[doctor] hi , anna . how are you ?
[patient] i'm doing okay . how are you ?
[doctor] i'm doing okay . so i know the nurse told you about dax . i'd like to tell dax a little bit about you .
[patient] all right .
[doctor] so , anna is a 44-year-old female with a past medical history significant for arthritis , gout , and reflux , who presents today for follow up of her chronic problems .
[doctor] so , anna , it's been probably about six months since i've seen you . how are you doing ?
[patient] i'm doing okay . um , my arthritis is starting to get better . um , i've been trying to move my body , doing pilates , lifting weights , um , and that's , kind of , helped me build up some muscle , so the joint pain is , has been going away .
[doctor] okay . yeah . i know you were having , you know , some problems with your right knee , uh , and we sent you for physical therapy . so , so that's going well ?
[patient] yeah . the physical therapy's gone really well . i've built up my strength back and it's been really great .
[doctor] okay . so you feel like you're able to walk a little bit further now ?
[patient] yup . i'm walking about a mile , a mile and a half a day .
[doctor] okay . great . that's good . i'm glad to hear that . okay .
[doctor] and then , in terms of your gout , um , how are you doing with that ? i know you had an episode of gout of your , your right first big toe , um , about two months ago . how are you doing with that ?
[patient] i'm doing , doing well . the medication helped it , you know , go down and go away . hopefully , , it does n't come back .
[doctor] okay . and are you taking the allopurinol that i prescribed ?
[patient] yes .
[doctor] okay . and no issues with that ?
[patient] nope .
[doctor] okay . great . um , no further flare ups ?
[patient] no .
[doctor] okay . great . all right .
[doctor] and then , you know , how about your reflux ? we had placed you on , um , omeprazole , you know , to help with some of those symptoms and i know that you were gon na do some dietary modifications . how are you doing with that ?
[patient] so , i started to make some dietary modifications . unfortunately , i have n't cut the stone out quite yet . um , i've still been having some episodes and , and throwing up in the mornings , um , things like that .
[doctor] you're throwing up in the morning ?
[patient] yup .
[doctor] like , just , like , reflux into your throat or are you actually vomiting ?
[patient] um , actually vomiting .
[doctor] okay . that's a problem .
[patient] yup .
[doctor] all right . well , um , let's talk about any other symptoms that you might have . have you had any abdominal pain ? um , diarrhea ? um , do you feel like your belly's bigger than usual ?
[patient] um , the , the first and the last . so , i've been having some abdominal pain and then i feel like i'm bloated all the time .
[doctor] okay . and when was your last bowel movement ?
[patient] uh , probably two days ago .
[doctor] okay . was it normal ?
[patient] yes .
[doctor] okay . any blood ?
[patient] no .
[doctor] okay . all right . and any weight loss ? anything like that ?
[patient] no , not that i've noticed .
[doctor] okay . and any fever or chills ?
[patient] no .
[doctor] okay . all right . uh , well , sounds like we just did the review of systems with you . it sounds like you're endorsing this , you know , nausea , vomiting , abdominal distension . um , any other symptoms ?
[patient] no .
[doctor] no ? okay . all right . well , i wan na go ahead and do a quick physical exam . okay ?
[doctor] hey , dragon , show me the vital signs . all right . well , your , your vital signs here look quite good . all right . so , i'm , i'm reassured by that . i'm just gon na check out your heart and lungs and your belly and , and l- let you know what i find , okay ?
[patient] okay .
[doctor] all right . so , on physical examination , you know , everything looks good . your heart sounds good . your lungs sound good . you know , on your abdominal exam , you do have some pain to your right upper quadrant when i press on it , um , and there's no rebound or guarding and there's no peritoneal signs and your right knee does show a little bit of , uh , an effusion there and there's , uh , some slight pain to palpation and some decreased range of motion .
[doctor] so what does that mean , you know ? that means that you have some findings on your belly exam that concern me about your gall bladder , okay ? so , we'll have to look into that and then , um , your right knee looks a little swollen , but you know , we know you have some arthritis there , okay ?
[patient] okay .
[doctor] let's take a look at some of your results . hey , dragon , show me the autoimmune panel . hey , dragon , show me the autoimmune labs .
[doctor] okay . so looking at your autoimmune panel here , you know , we sent that because , you know , you're young and you have , you know , arthritis and gout and that type of thing and everything seemed to be fine .
[patient] okay .
[doctor] hey , dragon , show me the right knee x-ray .
[doctor] so , looking here at your right knee x-ray , you know , there's no fracture or anything , but you know , it does show that you do have that residual arthritis there , um , that we're , you know , we're working on improving so that we do n't have to do some type of surgery or intervention , okay ?
[patient] okay .
[doctor] so let's talk a little bit about my assessment and plan for you , okay ? so , for your first problem , um , your reflux and your nausea and vomiting , uh , i wan na go ahead and get a right upper quadrant ultrasound to rule out any gallstones , okay ? um , and then i'm gon na check some labs on you . okay ?
[patient] okay .
[doctor] i want you to continue on the omeprazole , 40 milligrams , once a day and continue with those dietary modifications .
[doctor] um , for your second problem , your gout , um , you know , everything seems controlled right now . let's continue you on the allopurinol , 100 milligrams , once a day . um , do you need a refill of that ?
[patient] yes , i do actually .
[doctor] hey , dragon , order allopurinol , 100 milligrams , once daily .
[doctor] and then from your last problem , your arthritis , i'm very pleased with how your right knee is doing and i want you to continue pilates and using the knee and let me know if you have any issues and we can , and we can talk about further imaging or intervention at that time , okay ?
[patient] okay .
[doctor] any questions ?
[patient] uh , no . that's it .
[doctor] okay . great . hey , dragon , finalize the note .

Medical orders:
description: right upper quadrant ultrasound ultrasound
order_type: imaging
reason: rule out any gallstones
description: labs
order_type: lab
description: allopurinol 100 milligrams once daily
order_type: medication
reason: gout