jshargo/medical-interview-conversations2 huggingface dataset:
user: Per week, maybe about 5 milligrams. Not that much. 

assistant: OK, and do you use any other recreational drugs like cocaine, crystal, meth, opioids? 

user: No. 

assistant: OK. Have you used IV drugs before?
user: No. 

assistant: OK. And do you drink alcohol? 

user: I do. 

assistant: OK. How much alcohol do you drink each week?
user: Uhm about I would say I have like one or two drinks a day, so about 10 drinks a week. 

assistant: OK, uh, yeah and um alright, and then briefly, could you tell me a little bit about your like diet and exercise? 

user: Sure, I try to eat healthy for dinner at least, but most of my lunches are, uh I eat out. And then in terms of exercise, I try to exercise every other day, I run for about half an hour.  D; OK, well that's great that you've been working on the the activity and the diet as well. So has anything like this happened in your family before?  No. 

assistant: OK, has anybody in the family had a heart attack before?
user: Actually, yes, my father had a heart attack when he was 45. 

assistant: OK, and anybody in the family have cholesterol problems?
user: I think my father did. 

assistant: I see OK, and how about anybody in the family have a stroke?
user: No strokes. 

assistant: OK, and then any cancers in the family? 

user: No. 

assistant: OK, and is there anything else that you wanted to tell me about today that that I on on history?
user: Hi, yes. Thank you for seeing me. I just came in today because I've been having for the last week this cough and recently also started noticing that I've been having some diarrhea as well. 

assistant: Hm, when did the cough start?
user: The cough started around 5 days ago. And it's it got worse, but now I think it's a little bit better. 

assistant: What about the diarrhea? 

user: The diarrhea started just two days ago and I'm having to go like almost 8 to 10 times in the last two days. 

assistant: And what is, what does your stool look like? Is it completely watery?
user: Yeah, it's mostly watery. 

assistant: And what colour is it?
user: Just normal colour, no, it's not dark or anything like that. 

assistant: OK, any blood that you've noticed, anything red?
user: No blood. 

assistant: And you've had this cough, but your cough is getting better. What's the cough like? Is it a dry cough or wet cough? 

user: It's uh, it's more of a dry cough. 

assistant: Have you coughed up anything at all, like blood or any, any mucus?
user: No, no I haven't coughed up anything. 

assistant: OK. And other than the cough, have you had any other like flu like symptoms? Have you had like a runny nose or stuffy nose? Sore throat? Any of those symptoms? 

user: No, none of those. But I, I have also been having like a little bit of a headache as well in the last few days. 

assistant: Where is, where is your headache?
user: Just in the like on my forehead, on both sides. 

assistant: What does it feel like? 

user: Aching sensation. 

assistant: And how bad is your headache from 1 to 10, with 10 being the worst headache ever?
user: Right now, probably a 5, but it was probably like a 7 yesterday. 

assistant: So do you feel like your headaches getting better?
user: Right now, like today I took Tylenol so I don't know if it's just better because of that. 

assistant: I see. And have you taken any other medications to help with your symptoms?
user: No. 

assistant: OK, uhm, have you had a fever or chills?
user: Uhm, I know I haven't felt any fever, chills. 

assistant: OK and have you had any chest pain or any difficulties breathing?
user: No. 

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

user: Uh no, nothing like that. 

assistant: OK, any pain in your belly?
user: Um just like a little discomfort with going to the washroom so much. 

assistant: And any muscle aches in your body? 

user: No. 

assistant: OK, any numbness or tingling in your arms or feet?
user: Uh, no, nothing like that. 

assistant: Any change in your sense of smell? 

user: Uhm, maybe a little bit, I haven't really.. Yeah, I would say in the last few days, maybe a little like I've been able to smell less. 

assistant: Any change in your sense of taste?
user: Uh no. 

assistant: OK. Have you have you been in contact with someone who you think could potentially be sick? 

user: Uh, no, not that I know of. I do I do go to work in, like in person. Unfortunately I'm I can't work from home. But I've been noticing anyone sick around me though. 

assistant: And what do you do for work?
user: So I work at like a car shop. 

assistant: OK. And do you wear a mask and maintain social distancing? 

user: Yeah, most of the times I would say we're pretty strict, strict with that. Uhm, sometimes when we're in our office I take off my mask, but usually when we're seeing other people or within close proximity, we keep the masks on. 

assistant: OK. And, uh, do you, I, I guess, who do you live with at home?
user: I just live with my wife. 

assistant: Do you think she might have had any exposures? 

user: No, she's been fine and she doesn't have any symptoms. And she's, she's a school teacher. Right now that she is working from Canada. 

assistant: OK, and do you, smoke at all? Or have you smoked in the past?
user: Oh yeah, I do, or I used to smoke in my 20s and 30s, but I quit smoking. 

assistant: How much did you smoke back then? 

user: Probably half a pack a day. 

assistant: And for how many years?
user: Only like 15, 15 years. 

assistant: OK do you, do you smoke marijuana or have you smoked in the past?
user: Uh, I've tried it a couple times. I don't really like it, so no. 

assistant: Any recreational drugs? 

user: No. 

assistant: Alcohol?
user: Uh, I probably have a beer every day. 

assistant: Do you have any medical conditions that you've been diagnosed with?
user: Uhm I, I take uh, medications for blood pressure and high cholesterol. 

assistant: What do you take?
user: Uhm, I take this medication called, I think it's it's like a Lipitor. And then I take uh, Ramipril for the blood pressure. 

assistant: Any allergies to food, environmental allergies or any medication allergies to medications? 

user: Not that I know of, no. 

assistant: Any medical conditions that run in the family?
user: Uhm so I think, uh, diabetes, and for my family, but I I I don't have it so and I think that's pretty much about it on my dad's side. On my mom's side and there was someone, like my aunt did have ovarian cancer. 

assistant: OK, and have you, I guess have you, I forgot to ask earlier, have you had any surgeries or hospitalizations? 

user: Uhm I had a surgery to remove my appendix in my 20s and since then, no. No surgeries or hospitalizations. 

assistant: OK.  Alright, and I guess that's all the questions I have for you. You haven't had any difficulties breathing right?
user: No, 

assistant: No, OK. Do you OK? And you've had diarrhea for two days. How's your appetite and have you been eating and drinking OK? 

user: Uhm appetites pretty OK, like I feel like, I've been more hungry, with the carry I feel like I, need to eat more. 

assistant: Uhm, It's also important with the diarrhea to drink lots of fluids and to make sure that you're not losing important minerals and you're not losing like sodium or potassium in diarrhea and other things like calcium that could create problems. So, continue to eat well and continue to drink lots of water. I guess so what we'll do is we'll do a COVID swab just to just to check if you have COVID or not. We'll also do a few labs to see how your electrolytes are, do your vitals to see if you have fever, measure your heart rate and do a physical exam and then go from there. And I'll off - I'll talk to my attending as well and we'll come back and discuss the management plan with you.
user: Hi, I'm um, I'm just, so I am here because I have this cough that I've had for the past um, week and a half, and I'm just uh, I usually don't come in with symptoms this minor, but because it's, because we're in the middle of a pandemic, I thought I should come in and get checked out. 

assistant: Okay, yeah, so it's been going on for like more than a week. Um, can you describe to me what kind of cough you're having? Is it like a wet cough or a dry cough?
user: It's a dry cough. 

assistant: Okay, and has it been getting worse over the, over the time period you described?
user: Um, it's kind of the same. 

assistant: It's the same. Um, have you noticed, although it's like dry, have you brought up any kind of sputum or phlegm at all? 

user: Um no, not, not, not recently. But yeah, in the first couple of days, the first two, three days. 

assistant: Okay, um and have you noticed any kind of yellowish to greenish tinge to it?
user: No, it was watery. 

assistant: Watery, okay. Have you noticed at all, any blood, have you been coughing up any blood at all? 

user: Uh, no. 

assistant: Okay, and is your cough like constant or does it come and go?
user: Um, kind of comes and goes. There's just times when I'm coughing a lot and then it just goes away. 

assistant: Okay, and is there a pattern to it? Like, uh, do you cough more when you're exerting yourself or any time, a certain time of the day? 

user: Um, it's worse when I'm smoking. 

assistant: When you're smoking, okay. And uh, how long do those episodes last?
user: Couple of seconds, maybe? 

assistant: Okay, and has this happened to you before at all?
user: Yeah. I think, um, yeah, I usually don't pay much attention to it. You know, I think must have happened last year or the year before. It just kind of goes away on its own. 

assistant: Okay, and is there any anything that makes it better or worse? 

user: Um, I um, I take this cough syrup, over the counter syrup, that helps. 

assistant: Okay. And um, have you found that it's been helping over, like, to help improve your cough over the last few days?
user: It goes away for a couple hours and then it comes back. 

assistant: I see. Does it keep keep you up at night at all? 

user: No, no, no. 

assistant: No, okay. Are you having any other symptoms like shortness of breath, um sore throat, runny nose, anything like that?
user: Uh, I kind of had those symptoms in those first two, three days, but then it went away, and then I only had this cough that stayed. 

assistant: Okay, okay. And have you been in contact with anyone that's been sick around you at all? 

user: Um, my daughter had the sniffles. 

assistant: When was that?
user: Last, two weeks ago. 

assistant: Two weeks ago? Okay. And uh, how is she now like, did it just go away on its own, or did she have to go to the doctor?
user: Um, no, it kind of went away on its own. 

assistant: Okay. Have you traveled at all recently outside of the province or the country?
user: No. 

assistant: No, okay. And besides the cough, are you having any headaches at all? 

user: No. 

assistant: Any nausea or vomiting?
user: Not anymore. 

assistant: Not anymore, when was the last time that you had fevers or chills?
user: I think I had like a very, it must have been 37.4, um, in the first, two, three days. But it got better really quickly. 

assistant: Okay, I see. Any night sweats?
user: No. 

assistant: No, okay. Any, um, do you feel tired throughout the day? 

user: Not anymore. 

assistant: Not anymore, okay. So any kind of chest pain, or sensation that your heart is racing?
user: No. 

assistant: No. Any dizziness or fainting spell?
user: No. 

assistant: Any changes in your bowel movements at all? 

user: Um, no. 

assistant: No, so no constipation, diarrhea?
user: No. 

assistant: Okay, any changes in your urination?
user: No. 

assistant: No, okay. Um, have you had to miss work at all or, do you currently work? 

user: Yeah, but I've been working from home. 

assistant: Okay.
user: I didn't have to miss work, so. 

assistant: Okay. And any changes in your sleep or appetite? 

user: No. 

assistant: Okay, any loss of sense of taste or smell at all?
user: Um, initially, I guess the cough's first few days, my nose was a little stuffy, so yeah, I couldn't smell very well, but since then it's been fine. 

assistant: Okay, but no loss of taste? 

user: No loss of taste, no. 

assistant: Okay. Uh, any recent significant changes to your weight at all over the last few months?
user: No. 

assistant: Okay, um, and any exposure in your home environment to dust, fumes? Any animals in the household? 

user: No. 

assistant: Okay. And otherwise, uh, do you have any medical conditions that you've been diagnosed with in the past?
user: Uh no, I'm pretty healthy. 

assistant: Pretty healthy, okay. Any allergies, either to medications or environmental? 

user: Um, I'm allergic to penicillin. 

assistant: To penicillin, okay. And what kind of reaction do you get to penicillin?
user: Um, I was told that I got a rash when I was a child. I don't really remember. 

assistant: Okay, and do you take any medications on a regular basis? 

user: No. 

assistant: No, okay. And have you been hospitalized in the past or had any surgeries?
user: Um, I had my appendix removed about um, five years ago. 

assistant: Five years ago, okay. Any complications at all after that?
user: No. 

assistant: Okay. Any family history of any lung conditions, heart conditions, any cancers at all? 

user: Um, colon cancer. 

assistant: Colon cancer?
user: Yeah my dad and my grandfather had it. 

assistant: Okay, um, and have you, have you had any scopes done recently at all? 

user: Oh yeah, I had mine done uh, seven years ago. 

assistant: Seven years ago, okay. And were there any findings at all?
user: No. 

assistant: No, okay. Um, currently so you work from home, so what's your home and living situation like? Who do you live with, and where, do you live in like a house, appartment?
user: Uh, I live in an apartment with my wife and my daughter. 

assistant: Okay uh, and uh, do they have any symptoms at all? Or are they, are they fine? 

user: Well, my daughter doesn't have any symptoms anymore. She did as I mentioned, have some flu like symptoms 2 weeks ago. My wife's been healthy. 

assistant: Okay, and uh, does your daughter go to school right now or is she doing school from home?
user: Uh, school from home. 

assistant: School from home, okay. Um, and do you at all smoke? So you mentioned your symptoms get worse with smoking. 

user: Yeah. 

assistant: Um, how much would you say you smoke on an average day?
user: Um, I don't, I try, I've been trying to cut down, so I, I smoke about 3 or 4 cigarettes a week. I used to smoke a lot more before. 

assistant: Wow, yeah, that's really good! That's really great progress, um, it's really difficult to quit, but it's great to see that you're trying to quit. Um, so how much would you say you used to smoke? 

user: Well, half a pack. Um, half a pack a day, but then over the past three years I've been trying to cut it down. I started smoking when I was 20, so it's been um, 30 years now. 

assistant: Okay, so 30 years, okay. And um, are you just, are you using anything to help you quit smoking or are you doing it without any medications, or um, like, have you used anything in the past that has worked for you?
user: Um, no I, I went to my doc and he said to try on my own first and if I'm struggling with it to come back, but I've been doing it very gradually so it's, it's going well. 

assistant: Okay, and that's really good. And yeah, if you, at all, need any resources to help you quit smoking, it's great that you're doing really well, but if you need to talk more about it or need any more resources we can provide that for you. Um, other than uh, smoking cigarettes, do you use any recreational drugs like marijuana at all?
user: No. 

assistant: No. How about alcohol? 

user: Uh, I just drink on the weekends. Maybe a glass or two of wine. 

assistant: Okay, and uh yeah. So those were kind of all the questions I had for you today. Do you have any questions or concerns?
user: No. 

assistant: No?
user: I was, I guess I was just worried about the cough um, it's just, I was worried that it could be COVID. 

assistant: Yeah, so definitely right now, any of these symptoms, like COVID can have a lot of different symptoms um, so we should definitely make sure that we, to check if you have COVID or not and we'll get a COVID swab test done for you today, and the results will come back in 24 to 48 hours. Uh, and in that time, you will need to isolate even in your own home. Try to wear a mask around your family members, um, trying to eat separately and use all those methods, and, and then after the test comes back you may, you'll be contacted by public health if it's positive and kind of given more instruction on what to do. And it doesn't necessarily have to be COVID either, it can be just another virus uh, like it can be just your common cold that's been going on. So it does seem that your symptoms have gotten better. Oftentimes uh, a cough can be the last thing to go, it can take up to two weeks or more for the cough to get relieved, but it seems that you're not having any systemic symptoms like no fevers or anything else right now, so it's, it's uh, that's, that's pretty good. 

user: Great, I'm glad. 

assistant: Alright, yeah.
user: I haven't been coughing these last two weeks since I got back from Mexico. I think I got sick there. 

assistant: OK, so just the last couple weeks you've been coughing? 

user: Yeah, ever since I got back from Mexico it's been yeah so about about two weeks. 

assistant: OK. And is your cough for a wet cough or dry cough?
user: It's dry and I'm not bringing up any any sputum. 

assistant: OK, and are you coughing up any blood at all?
user: No blood. 

assistant: No, OK. And is the cough constant or does it come and go?
user: It, it comes and goes. I would say sometimes it can be worse. Yeah, depending on on what I'm what I'm doing. I guess if I'm exercising or if it's if it's really cold outside, it might get worse. 

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

assistant: OK, and anything that you did when you were in Mexico that might you think might have caused your cough?
user: Uh, I don't know, maybe I, I was drinking a little bit too much and partying a little bit too much so might have got sick while I was there. 

assistant: I see. Did you have any cold symptoms like runny nose, sore throat? Um, any anything like that when you were there or after you came back? 

user: No, sometimes my eyes can get a little itchy, but no runny nose or sore throat. 

assistant: OK, have you had any previous episodes that are similar to how you're feeling now?
user: Uh, maybe years ago when I like when I was in elementary school, but nothing for the last few years. 

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

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

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

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

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

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

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

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

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

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

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

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

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

assistant: OK. Have you had any fevers or chills recently?
user: No. 

assistant: Any night sweats? 

user: No. 

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

assistant: OK, have you noticed any swelling in your feet or hands? 

user: No. 

assistant: Any dizziness?
user: No dizziness. 

assistant: Do you ever feel your heart is racing when you get like these thumping like heart palpitations? 

user: Uh, nothing like that. 

assistant: OK, and you said no chest pain, right?
user: No chest pain. 

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

assistant: OK. Any changes in your urinary patterns? 

user: No, everything's been normal. 

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

assistant: OK. And have you noticed any changes in your weight at all? 

user: My weight's been about the same. 

assistant: OK, any changes in your appetite?
user: No, been eating well. 

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

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

user: Neither of those. 

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

assistant: OK. And how long you've had those cats for?
user: We've had them for for almost a year. 

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

assistant: OK. Any medications that you are on currently?
user: Uh, no medications. 

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

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

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

assistant: OK. And have you ever been hospitalized before? 

user: No, I haven't. 

assistant: Ok, any previous surgeries?
user: No surgeries. 

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

user: Everybody's been healthy. 

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

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

user: Uh, no. Everyone's healthy. 

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

assistant: OK, and has there been any, have you moved there recently or how long have you lived there for? 

user: Uh we've lived there for about four years now. 

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

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

assistant: OK. And do you smoke at all? 

user: No, I don't. 

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

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

user: OK, thank you. 

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

assistant: OK. And do you drink alcohol? 

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

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

assistant: OK. And in terms of exercise, do you find that you're getting adequate exercise throughout the week? 

user: I tried to, I tried to run and go for walks but always trying to be a little bit more active. 

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

assistant: OK, so based on what we talked about, it seems that based on your past history and the coughing that you're having right now, one of the things that we definitely want to look at is if you do in fact have asthma. Um, it can also be like viral upper respiratory tract infection, but we will do some pulmonary function tests for you and see if the bronchodilators just like you use the inhaler from your son if that helps helps you with your symptoms and then we can go from there.
user: Yeah, I'm just feeling, so, I do have COPD, but I just feel so much worse. I do have shortness of breath, but I think it's just been worse over the past three days. I'm having more difficulty climbing stairs, or even just going to the bathroom. 

assistant: OK, and you said this started? 

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

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

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

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

assistant: OK, and have you had any, uh, episodes where you've woken up in the middle of the night and were really short of breath, you had to, uh, sit up?
user: No, no, no. 

assistant: OK, and are you able to lie flat?
user: Yes. 

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

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

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

assistant: OK, yeah, it sounds like a lot more and have you noticed any blood?
user: No, no, no. 

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

assistant: OK, and is your cough worse at any particular time of the day, Or does it happen throughout the day? 

user: Well, it's a bit worse when I'm smoking, but otherwise it's the same. 

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

assistant: OK, and have you had any headaches? 

user: No. 

assistant: How about any ear pain or eye pain?
user: No. 

assistant: Any sore throat? 

user: No. 

assistant: OK, have you had a loss of smell or a loss of taste?
user: No, I don't think so. 

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

assistant: OK, have you noticed any changes to the wheeze? 

user: No, I don't think so. I don't know. I can't tell. 

assistant: I see, OK, and have you had any chest pain?
user: No. 

assistant: Have you had any lightheadedness or dizziness?
user: No. 

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

user: No. 

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

assistant: Alright, and any urinary problems?
user: No. 

assistant: OK, and have you had any changes to your skin or any rashes? 

user: No, not really. 

assistant: OK, and have you had any fevers or chills?
user: I think I was feeling very chilly last night. My wife had to bring an extra blanket for me. 

assistant: OK, have you had any night sweats? 

user: No, I don't think so. 

assistant: OK, and uh, have you checked your temperature?
user: No, I didn't. 

assistant: OK, we'll certainly check that today. And have you had any weight loss in the last several months? 

user: I don't check my weight very often, but no, uh, yeah, my clothes still fit, they're all, they're fine. 

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

assistant: OK, and in regards to your past health, you mentioned COPD, but have you been diagnosed with any other medical conditions?
user: Yeah I have high blood pressure, and my cholesterol is also a little bit on the high side. 

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

assistant: OK, we can get that information. Have you had any hospitalizations?
user: Uhm, I've been to the ER a couple of times and this one time, it was similar to this time, when I was having difficulties breathing and had to stay for about five days or so. I think that was two years ago. 

assistant: OK, and how are your symptoms feeling now when compared to, uh, that time? 

user: I wasn't producing this green yellow thing that's coming out of my mouth right now. It was not that bad. It's just last time I was having difficulties breathing, so I decided to come in. But this time I just have this weird thing, I don't even feel like looking at it. 

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

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

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

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

assistant: OK, and have you been around anybody who might be sick?
user: No. 

assistant: Alright, how about, have you traveled anywhere? 

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

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

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

assistant: OK, have you thought about quitting?
user: Yeah, yeah, multiple doctors have told me to quit and it's just, I don't think I can quit. It's not gonna happen. I can't live without my cigarettes. 

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

user: I drink a glass or two every weekend. 

assistant: OK, and do use any other recreational drugs like marijuana, cocaine?
user: No. 

assistant: OK, and, any family history of heart or lung conditions? 

user: Uhm, high blood pressure. 

assistant: OK, has anybody in the family had lung cancer?
user: No. 

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

user: Sure. 

assistant: Alright, we'll get that started.
user: I just had uh, well, it was just uh, I came from football practice I, uh, just felt like somebody fell on me while, like while I was on the ground and it's like, I've had this shoulder pain immediately afterwards and I can see a, like lump, um, kind of pointing out like in my skin here on my, on my, um, clavicle or shoulder bone. 

assistant: Okay, is it the right side or the left side? 

user: Uh, it's the right side. 

assistant: The right side, okay. Um, okay, and how long ago did this happen?
user: It happened about, just a couple of hours ago. Yeah, just about 2 hours ago. 

assistant: Okay, um. Um, did someone, did someone fall onto your side? Okay, uh, so, your main, are you having mainly pain in that, in that area, or is it going to other places?
user: It's mostly just the pain like right in that area. I'm not feeling it anywhere else. 

assistant: Okay, and um, what kind of pain are you feeling? Is it sharp, stabbing, or is it aching?
user: It's really sharp. It feels like I'm, I'm getting stabbed in the shoulder. 

assistant: Okay, I see, and on a scale of 0 to 10, 10 being the worst pain you've felt in your life, how much would you rate it?
user: Uh, this is like a 10. It hurts really bad. 

assistant: Okay, and um, are able to do any movements, or are you just kind of holding your arm up with your other other arm?
user: I, yeah I've just been holding my arm up by, uh, I kind of made a sling out of, yeah, like the coaches helped make a sling out of one of the, uh, what we, like a shirt or something like that at the practice. And so I've been just kind of holding my arm against my chest with my elbow flexed. I haven't really moved it at all. 

assistant: I see, okay. Um, and if you were to describe just what it looks like right now, does your shoulder kind of seem like it's sagging?
user: Yeah it does. 

assistant: Okay, and do you notice any point near your shoulder like clavicle area that has any bruising, swelling looks, like red? Anything like that? 

user: Um, like maybe a little bit of bruising and swelling like over the area where I can see like my, my skin pointing up, but um, yeah, that's the only area. 

assistant: Okay, I see. Okay. Any other symptoms, like any pain in any other joints, muscles?
user: No, just the pain right there. 

assistant: Okay. Alright um, and uh, other than that, have you previously had any popped joints before?
user: Uh, I, no, I haven't. 

assistant: Okay, and no other trauma or anything in the same region? 

user: No, I haven't had any pains there before or anything like that. 

assistant: Okay, I see. Okay, um and have you been diagnosed with any medical conditions in the past?
user: Uh, no I haven't. 

assistant: Okay, alright, and did you hurt yourself anywhere else? Like did you hurt your head at all? Um, suffer any loss of consciousness or anything like that? 

user: No, no, I, I didn't. I was kind of just like laying on my side and they fell like on my left shoulder and I, I just got squished. 

assistant: Okay, and did it have any impact on your chest like you do you feel short of breath or anything like that?
user: No shortness of breath, kind of knocked the wind out of me at at first, but I'm okay now. 

assistant: Okay, I see, that's good. Um, okay, and other than uh, so no medical conditions? Do you take any medications at all? 

user: Um, yeah, I'll take like uh, just some allergy medication every once in a while. When it's like, just seasonal allergies, I think to just some environmental triggers is all. 

assistant: Okay, and and do you have any allergies to any medications at all?
user: Uh, no, I don't believe so. 

assistant: Okay, anything that you've tried that has helped or made your pain worse?
user: No, I haven't, I haven't taken anything yet, I just uh, like basically came right from practice to the, to the hospital. 

assistant: Okay, um, have you had any kind of fevers or chills? 

user: No. 

assistant: Any skin changes, like rashes?
user: No, I haven't had any rashes. 

assistant: Okay, any weakness in your upper or lower extremities, besides like the area that's affected? 

user: No. 

assistant: No, okay. Um, any dizziness, fainting episodes?
user: Uh, no, nothing like that. 

assistant: Okay, and your hearing and vision is alright right now?
user: It is, yeah. I haven't had any problems with that. 

assistant: Okay, and have you had any kind of concussions or anything in the past? 

user: Um, no, I haven't had any. 

assistant: Alright. Uh, have you been hospitalized or had any surgeries in the past?
user: Um, no, not, not ever. 

assistant: Okay. Any family history of any medical conditions?
user: Uh, no. No, nothing that I can think of. Everybody's pretty healthy. 

assistant: Okay. Um, and what's your living situation like right now? 

user: So I live with both of my parents and um, I have a younger brother and a younger sister as well. We live in a, in a house. 

assistant: Okay, alright, and um, do you work currently? Or are you a student?
user: Yeah, I'm in high school and, um, I, I work part-time at the grocery store as well, but uh, it's not that often though, because I've just been been playing sports, on the football team, we have a lot of practices and games and stuff. 

assistant: Okay. Um, do you drink alcohol?
user: Uh I, sometimes I, with friends. Um, we've had a couple of beers here and, here and there, but I mean it's, it's not something that I've done very often. Yeah, we've been pretty safe, I feel like. 

assistant: Okay, and do you smoke cigarettes or marijuana, or use any recreational drugs? 

user: No, nothing like that. 

assistant: Okay, alright, so those are all the questions I had for you today. We'll do a full physical examination of the area. Um, we, we will definitely get an x-ray of the shoulder and clavicle to see what kind of, it seems like you have a clavicular fracture from just the mechanism of the injury, as well as everything you were describing. Um, but it is important to understand how, like what kind of clavicle injury it is and where it's affected, if it's in the middle area, on like the outer areas of the clavicle, um, and how much it's displaced because that will determine if we just need to reduce it here, and then give you a sling, and then you can go home. That's usually the case, but sometimes you may require surgery as well, and we would need to refer you to an orthopaedic surgeon. So yeah, we'll, we'll get the x-ray done, and if you need anything for pain currently, we will give you some medications here, um and then we'll go from there.
user: Alright, thank you. 

assistant: You're welcome. Um, I'll be here with you shortly.
user: Low back pain. 

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

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

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

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

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

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

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

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

assistant: OK, and has this pain changed at all since yesterday? 

user: No, it's been this same awful pain this whole time. 

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

assistant: OK. And does it, does the pain go anywhere or does it just stay in the lower back? 

user: I also feel the pain uh into my right leg. 

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

assistant: OK. And do you have any other symptoms besides the pain? Like are you experiencing any kind of weakness or any kind of, any other changes in your health? 

user: Uh no it's just the uh the low back pain. 

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

assistant: OK, any uh fevers or chills or night sweats?
user: Um no fever, uh no chills, no night sweats. 

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

assistant: OK. Any changes to your skin at all? Uh I mean, any rashes?
user: No. 

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

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

user: Uh no. 

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

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

assistant: OK, and how has your appetite been? 

user: Uh appetite's been normal. 

assistant: Any significant weight loss or weight gain recently?
user: No, the weight's been about the same. 

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

assistant: OK. Any uh tingling sensation or numbness uh in your back or lower limbs, in your legs? 

user: Uh no numbness or tingling. 

assistant: OK. Any muscle weakness at all?
user: Uh no muscle weakness. 

assistant: OK, have you been uh having any uh kind of erectile dysfunction? 

user: Uh no concerns with uh erectile dysfunction. 

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

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

assistant: OK, and do you take any medications for it?
user: Uh I, um insulin for diabetes. 

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

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

assistant: OK, any allergies?
user: Uh nope. 

assistant: OK. Any previous surgeries?
user: Uh I had hemorrhoids removed three years ago. 

assistant: OK. Um any hospitalizations before? 

user: Uh no, it was just day surgery, 

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

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

assistant: OK, and where do you live? 

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

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

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

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

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

user: Uh never. 

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

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

user: Yes, I am. 

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

assistant: And, uh, how many, I'm sorry, go ahead.
user: Um just my my girlfriend recently. 

assistant: OK, and have you been sexually active with more than one partner in the past, past year? 

user: Uh yes, I have, um um two women over the past year. 

assistant: OK, and um do you use any kind of protection?
user: Yeah, so I just came in. I was a bit worried because I've been having this cough for around two years, which has been getting worse. But recently I've noticed that I see streaks of blood in the sputum that I'm producing. Before it just used to be like white but now I'm seeing over the last, I would say two months occasionally some streaks of blood. 

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

user: Yeah. 

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

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

assistant: OK, and uh, is are you seeing like bright red blood when you're when you're coughing it up? 

user: Uh. In this it's kind of mixed into the sputum. I would say like, but it definitely is red. 

assistant: OK. And how much blood would you say that you're you're bringing up would be teaspoons? Or a Cup? Or?
user: No. It's just like a little streaks. It's not really significant, it doesn't feel like the whole production of the sputum, but just like little streaks that I've noticed. 

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

assistant: OK, anything that that makes it worse? You said some viral infections. Have you had a viral infection recently?
user: Yeah, like in the last two years, I've probably had two or three viral infections, just just just cold cold symptoms. 

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

assistant: OK. And prior to two years ago um, were you experiencing any similar symptoms like, uh, like this cough or bringing up blood before?
user: In the past, I've always had a somewhat of a cough like I have COPD. So I've always had a little bit of a cough here and there, but over the last two years I feel that it's been getting much worse. 

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

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

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

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

assistant: OK, and have you been having any fevers or chills?
user: No, no I haven't. 

assistant: How about any night sweats? 

user: No. 

assistant: Have you lost any weight?