[doctor] next is betty hill , uh , date of birth is 2/21/1968 . she has a past medical history of uterine fibroids and anemia . she's a new patient with a referral from the er of esophagitis . um , i reviewed our records from the er , including the normal cardiac workup , and we're about to go in and see her now . good morning . you miss hill ?
[patient] good morning . yes . that's me .
[doctor] hey , i'm dr. sanders . it's nice to meet you .
[patient] nice to meet you too .
[doctor] so tell me about what brings you in today ?
[patient] well , i really needed to see you three months ... three months ago , but this was your first available appointment . when i called to make the appointment , i was having chest pains , but it stopped after four days , and i have n't had any since then .
[doctor] okay . when did these four days of chest pain occur ?
[patient] um , early october .
[doctor] of 2020 , correct ?
[patient] yes .
[doctor] okay . can you think of anything that might have caused the chest pain ? did you wake up with it ?
[patient] no . it just it randomly . i tolerated it for four days but then had to go to the emergency room because nothing i did relieved it . they did a bunch of testing and did n't find anything .
[doctor] okay . can you point to the area of your chest where the pain was located ?
[patient] well , it was here in the center of my chest , right behind my breastbone . it felt like i was having a heart attack . the pain was really sharp .
[doctor] did they prescribe you any medications in the er ?
[patient] no . they ran an ekg and did blood tests , but like i said , everything was normal .
[doctor] okay . i see .
[patient] they thought it was something to do with the gi system , so that's why they referred me here .
[doctor] interesting . uh , do you remember having any heartburn or indigestion at , at the time ?
[patient] uh , maybe . i do n't think i've ever had heartburn , so i'm not sure what that feels like .
[doctor] was the pain worse with eating or exercise ?
[patient] yes . with eating .
[doctor] okay . any difficulty swallowing ?
[patient] mm-hmm . i did .
[doctor] okay . and that's also resolved since the initial episode three months ago ?
[patient] yes . thankfully . the chest pain and swallowing problem got better about three days after i went to the er . but i just feel like there's something wrong .
[doctor] okay . so how has your weight been .
[patient] i've been trying to lose weight .
[doctor] that's good . any in- ... issues with abdominal pain ?
[patient] uh , no .
[doctor] okay . good . and how about your bowel movements ; are they okay ?
[patient] they're normal .
[doctor] all right . are you aware of any family history of gi problems ?
[patient] i do n't think so .
[doctor] have had you had any surgeries on your abdomen , or gall bladder , or appendix ?
[patient] yes . they took my gall bladder out several years ago .
[doctor] okay . if you wan na lay down here on the table for me and lets take a look at you .
[patient] okay .
[doctor] so when i push on your lower belly , do you have any pain , or does it feel tender ?
[patient] no .
[doctor] okay . how about up here in your upper abdomen ?
[patient] yes . it , it hurts a little .
[doctor] okay . and even when i press lightly like this ?
[patient] yes . uh , just a little uncomfortable .
[doctor] okay . does it hurt more when i press over here on the left or over here on the right ? or is it about the same ?
[patient] i'd say it's about the same .
[doctor] okay . so we'll say you have some mild tenderness to light palpation in the upper abdominal quadrants , but everything on your exam looks normal and looks good .
[patient] okay . good .
[doctor] so let's talk about your symptoms real quick . obviously , with the chest discomfort , we worry about heart issues , but i'm reassured that those were ruled out with all the testing they did in the er . um , other potential causes could be anxiety , esophagitis , which is irritation of the esophagus . but typically with these , um ... but typically , these cause the pain that would last for a long time rather than that isolated incident like you had . um , it's also possible that you had intense heartburn for a few days .
[patient] well , since you mention anxiety , i was going through a really stressful job transition right around the time this happened .
[doctor] okay . that's good to know . so stress from this could be , um ... could be , uh ... could be very well have contributed to your condition .
[patient] okay .
[doctor] so we could do an , uh , egd or upper endoscopy to take a look at your esophagus and stomach . this would allow us to look for esophagitis . but your symptoms occurred three months ago and you have n't had any additional episodes , so likely if it were esophagitis , it's already healed by the point ... by this point , and we would n't be able to see anything . the other option is just to continue to monitor , uh , for any additional symptoms at which point we could do the egd . uh , with you being asymptomatic for so long right now , i'm comfortable with that option . but what do you think ?
[patient] i'd like to hold off on the egd and wait to see if i have more symptoms .
[doctor] that sounds good . um , so you can call the office if you have any additional episodes of pain or any other symptoms you're concerned about . if that happens , we'll get you scheduled for an egd to take a look . if not , you can follow up with me ... follow up with me as needed for any other gi complaints .
[patient] okay .
[doctor] all right ? if you do n't have any questions for me , i'll walk you out to the check-out desk .
[patient] no . that's it . thank you .
[doctor] you're welcome . right this way . all right . uh , in assessment , please summarize the patient's history briefly , and let's list her possible etiologies such as , uh , gerd , dyspepsia , esophagitis , musculoskeletal etiologies , and anxiety . uh , suspect she had an anxiety attack related to her job transition , plus or minus a contribution from her musculoskeletal etiologies . um , in the plan , include our discussion of the egd versus monderning ... monitoring for symptom . patient elected to self-monitor her symptoms and will call with any reoccurrence or change . thanks .

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