uh we've been in Canada, Ontario, haven't left to go anywhere. 

assistant: OK. OK, well those are all the questions that I had for you. Did you have any questions or did you have any concerns, anything that you wanted to discuss today?
user: Yeah no, I just uh was wondering if I can get the covid test, that would just, I wanted to make sure I don't give anyone covid if I do have it. 

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

assistant: Yes, please do.
user: OK, sounds good. 

assistant: Alright, take care.
user: Yeah, I'm so I'm here with my mom because I am having this pain in my right hip and groin area. Um I was playing with my friends too. Maybe yeah, yesterday and I fell down. I didn't fall down hard, but I had a small fall and since then my hip has been hurting and it's painful for me to bear any weight on my right leg. 

assistant: OK, and did you have this pain at all before your fall or is this something that just started after the fall?
user: It just started after. 

assistant: OK and when did you have the fall? 

user: Yesterday. 

assistant: OK and can you describe what you were doing and from how high did you fall and if like on what surface you fell on?
user: Sure um we were playing soccer on like a field and I and I just fell on the grass, like it was a flat surface. 

assistant: OK, and so did you say it was the right hip that's giving you pain? 

user: Yes, that's right. 

assistant: OK, did you fall on the right hip?
user: I did. 

assistant: OK an after you fell were you able to um weight bear like get up, get back up on your feet or was it difficult? 

user: It was difficult an I'm still limping. 

assistant: OK and you're still limping on. Have you noticed, so any pain anywhere else, or is it just your hip?
user: Um just my hip. 

assistant: OK and where exactly is your pain on the hip?
user: It's like on the side of my hip as well as like in the groin area. 

assistant: OK I see, and what kind of pain are you experiencing, is it a sharp pain or is it a dull aching pain?
user: It's pretty sharp. 

assistant: It's sharp OK. And do you experience any other symptoms, like any dizziness or fainting spells? 

user: No. 

assistant: And are you able to move your hip at all, like are you able to flex it, or extend it, rotate it?
user: I can move it, but it comes with a lot of pain. 

assistant: OK, and do you find that your hip is at all rotated outwards? 

user: Yeah, it looks um. Yeah, it looks like it is. 

assistant: OK. Alright, have you taken any medications for your pain?
user: I just took some ibuprofen. 

assistant: OK. And. Other than that, have you recently been sick at all?
user: No, I haven't. 

assistant: OK, and on a scale of zero to 10, 10 being the worst pain you've found in your life, how much would you rate this?
user: How would say like an 8. 

assistant: An eight, and as the pain travel anywhere, to other parts of your body?
user: No, just stays in that area. 

assistant: OK, any numbness or tingling? 

user: No. 

assistant: No OK. Any fevers or chills?
user: Um noo. 

assistant: Any skin changes? 

user: No. 

assistant: So no swelling redness or anything like that?
user: Uhm no it doesn't seem to be red. Maybe some slight swelling. 

assistant: OK. 

user: Uhm yeah. 

assistant: OK, any shortness of breath, chest pain?
user: No. 

assistant: OK, any pain in any other joints? 

user: No. 

assistant: OK. Do you feel any weakness in your upper legs or lower legs at all?
user: No, not that I can tell no. 

assistant: OK. And do you have any past medical conditions that you've been diagnosed with? 

user: No, I've been pretty healthy otherwise. 

assistant: OK, and you take any medications on a daily basis?
user: Uh no. 

assistant: OK, any allergies that you know of?
user: No. 

assistant: OK. Are all your immunizations up to date? 

user: Yep, they should be. 

assistant: OK and have you ever been hospitalized or had any surgeries in the past?
user: No. 

assistant: No OK. And yeah, I'll just ask you as well as your mother during the time she was pregnant with you, did you have any kind of complications during pregnancy at all? 

user: Um no, no complications 

assistant: OK and when when you were born any complications after birth, any stay in the hospital for any reason?
user: No. 

assistant: And was it a vaginal delivery or a c-section? 

user: It was a vaginal delivery. 

assistant: OK and was there the use of any kind of instruments like forceps or vacuum for any reason?
user: No. 

assistant: No OK. So it was like a fairly normal pregnancy and were you at term or premature?
user: At term. 

assistant: Alright, and any complications difficulties while you were growing up at all with your growth like height or weight, or any kind of developmental issues that you know?
user: No, um I hit all my milestones and otherwise, doing pretty well on par with my peers in terms of milestones. 

assistant: OK, and schools going well?
user: Yeah, schools going well. 

assistant: OK. And in terms of your family history, any musculoskeletal or rheumatologic conditions?
user: Uhm no, nothing like that in my family. 

assistant: OK, and currently right now, who do you live with?
user: I live with both my parents as well as my 7 year old sister. 

assistant: OK Alright. And yeah, if I can, just, uh, is it OK if I just talk to you alone for a little bit? 

user: Sure, yeah. 

assistant: Alright, yeah, so anything that we talked about here today will stay confidential as long as there is no harm to yourself or others or risk of harm to yourself or others. So yeah, I'm just going to ask you a few questions pertaining to your health.
user: Sure, that sounds good. 

assistant: Yeah, so at home, do you find that you're in a safe environment even outside of your home in your neighborhood do you feel safe? 

user: I do. 

assistant: OK and how about at school, do you feel safe? Have you experienced any kind of bullying or anything like that?
user: No. 

assistant: OK. Have you tried any alcohol, recrea' recreational drugs or cigarettes or do you know any friends that have tried? 

user: I know, I know, older kids that have tried in the school, but we haven't. 

assistant: OK, and are you sexually active?
user: No. 

assistant: No OK alright yeah so those are just a few questions I had I'll call your mom back in. OK, so yeah, we're just gonna try and do a couple of examinations. So are you able to stand up by yourself? 

user: Um I can, but I need a lot of assistance like I have to hold on to the desk or have a crutch or something like that. 

assistant: OK, uh, no worries and then while laying down, are you able to lift your right leg with your knees straight?
user: I don't know about straightening my knees. My leg seems to have permanently turned outward and look shorter than my other leg. 

assistant: OK and yeah, I forgot to ask you this earlier. I don't I don't think we weighed you when you were coming in, but approximately how much would you say you weigh?
user: I weigh about um 130 pounds. 

assistant: OK, and do you know how tall you are?
user: Uhm I'm about 4'8". 

assistant: OK. OK, alright, so yeah those were just some of the questions I had today we'll do a full physical examination and have you come in. Alright, sorry and like well will continue with the full examination today and what currently it seems like it can definitely be from the fall. You may have injured yourself and we just want to make sure there's no fractures like a hip fracture. 

user: OK. 

assistant: One thing that's also something that we have to investigate is something called slipped capital femoral epiphysis. So this is, this is a common hip issue in adolescents, especially from boys aged 10 to 16. And usually it's the left hip that's affected, but it it can be the right. And as adolescents are in a phase where they were growing, there is, if they have some predisposed disposition too slipping of the capital femoral if epiphysis, which is right between your hips, you can get some slipping. It can be after a fall or it can happen just as the child is growing, and it can also it is also associated with the increasing weight that a child may have. So what we can do is just get first an X-Ray of both the hips.