[doctor] michelle king , date of birth 01/05/1986 , mrnq27631 . new patient visit for acid reflux . past medical history of anxiety and seasonal allergies .
[doctor] hello , are you mrs. king ?
[patient] i am .
[doctor] i'm dr. phillips . very nice to meet you .
[patient] you as well .
[doctor] how can i help you today ?
[patient] well , my primary doctor , dr. scott , he referred me here .
[doctor] okay .
[patient] i've just got really bad acid reflux .
[doctor] okay . can you tell me more about it ?
[patient] yeah . though i mean i ... right now , i take 40 milligrams of omeprazole twice a day . some days , it is fine , but others are just really bad .
[doctor] what do you feel ?
[patient] it feels like burning .
[doctor] in your chest ?
[patient] yes , in my chest and also in my throat .
[doctor] in your throat and chest . all right . any difficulty with swallowing ? feels like food or liquids kinda get stuck ?
[patient] no .
[doctor] okay . that's good . any abdominal pain ?
[patient] no , not really .
[doctor] nausea or vomiting , changes in bowel movements ?
[patient] no .
[doctor] constipation , diarrhea , rectal bleeding ?
[patient] nope .
[doctor] okay . very good . and how long have you had this problem ?
[patient] i've had acid reflux since i was around 12 , but it has gotten worse over the past few years .
[doctor] okay . and how long have you been on the omeprazole ?
[patient] on the way , it is now i think about a year .
[doctor] okay . do you find that it's done anything for you in the past ?
[patient] i mean , i can tell it's helped because some days , i'll be fine , and then some days , i eat something and it feels terrible .
[doctor] are there any things that make your symptoms worse that you can pinpoint , like food choices or stress ?
[patient] sure . probably stress and food choices sometimes .
[doctor] okay . what things bother you ?
[patient] spicy foods , um , so i try not to eat them too often , but sometimes even drinking a soda can cause it .
[doctor] we do know that caffeine and caffeinated beverages will do that , even sodas . um , even just the carbonation can cause that . how about tomato-based products or citrus products ?
[patient] yeah , sometimes , but i still eat them .
[doctor] okay . it's reassuring that you are n't having any difficulty swallowing , though . how's your weight been ? pretty stable ?
[patient] i'd say pretty stable , although i have n't had much of an appetite for the past two months . i have been under a lot of work stress .
[doctor] what do you do for work ?
[patient] i'm a paralegal .
[doctor] okay . and any family history of gi issues ?
[patient] um , my grandmother had esophageal cancer .
[doctor] on your mom or dad's side ?
[patient] mom's side . and my mom had some issues like acid reflux , and she was taking some medication that coats the lining of your stomach .
[doctor] okay . have you ever had an upper endoscopy ?
[patient] i think maybe when i was younger .
[doctor] but not in the last 10 years ?
[patient] no .
[doctor] have you ever tried any medication other than omeprazole ?
[patient] um , at one point i was on omeprazole and ranititine -dine . it did help . but other than that , those are the only medications i have taken .
[doctor] okay . have a seat here , and let me listen to your heart and lungs , and then we can talk about a plan for you .
[patient] okay .
[doctor] so normal physical exam per my new patient template , except for well-healed abdominal surgical scars noted . what's the surgical scar here on your abdomen from ?
[patient] i always forget about that surgery . i had it when i was a baby . my mom said my intestines were twisted , so i had to have surgery when i was around one month old .
[doctor] hm , gotcha . okay . so let's talk about what you have going on . from what you've told me , it sounds like you've had a several-year history of gerd , which is the medical term for acid reflux . and recently your symptoms have been poorly controlled with the omeprazole , 40 milligrams twice daily . you've been having heartburn despite taking this medication , correct ?
[patient] yes .
[doctor] and you've identified trigger foods like spicy foods , carbonated bev- beverages , citrus , and tomato-based foods , but you have n't cut these foods out of your diet completely yet . so the first thing i'd try is changing your diet because these foods can exacerbate your gerd , even though you're taking the ppi .
[patient] okay , yeah , i could definitely do a better job of avoiding those foods .
[doctor] great . so stress is another trigger that we need to address . high stress can cause worsening of your symptoms .
[patient] yeah , stress and anxiety are definitely big problems for me .
[doctor] so working on that may help with your gerd . additionally , we can consider trying a different ppi since the only one you've tried up to this point is omeprazole . if you're okay with this , we can switch your omeprazole to nexium .
[patient] that's fine with me . i'm definitely open to trying whatever .
[doctor] perfect . i will send a prescription for nexium 40 milligrams twice daily to your pharmacy on file . i'll also recommend that you have a procedure called a egd , or upper endoscopy , to look for potential causes of the gerd . we'd sedate you and then pass a small camera through your mouth , down your throat , through your stomach , and end in the small intestines . we'd look for any ulcers or signs of precancerous or cancerous conditions that we can take biopsies at the same time if we see anything .
[patient] okay . can i schedule that today ?
[doctor] yeah . you can get scheduled at checkout desk . i'll have you follow up with me in the office for the egd so we can discuss the results and talk about how you're doing with the dietary , stress , and medication changes . how does all of that sound ?
[patient] that sounds good .
[doctor] perfect . i will walk you to the checkout desk . be sure to call my office and let me know if anything changes or if you have problems before your egd and follow-up appointment .
[doctor] please insert the procedure paragraph in the plan . i suspect that she likely has gerd with underlying functional etiology as well . reassuringly , she has no unintentional weight loss and denies any dysphagia . if her egd is normal and her symptoms pers- persist despite a trial of nexium , we can consider a trial of protonix and obtain a ph-impedance study . this will allow us to rule out abnormal acid reflux exposure and to decipher between a functional etiology and hypersensitivity .

Medical orders:
description: 40 milligrams twice daily nexium
order_type: medication
reason: gerd