Repository: stanford-crfm/helm
Issue: GoogleClient Caching Error with Gemini 2.5 Pro - "The result has not been uploaded to the cache"
Root cause: Configuration Error

Bug Description
GoogleClient consistently fails to cache responses from Google's Gemini 2.5 Pro API, causing all evaluation runs to fail with repeated retry attempts. The client successfully authenticates and receives responses from Google's API, but fails to serialize/cache the results.
Environment

HELM Version: 0.5.8 (also reproduced on 0.5.7)
Python Version: 3.10
OS: Ubuntu (cloud instance)
Model: google/gemini-2.5-pro

Error Message
GoogleClient error: The result has not been uploaded to the cache for the following request: {
    'best_of': 1, 
    'echo': False, 
    'logprobs': 1, 
    'max_tokens': 4864, 
    'model': 'gemini-2.5-pro', 
    'n': 1, 
    'prompt': "...", 
    'request_type': 'language-model-inference', 
    'stop': None, 
    'temperature': 0.0, 
    'top_p': 1
}

complete Logs

(client_env) ubuntu@152-69-160-19:/lambda/nfs/glm/MedHELM$ helm-run -c ./entries-3.conf     --suite google/gemini-2.5-pro     --max-eval-instances 10     --local-path ./config     --models-to-run google/gemini-2.5-pro
2025-09-23T09:13:45 INFO     helm_run {
2025-09-23T09:13:46 INFO       Reading tokenizer configs from /home/ubuntu/glm/MedHELM/client_env/lib/python3.10/site-packages/helm/config/tokenizer_configs.yaml...
2025-09-23T09:13:46 INFO       Reading model deployments from /home/ubuntu/glm/MedHELM/client_env/lib/python3.10/site-packages/helm/config/model_deployments.yaml...
2025-09-23T09:13:46 WARNING    Could not find model metadata for model mistralai/mistral-medium-3.1 of model deployment openrouter/mistral-medium-3.1
2025-09-23T09:13:46 INFO       Reading tokenizer configs from ./config/tokenizer_configs.yaml...
2025-09-23T09:13:46 INFO       Reading model deployments from ./config/model_deployments.yaml...
2025-09-23T09:13:46 INFO       Read 1 run entries from ./entries-3.conf
2025-09-23T09:13:52 INFO       1 entries produced 1 run specs
2025-09-23T09:13:52 INFO       run_specs {
2025-09-23T09:13:52 INFO         RunSpec(name='aci_bench:model=google_gemini-2.5-pro', scenario_spec=ScenarioSpec(class_name='helm.benchmark.scenarios.aci_bench_scenario.ACIBenchScenario', args={}), adapter_spec=AdapterSpec(method='generation', global_prefix='', global_suffix='', instructions='Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n', input_prefix='Conversation: ', input_suffix='\n', reference_prefix='A. ', reference_prefix_characters=None, reference_suffix='\n', chain_of_thought_prefix='', chain_of_thought_suffix='\n', output_prefix='Clinical Note: ', output_suffix='\n', instance_prefix='\n', substitutions=[], max_train_instances=0, max_eval_instances=10, num_outputs=1, num_train_trials=1, num_trials=1, sample_train=True, model_deployment='google/gemini-2.5-pro', model='google/gemini-2.5-pro', temperature=0.0, max_tokens=4864, stop_sequences=[], random=None, multi_label=False, image_generation_parameters=None, reeval_parameters=None, eval_splits=None), metric_specs=[MetricSpec(class_name='helm.benchmark.metrics.summarization_metrics.SummarizationMetric', args={'task': 'aci_bench', 'device': 'cuda', 'bertscore_model': 'distilbert-base-uncased', 'rescale_with_baseline': False}), MetricSpec(class_name='helm.benchmark.metrics.basic_metrics.BasicGenerationMetric', args={'names': []}), MetricSpec(class_name='helm.benchmark.metrics.basic_metrics.BasicReferenceMetric', args={}), MetricSpec(class_name='helm.benchmark.metrics.basic_metrics.InstancesPerSplitMetric', args={}), MetricSpec(class_name='helm.benchmark.metrics.llm_jury_metrics.LLMJuryMetric', args={'metric_name': 'aci_bench_accuracy', 'scenario_name': 'aci_bench', 'annotator_models': {'gpt': AnnotatorModelInfo(model_name='openai/gpt-4o-2024-05-13', model_deployment='stanfordhealthcare/gpt-4o-2024-05-13'), 'llama': AnnotatorModelInfo(model_name='meta/llama-3.3-70b-instruct', model_deployment='stanfordhealthcare/llama-3.3-70b-instruct'), 'claude': AnnotatorModelInfo(model_name='anthropic/claude-3-7-sonnet-20250219', model_deployment='stanfordhealthcare/claude-3-7-sonnet-20250219')}, 'default_score': 1.0})], data_augmenter_spec=DataAugmenterSpec(perturbation_specs=[], should_augment_train_instances=False, should_include_original_train=False, should_skip_unchanged_train=False, should_augment_eval_instances=False, should_include_original_eval=False, should_skip_unchanged_eval=False, seeds_per_instance=1), groups=['clinical', 'aci_bench'], annotators=[AnnotatorSpec(class_name='helm.benchmark.annotation.aci_bench_annotator.ACIBenchAnnotator', args={'annotator_models': {'gpt': AnnotatorModelInfo(model_name='openai/gpt-4o-2024-05-13', model_deployment='stanfordhealthcare/gpt-4o-2024-05-13'), 'llama': AnnotatorModelInfo(model_name='meta/llama-3.3-70b-instruct', model_deployment='stanfordhealthcare/llama-3.3-70b-instruct'), 'claude': AnnotatorModelInfo(model_name='anthropic/claude-3-7-sonnet-20250219', model_deployment='stanfordhealthcare/claude-3-7-sonnet-20250219')}})])
2025-09-23T09:13:52 INFO       } [0.0s]
2025-09-23T09:13:52 INFO       Running in local mode with base path: ./config
Looking in path: ./config
2025-09-23T09:13:52 INFO       AutoTokenizer: cache_backend_config = SqliteCacheBackendConfig(path='./config/cache')
2025-09-23T09:13:52 INFO       AutoClient: file_storage_path = ./config/cache
2025-09-23T09:13:52 INFO       AutoClient: cache_backend_config = SqliteCacheBackendConfig(path='./config/cache')
2025-09-23T09:13:52 INFO       AutoTokenizer: cache_backend_config = SqliteCacheBackendConfig(path='./config/cache')
Looking in path: ./config
2025-09-23T09:13:52 INFO       AnnotatorFactory: file_storage_path = ./config/cache
2025-09-23T09:13:52 INFO       AnnotatorFactory: cache_backend_config = SqliteCacheBackendConfig(path='./config/cache')
  0%|                                                                                                                           | 0/1 [00:00<?, ?it/s]2025-09-23T09:13:52 INFO       Running aci_bench:model=google_gemini-2.5-pro {
2025-09-23T09:13:52 INFO         scenario.get_instances {
2025-09-23T09:13:52 INFO           ensure_file_downloaded {
2025-09-23T09:13:52 INFO             Not downloading https://raw.githubusercontent.com/wyim/aci-bench/e75b383172195414a7a68843ec4876e83e5409f7/data/challenge_data_json/train_full.json because benchmark_output/scenarios/aci_bench/aci_bench_train.json already exists
2025-09-23T09:13:52 INFO           } [0.004s]
2025-09-23T09:13:52 INFO           ensure_file_downloaded {
2025-09-23T09:13:52 INFO             Not downloading https://raw.githubusercontent.com/wyim/aci-bench/e75b383172195414a7a68843ec4876e83e5409f7/data/challenge_data_json/clinicalnlp_taskB_test1_full.json because benchmark_output/scenarios/aci_bench/aci_bench_test_1.json already exists
2025-09-23T09:13:52 INFO           } [0.003s]
2025-09-23T09:13:52 INFO           ensure_file_downloaded {
2025-09-23T09:13:52 INFO             Not downloading https://raw.githubusercontent.com/wyim/aci-bench/e75b383172195414a7a68843ec4876e83e5409f7/data/challenge_data_json/clef_taskC_test3_full.json because benchmark_output/scenarios/aci_bench/aci_bench_test_2.json already exists
2025-09-23T09:13:52 INFO           } [0.002s]
2025-09-23T09:13:52 INFO           ensure_file_downloaded {
2025-09-23T09:13:52 INFO             Not downloading https://raw.githubusercontent.com/wyim/aci-bench/e75b383172195414a7a68843ec4876e83e5409f7/data/challenge_data_json/clinicalnlp_taskC_test2_full.json because benchmark_output/scenarios/aci_bench/aci_bench_test_3.json already exists
2025-09-23T09:13:52 INFO           } [0.002s]
2025-09-23T09:13:52 INFO         } [0.024s]
2025-09-23T09:13:52 INFO         187 instances, 67 train instances, 10/120 eval instances
2025-09-23T09:13:52 INFO         DataPreprocessor.preprocess {
2025-09-23T09:13:52 INFO         } [0.0s]
2025-09-23T09:13:52 INFO         GenerationAdapter.adapt {
2025-09-23T09:13:52 INFO           77 instances, choosing 0/67 train instances, 10 eval instances
2025-09-23T09:13:52 INFO           Adapting with train_trial_index=0 {
2025-09-23T09:13:52 INFO             Sampled 0 examples for trial #0.
2025-09-23T09:13:52 INFO             Parallelizing computation on 10 items over 4 threads {
                                                                                                                                                     2025-09-23T09:13:53 INFO               Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')        | 0/10 [00:00<?, ?it/s]
2025-09-23T09:13:53 INFO               Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')
2025-09-23T09:13:53 INFO               Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')
2025-09-23T09:13:53 INFO               Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')
100%|█████████████████████████████████████████████████████████████████████████████████████████████████████████████████| 10/10 [00:01<00:00,  8.28it/s]
2025-09-23T09:13:53 INFO             } [1.211s]                                                                        | 1/10 [00:01<00:10,  1.12s/it]
2025-09-23T09:13:53 INFO             Sample prompts {
2025-09-23T09:13:53 INFO               reference index = None, request_mode = None {
2025-09-23T09:13:53 INFO                 Summarize the conversation to generate a clinical note with four sections:
2025-09-23T09:13:53 INFO                 1. HISTORY OF PRESENT ILLNESS
2025-09-23T09:13:53 INFO                 2. PHYSICAL EXAM
2025-09-23T09:13:53 INFO                 3. RESULTS
2025-09-23T09:13:53 INFO                 4. ASSESSMENT AND PLAN
2025-09-23T09:13:53 INFO                 
2025-09-23T09:13:53 INFO                 The conversation is:
2025-09-23T09:13:53 INFO                 
2025-09-23T09:13:53 INFO                 Conversation: Doctor-patient dialogue:
2025-09-23T09:13:53 INFO                 
2025-09-23T09:13:53 INFO                 [doctor] hi , alexander . how are you ?
2025-09-23T09:13:53 INFO                 [patient] i'm doing really well . thank you .
2025-09-23T09:13:53 INFO                 [doctor] so , i know the nurse told you a little bit about dax . i'd like to tell dax about you . okay ?
2025-09-23T09:13:53 INFO                 [patient] sure .
2025-09-23T09:13:53 INFO                 [doctor] so , alexander is a 62-year-old male , with a past medical history significant for reflux , who presents for follow-up of his chronic problems .
2025-09-23T09:13:53 INFO                 [doctor] so , alexander , what's being going on ?
2025-09-23T09:13:53 INFO                 [patient] well , i am so thankful you put me on that medicine for my , my reflux .
2025-09-23T09:13:53 INFO                 [doctor] the protonix ?
2025-09-23T09:13:53 INFO                 [patient] the protonix . that , i had , w- made an amazing change in my life .
2025-09-23T09:13:53 INFO                 [doctor] yeah .
2025-09-23T09:13:53 INFO                 [patient] i'm really comfortable now . i eat whatever i want , and i feel so much better .
2025-09-23T09:13:53 INFO                 [doctor] okay , great . i'm glad to hear that . i know you were having a lot of discomfort there before , so that's good . okay . and how are you doing , kind of , managing your diet ? i know , you know , you have to do some lifestyle modifications , like cutting back on caffeine and spicy foods and alcohol . how are you doing with that ?
2025-09-23T09:13:53 INFO                 [patient] i'm doing really well . i moved over from caffeine , over to green tea .
2025-09-23T09:13:53 INFO                 [doctor] okay .
2025-09-23T09:13:53 INFO                 [patient] and it , it is so , m- it does n't cause as much problem as it did with , when i was drinking so many energy drinks a day .
2025-09-23T09:13:53 INFO                 [doctor] all right . good . i'm glad to hear that . great . all right .
2025-09-23T09:13:53 INFO                 [patient] uh , i think getting that , rid of that reflux , really helped my attitude improve .
2025-09-23T09:13:53 INFO                 [doctor] okay .
2025-09-23T09:13:53 INFO                 [patient] uh , my job's going great . everything's phenomenal right now .
2025-09-23T09:13:53 INFO                 [doctor] okay .
2025-09-23T09:13:53 INFO                 [doctor] okay . and you have a , a good support system at home ? i know you have a big-
2025-09-23T09:13:53 INFO                 [patient] yeah .
2025-09-23T09:13:53 INFO                 [doctor] . family .
2025-09-23T09:13:53 INFO                 [patient] yes . yes . all my kids-
2025-09-23T09:13:53 INFO                 [doctor] okay .
2025-09-23T09:13:53 INFO                 [patient] . call and check on me every day .
2025-09-23T09:13:53 INFO                 [doctor] okay . great . i'm glad to hear that . now , i know you did a review of systems sheet when you checked in .
2025-09-23T09:13:53 INFO                 [patient] yes .
2025-09-23T09:13:53 INFO                 [doctor] i , are you having any symptoms ? any chest pain , shortness of breath , belly pain , of , nausea or vomiting ? anything like that ?
2025-09-23T09:13:53 INFO                 [patient] no . no symptoms at all .
2025-09-23T09:13:53 INFO                 [doctor] okay , great . um , well , let me go ahead . i wan na do a quick physical exam .
2025-09-23T09:13:53 INFO                 [doctor] hey , dragon . show me the vital signs .
2025-09-23T09:13:53 INFO                 [doctor] so , your vital signs here in the office look really good . so , you're doing a great job managing your , your blood pressure . your heart rate's nice and low . i'm gon na go ahead and take a listen to your heart and lungs .
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [doctor] and i'll let you know what i find . okay ?
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [doctor] okay . good . all right . so , on physical examination , i , i do n't hear any carotid bruits in your neck , which is really good . you know , your heart exam , i do hear a slight 2/6 systolic ejection murmur , which i've heard in the past , so that's stable . uh , your lungs are nice and clear , and you do have , you know , 1+ pitting edema bilaterally in your lower extremities .
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [doctor] so , what does that mean ? you know , i , i think , you know , you're doing a ... it sounds like a doing a good job watching your diet . you could ... you just are retaining a little bit of fluid , maybe just from standing all day .
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [doctor] okay ? let's take a look at some of your results . okay ?
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [doctor] hey , dragon . show me the endoscope results .
2025-09-23T09:13:53 INFO                 [doctor] so , this was the endoscopy that you had last year when you were having all that pain . it just showed that you had had some mild gastritis . so , it's good to hear that that , you know , protonix is helping you a lot . okay ?
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [patient] i'll do a little more exercise too .
2025-09-23T09:13:53 INFO                 [doctor] that sounds great . all right . so , let's talk just a little bit about , you know , my assessment and my plan for you .
2025-09-23T09:13:53 INFO                 [doctor] for your reflux , i want you to continue on the protonix 40 mg a day , and continue with those lifestyle modifications with the dietary stuff-
2025-09-23T09:13:53 INFO                 [patient] okay .
2025-09-23T09:13:53 INFO                 [doctor] . okay ? do you have any questions ?
2025-09-23T09:13:53 INFO                 [patient] no questions .
2025-09-23T09:13:53 INFO                 [doctor] okay . all right . well , the nurse is gon na come in soon , and she's gon na check you , get you checked out . okay ?
2025-09-23T09:13:53 INFO                 [patient] okay . thank you .
2025-09-23T09:13:53 INFO                 [doctor] hey , dragon . finalize the note .
2025-09-23T09:13:53 INFO                 Clinical Note:
2025-09-23T09:13:53 INFO               } [0.005s]
2025-09-23T09:13:53 INFO             } [0.006s]
2025-09-23T09:13:53 INFO           } [1.217s]
2025-09-23T09:13:53 INFO           10 requests
2025-09-23T09:13:53 INFO         } [1.218s]
2025-09-23T09:13:53 INFO         Executor.execute {
2025-09-23T09:13:53 INFO           Parallelizing computation on 10 items over 4 threads {
                                                                                                                                                     2025-09-23T09:13:53 INFO             Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')          | 0/10 [00:00<?, ?it/s]
2025-09-23T09:13:53 INFO             Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')
2025-09-23T09:13:53 INFO             Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')
2025-09-23T09:13:53 INFO             Created cache with config: SqliteCacheConfig(path='./config/cache/google.sqlite')
2025-09-23T09:13:53 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] next patient is grace ross . date of birth 8-23-97 . ms. ross is a new patient . she's here today for a full spectrum std testing . the patient states that she's having symptoms of discomfort , a change in discharge , and odor in her vaginal region . she says that the right side of her vagina is starting to become painful . she denies any fevers or chills . she reports , that she recently learned , her partner has been in sexual encounters with other people , and she wants to be evaluated for all stds .\n[doctor] hello , ms. ross . i'm dr. diaz . it's good to meet you .\n[patient] hi . yes . nice to meet you , too .\n[doctor] so , how are you doing today ? i hear that you're here for std testing . is that correct ?\n[patient] yeah . actually , i found out earlier this week , that my boyfriend has been cheating on me , for some time . i'm really worried , that i could have caught something , you know ?\n[doctor] mm-hmm .\n[patient] i wanted to make sure i do n't have anything .\n[doctor] yeah . i'm sorry to hear that . of course , we can do that today . um . well , let's see . how do you feel ? do you have any symptoms ?\n[patient] well , um , i started noticing some weird discharge last week .\n[doctor] mm-hmm .\n[patient] uh , it smells different . it's not the same color , or consistency , as usually , it is .\n[doctor] right .\n[patient] um . that part did n't even phase me , until i noticed that the right side of my vagina was hurting . just sore , you know , but that has n't gone away .\n[doctor] yep . nah , that does sound like a cause for concern . how long have you been with him ?\n[patient] hmm , we've been dating for three years .\n[doctor] mm-hmm .\n[patient] as far as , i can figure , he started cheating on me , i think , about three months ago .\n[doctor] uh- . um , okay . do you ... have you ever had an irregular pap smear ?\n[patient] well , yeah , i did , but it was back whenever i was 20 or so . it has n't ... and i have n't had one since .\n[doctor] okay . and when was your last pap smear ?\n[patient] uh , about six months ago . it came back normal , though .\n[doctor] okay . good , okay . well , let's see ... let's take a look at you , and then , we'll get some samples for std testing . okay ?\n[patient] all right .\n[doctor] you'll hear me talk through your exam , so that i can get it all documented . uh- ?\n[doctor] use my general physical exam template . pelvic exam demonstrates no external lesions . normal labia majora and labia minora . normal physiological discharge , with normal color and smell .\n[doctor] ms. ross , i'm going to touch you , now . you'll feel my fingers , and the speculum in your vagina . you'll feel some pressure , now .\n[doctor] cervix is normal . vaginal wall is normal . no cervical motion tenderness and no adnexal tenderness or masses noted . swabs were done for std testing .\n[doctor] okay , ms. ross . everything looks good from a visual standpoint . i'm going to send off std testing for , uh , gonorrhea , chlamydia , trichomoniasis , and i'll have you give some blood for syphilis , hiv and hepatitis c. some of these tests will take longer than others . we will call you , if we see anything , but if you have n't heard anything , you can call us in three days for results .\n[patient] okay . sounds good . thank you , so much .\n[doctor] of course , my pleasure . and , if everything is normal , i'll see you again , at your next annual checkup .\n[doctor] assessment : is screen for std .\n[doctor] plan : discussed with patient , and please add that she is high risk due to an abnormal pap smear in the past , and the recent discovery of her sexual partner having multiple partners , for some period of time .\n[doctor] end of recording .\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:13:53 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] um , hi mrs. anderson . right ?\n[patient] yeah . yes , doctor .\n[doctor] what brings you here today ?\n[patient] hi , doctor . um , i'm having this left shoulder pain lately , uh , and it's paining a lot .\n[doctor] okay . all right . hey , dragon . i am seeing mrs. anderson , a 44-years-old female , uh , complaining to check the left shoulder pain . um , so how long how has this lasted ?\n[patient] it's been a week , doctor . yeah .\n[doctor] a week .\n[patient] yeah .\n[doctor] um , did you take any medication yourself ?\n[patient] no , i did not take any pain medications . actually , i did . i did take a tylenol for two or three days , but then that did n't help at all . so , uh , the reason why it started or when it started to happen is-\n[doctor] yeah .\n[patient] . i was actually in gymnastics class .\n[doctor] yeah , okay .\n[patient] and , uh , i do n't know . maybe i must have toppled over into some weird position , so it started to pain since then , uh , because of a certain move .\n[doctor] okay , uh-\n[patient] i went overboard , i think . yeah .\n[doctor] all right , lem me , uh , take a quick look . uh , can you move up a little bit ? yeah .\n[patient] uh , yeah . in fact , that's hurts .\n[doctor] does that- does it hurt ?\n[patient] yeah , it does .\n[doctor] what if you move back a little bit ?\n[patient] uh , that also hurts , doctor .\n[doctor] yeah , okay .\n[patient] any kind of movement on my left shoulder actually hurts .\n[doctor] okay . all right , um , so let's ... hey , dragon . show me the last x-ray . all right , from the x-ray , it does n't look like there is any , uh , broken bone or fracture . my guess is you probably , um , hurt your joint , uh-\n[patient] uh- .\n[doctor] . a little bit .\n[patient] mm-hmm .\n[doctor] so i would , uh , suggest you continue using the pain reliever , maybe just like 600 milligram of ibuprofen three times a day and use it for a week .\n[patient] and for how long ? yes .\n[doctor] for a week .\n[patient] a week , okay .\n[doctor] and then if you ... if it's still painful , you can use , uh , ice or , um , heat pad-\n[patient] okay .\n[doctor] . 'cause that might help relieve your pain .\n[patient] okay .\n[doctor] um ...\n[patient] but i wanted you to know that i did have past surgery on my , um , left arm-\n[doctor] mm-hmm .\n[patient] . so , um , i hope that should n't matter , right ?\n[doctor] um , that does n't seem related to your pain .\n[patient] okay .\n[doctor] so ... but i would try to rest my , your left arm-\n[patient] okay .\n[doctor] . while it's healing .\n[patient] okay .\n[doctor] so , um-\n[patient] can i , uh , carry any heavy weights or-\n[doctor] no , no . definitely not .\n[patient] . anything like that ?\n[doctor] definitely not .\n[patient] okay . okay .\n[doctor] yeah , use , um , right hand-\n[patient] okay .\n[doctor] . instead-\n[patient] mm-hmm .\n[doctor] . for the next , uh , at least just three to four weeks .\n[patient] mm-hmm .\n[doctor] uh , come back to see me if the pain , you know , still there after maybe three weeks-\n[patient] sure .\n[doctor] . so we can take a further look .\n[patient] okay . sure .\n[doctor] but you should be fine-\n[patient] yeah .\n[doctor] . after just resting and regular pain reliever .\n[patient] okay . all right .\n[doctor] um-\n[patient] should we take another x-ray when i come back , if the pain does n't improve ?\n[doctor] um , maybe . let's see how you're doing in the next three weeks .\n[patient] uh .\n[doctor] hey , dragon . um , order medications and procedures as discussed . all right .\n[patient] okay .\n[doctor] um , i think that's good for today . hope you feel better soon .\n[patient] okay . thank you , doctor .\n[doctor] yeah .\n[patient] hopefully , the pain reliever , uh , ibuprofen actually helps .\n[doctor] yeah .\n[patient] yeah , and if i have more pain , can i call you ? can i fix up another appointment earlier than three weeks ?\n[doctor] um , you can also try advil .\n[patient] okay .\n[doctor] yeah , so , um ...\n[patient] yeah .\n[doctor] ale- , aleve . i mean , aleve .\n[patient] i see . okay , thank you , doctor .\n[doctor] thank you .\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:13:53 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] amanda taylor , birth date october 31st 1949 . patient is a 72 year old woman who comes for followup for hypertension . her history includes significant alcohol use disorder and mi- mild hypercholesterolemia . at last visit on april 16th her blood pressure was 130 over 90 . after presenting at 150 over 100 she was prescribed hydrochlorothiazide 12.5 milligrams by mouth once daily , and lisinopril 20 milligrams by mouth once daily . cmp and cbc were essentially unremarkable .\n[doctor] hi miss taylor , how are you today ?\n[patient] hi , i'm- i'm good , thank you .\n[doctor] thanks for coming in today .\n[patient] yeah , no problem .\n[doctor] so how have things been going for you ?\n[patient] uh , they've been all right . i'm struggling with not drinking . i wanted to discuss that , uh , shot that you had mentioned last time , but we did n't get to discuss it too much .\n[doctor] okay , well i'll be happy to provide you with more information . so tell me when did you last have a drink ?\n[patient] on monday .\n[doctor] okay , so you've gone a couple days without it ?\n[patient] yeah , yeah i have .\n[doctor] yeah , and had you been drinking for a while ?\n[patient] yep .\n[doctor] how much had- how much had you been drinking ?\n[patient] um , four or five times a week hard alcohol , so , you know .\n[doctor] okay . well it will certainly help your blood pressure if you're able to stop drinking .\n[patient] yeah , yeah i- i- i agree with you .\n[doctor] okay . are you taking your blood pressure medications ?\n[patient] yeah , but i'm only taking half of the lisinopril .\n[doctor] okay .\n[patient] i- b- well , the first time i took it i felt lethargic and tired , so i only took a half dose the next time . i felt much better and i did n't have the headaches or the swooshing that started in my left ear . so i feel like it's definitely helping but i do n't know ... i know it's not gon na be okay until i stop drinking .\n[doctor] and are you also taking the full dose of the hydrochlorothiazide ? do you have any , um , chest tightness or pressure or any shortness of breath ?\n[patient] yeah i'm taking the full dose of that medicine too , and no none of those symptoms .\n[doctor] okay . anything else i should be aware of or that we should be checking ?\n[patient] mm , no .\n[doctor] okay , good . are you doing the blood pressure checks at home ?\n[patient] yes . yes i am .\n[doctor] okay good . what kind of numbers are you seeing ?\n[patient] well , in the morning i'm seeing lower numbers than in the evening , um , where i run anywhere from like 130 to 145 or 150 over 95 to 100 on the bottom .\n[doctor] okay .\n[patient] but in the evenings if i sit there for a while and then take it , it goes down . kind of like when i come here it's always high but then it goes down . in the mornings it's generally more normal where it's supposed to be .\n[doctor] uh- .\n[patient] mm , also i'm taking my medicine in the morning when i get up instead of in the evening .\n[doctor] yeah , so it sounds like we are not too far out of where we wan na be .\n[patient] right , mm-hmm .\n[doctor] okay . well let me get a listen to your heart , go ahead and hop up here .\n[patient] okay .\n[doctor] use my general exam template . all right , go ahead and take some deep breaths . okay , good . any fever , cough , shortness of breath or sore throat ?\n[patient] no .\n[doctor] any recent travel or contact or exposure to the coronavirus ?\n[patient] nope .\n[doctor] have you received your coronavirus vaccine ?\n[patient] yes , on february 9th .\n[doctor] okay , great . all right well i'm just going to look at your ankles and feet , i'm looking for any signs of swelling .\n[patient] okay .\n[doctor] all right , well everything looks good . you can go ahead and sit up miss taylor . all right , so the good news is everything is looking okay . i think we both agree if you were able to stop drinking your blood pressure would cease to be an issue for you .\n[patient] yeah i agree with that .\n[doctor] so let us discuss the potential medicine to help you with that . what it does is it blocks some of the brain receptors that alcohol stimulates and it tricks the brain into thinking it does not need alcohol , thereby cutting down the urges .\n[patient] the urge to drink or the constant thinking about it ?\n[doctor] it actually will help with both .\n[patient] okay . so is it like a one-time thing ?\n[doctor] generally the shot is given about once a month , it can also be given as a daily pill , but the shot does tend to work a bit better .\n[patient] yeah i've taken things like this in the past and if it is a pill , i know i wo n't take it . with a shot , it's not like you can un-take it .\n[doctor] yeah that's true . and the shot has been shown to work , it is more just a matter of getting you in to get your shot a month later with the nurse .\n[patient] yeah , sure , sure .\n[doctor] okay , so it's called naltrexone . i think the other name might be vivitrol . like i've said , the research on it is pretty good .\n[patient] i think i may have taken the naltrexone before .\n[doctor] okay , yeah , maybe you have .\n[patient] yeah , if it was available in a pill form then i'm almost certain i've tried it b- before .\n[doctor] okay . if this sounds good though , we can go ahead get you started with the shot . i am looking and it looks like we have you coming back in on may 17th for your first shot , does that sound good ?\n[patient] yeah , yeah , that sounds great . are there any possible side effects ?\n[doctor] yeah , some people will experience some nausea , headache , dizziness , anxi- anxiety , tiredness and trouble sleeping , but generally the side effects are mild and should go away within a few days .\n[patient] okay .\n[doctor] then we can schedule you for a follow-up in june to see how you are doing .\n[patient] all right that sounds good .\n[doctor] all right great . well otherwise stay with your current medicines , keep checking your blood pressure , and let's see if we can stop the alcohol for good . let us know if you have any questions or any issues come up after you receive the first dose .\n[patient] all right , sounds good , thank you .\n[doctor] you are welcome , have a good rest of your day .\n[patient] you too .\n[doctor] miss taylor is drinking alcohol four to five days per week to excess . no tobacco , no substance abuse , skin is moist , good trigger . on exam she is alert , pleasant , in no acute distress . she is not diabetic , there is no tremor , no cva tenderness , chest clear to percussion and auscultation , unlabored breathing , cardiac rhythm regular , no murmur , no gallop , jvp flat , with a head at 90 degrees . she does not appear anxious , agitated or depressed . my impression , alcohol use disorder . she would like to start naltrexone which we have previously discussed . she will take the injectable form and start on may 17th . we reviewed side effects and risks . the potential benefit of alcohol cessation would be highly beneficial to her for many reasons . hypertension , she is taking lisinopril 10 milligrams daily and hydrochlorothiazide 12.5 milligrams daily . quite possibly her blood pressure will improve completely with cessation of alcohol . her target bp is 130 to 140 over 70 to 80 . i will see her back week of june 14th , which is likely around the time of her second naltrexone injection . i recommend upgrading influenza vaccination and shingrix . number two , she did defer this .\n\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:13:53 INFO             Request failed. Retrying (attempt #2) in 10 seconds... (See above for error details)
2025-09-23T09:13:53 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] hi , alexander . how are you ?\n[patient] i'm doing really well . thank you .\n[doctor] so , i know the nurse told you a little bit about dax . i'd like to tell dax about you . okay ?\n[patient] sure .\n[doctor] so , alexander is a 62-year-old male , with a past medical history significant for reflux , who presents for follow-up of his chronic problems .\n[doctor] so , alexander , what's being going on ?\n[patient] well , i am so thankful you put me on that medicine for my , my reflux .\n[doctor] the protonix ?\n[patient] the protonix . that , i had , w- made an amazing change in my life .\n[doctor] yeah .\n[patient] i'm really comfortable now . i eat whatever i want , and i feel so much better .\n[doctor] okay , great . i'm glad to hear that . i know you were having a lot of discomfort there before , so that's good . okay . and how are you doing , kind of , managing your diet ? i know , you know , you have to do some lifestyle modifications , like cutting back on caffeine and spicy foods and alcohol . how are you doing with that ?\n[patient] i'm doing really well . i moved over from caffeine , over to green tea .\n[doctor] okay .\n[patient] and it , it is so , m- it does n't cause as much problem as it did with , when i was drinking so many energy drinks a day .\n[doctor] all right . good . i'm glad to hear that . great . all right .\n[patient] uh , i think getting that , rid of that reflux , really helped my attitude improve .\n[doctor] okay .\n[patient] uh , my job's going great . everything's phenomenal right now .\n[doctor] okay .\n[doctor] okay . and you have a , a good support system at home ? i know you have a big-\n[patient] yeah .\n[doctor] . family .\n[patient] yes . yes . all my kids-\n[doctor] okay .\n[patient] . call and check on me every day .\n[doctor] okay . great . i'm glad to hear that . now , i know you did a review of systems sheet when you checked in .\n[patient] yes .\n[doctor] i , are you having any symptoms ? any chest pain , shortness of breath , belly pain , of , nausea or vomiting ? anything like that ?\n[patient] no . no symptoms at all .\n[doctor] okay , great . um , well , let me go ahead . i wan na do a quick physical exam .\n[doctor] hey , dragon . show me the vital signs .\n[doctor] so , your vital signs here in the office look really good . so , you're doing a great job managing your , your blood pressure . your heart rate's nice and low . i'm gon na go ahead and take a listen to your heart and lungs .\n[patient] okay .\n[doctor] and i'll let you know what i find . okay ?\n[patient] okay .\n[doctor] okay . good . all right . so , on physical examination , i , i do n't hear any carotid bruits in your neck , which is really good . you know , your heart exam , i do hear a slight 2/6 systolic ejection murmur , which i've heard in the past , so that's stable . uh , your lungs are nice and clear , and you do have , you know , 1+ pitting edema bilaterally in your lower extremities .\n[patient] okay .\n[doctor] so , what does that mean ? you know , i , i think , you know , you're doing a ... it sounds like a doing a good job watching your diet . you could ... you just are retaining a little bit of fluid , maybe just from standing all day .\n[patient] okay .\n[doctor] okay ? let's take a look at some of your results . okay ?\n[patient] okay .\n[doctor] hey , dragon . show me the endoscope results .\n[doctor] so , this was the endoscopy that you had last year when you were having all that pain . it just showed that you had had some mild gastritis . so , it's good to hear that that , you know , protonix is helping you a lot . okay ?\n[patient] okay .\n[patient] i'll do a little more exercise too .\n[doctor] that sounds great . all right . so , let's talk just a little bit about , you know , my assessment and my plan for you .\n[doctor] for your reflux , i want you to continue on the protonix 40 mg a day , and continue with those lifestyle modifications with the dietary stuff-\n[patient] okay .\n[doctor] . okay ? do you have any questions ?\n[patient] no questions .\n[doctor] okay . all right . well , the nurse is gon na come in soon , and she's gon na check you , get you checked out . okay ?\n[patient] okay . thank you .\n[doctor] hey , dragon . finalize the note .\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:13:53 INFO             Request failed. Retrying (attempt #2) in 10 seconds... (See above for error details)
2025-09-23T09:13:53 INFO             Request failed. Retrying (attempt #2) in 10 seconds... (See above for error details)
2025-09-23T09:13:53 INFO             Request failed. Retrying (attempt #2) in 10 seconds... (See above for error details)
2025-09-23T09:14:03 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] um , hi mrs. anderson . right ?\n[patient] yeah . yes , doctor .\n[doctor] what brings you here today ?\n[patient] hi , doctor . um , i'm having this left shoulder pain lately , uh , and it's paining a lot .\n[doctor] okay . all right . hey , dragon . i am seeing mrs. anderson , a 44-years-old female , uh , complaining to check the left shoulder pain . um , so how long how has this lasted ?\n[patient] it's been a week , doctor . yeah .\n[doctor] a week .\n[patient] yeah .\n[doctor] um , did you take any medication yourself ?\n[patient] no , i did not take any pain medications . actually , i did . i did take a tylenol for two or three days , but then that did n't help at all . so , uh , the reason why it started or when it started to happen is-\n[doctor] yeah .\n[patient] . i was actually in gymnastics class .\n[doctor] yeah , okay .\n[patient] and , uh , i do n't know . maybe i must have toppled over into some weird position , so it started to pain since then , uh , because of a certain move .\n[doctor] okay , uh-\n[patient] i went overboard , i think . yeah .\n[doctor] all right , lem me , uh , take a quick look . uh , can you move up a little bit ? yeah .\n[patient] uh , yeah . in fact , that's hurts .\n[doctor] does that- does it hurt ?\n[patient] yeah , it does .\n[doctor] what if you move back a little bit ?\n[patient] uh , that also hurts , doctor .\n[doctor] yeah , okay .\n[patient] any kind of movement on my left shoulder actually hurts .\n[doctor] okay . all right , um , so let's ... hey , dragon . show me the last x-ray . all right , from the x-ray , it does n't look like there is any , uh , broken bone or fracture . my guess is you probably , um , hurt your joint , uh-\n[patient] uh- .\n[doctor] . a little bit .\n[patient] mm-hmm .\n[doctor] so i would , uh , suggest you continue using the pain reliever , maybe just like 600 milligram of ibuprofen three times a day and use it for a week .\n[patient] and for how long ? yes .\n[doctor] for a week .\n[patient] a week , okay .\n[doctor] and then if you ... if it's still painful , you can use , uh , ice or , um , heat pad-\n[patient] okay .\n[doctor] . 'cause that might help relieve your pain .\n[patient] okay .\n[doctor] um ...\n[patient] but i wanted you to know that i did have past surgery on my , um , left arm-\n[doctor] mm-hmm .\n[patient] . so , um , i hope that should n't matter , right ?\n[doctor] um , that does n't seem related to your pain .\n[patient] okay .\n[doctor] so ... but i would try to rest my , your left arm-\n[patient] okay .\n[doctor] . while it's healing .\n[patient] okay .\n[doctor] so , um-\n[patient] can i , uh , carry any heavy weights or-\n[doctor] no , no . definitely not .\n[patient] . anything like that ?\n[doctor] definitely not .\n[patient] okay . okay .\n[doctor] yeah , use , um , right hand-\n[patient] okay .\n[doctor] . instead-\n[patient] mm-hmm .\n[doctor] . for the next , uh , at least just three to four weeks .\n[patient] mm-hmm .\n[doctor] uh , come back to see me if the pain , you know , still there after maybe three weeks-\n[patient] sure .\n[doctor] . so we can take a further look .\n[patient] okay . sure .\n[doctor] but you should be fine-\n[patient] yeah .\n[doctor] . after just resting and regular pain reliever .\n[patient] okay . all right .\n[doctor] um-\n[patient] should we take another x-ray when i come back , if the pain does n't improve ?\n[doctor] um , maybe . let's see how you're doing in the next three weeks .\n[patient] uh .\n[doctor] hey , dragon . um , order medications and procedures as discussed . all right .\n[patient] okay .\n[doctor] um , i think that's good for today . hope you feel better soon .\n[patient] okay . thank you , doctor .\n[doctor] yeah .\n[patient] hopefully , the pain reliever , uh , ibuprofen actually helps .\n[doctor] yeah .\n[patient] yeah , and if i have more pain , can i call you ? can i fix up another appointment earlier than three weeks ?\n[doctor] um , you can also try advil .\n[patient] okay .\n[doctor] yeah , so , um ...\n[patient] yeah .\n[doctor] ale- , aleve . i mean , aleve .\n[patient] i see . okay , thank you , doctor .\n[doctor] thank you .\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:14:03 INFO             Request failed. Retrying (attempt #3) in 20 seconds... (See above for error details)
2025-09-23T09:14:03 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] amanda taylor , birth date october 31st 1949 . patient is a 72 year old woman who comes for followup for hypertension . her history includes significant alcohol use disorder and mi- mild hypercholesterolemia . at last visit on april 16th her blood pressure was 130 over 90 . after presenting at 150 over 100 she was prescribed hydrochlorothiazide 12.5 milligrams by mouth once daily , and lisinopril 20 milligrams by mouth once daily . cmp and cbc were essentially unremarkable .\n[doctor] hi miss taylor , how are you today ?\n[patient] hi , i'm- i'm good , thank you .\n[doctor] thanks for coming in today .\n[patient] yeah , no problem .\n[doctor] so how have things been going for you ?\n[patient] uh , they've been all right . i'm struggling with not drinking . i wanted to discuss that , uh , shot that you had mentioned last time , but we did n't get to discuss it too much .\n[doctor] okay , well i'll be happy to provide you with more information . so tell me when did you last have a drink ?\n[patient] on monday .\n[doctor] okay , so you've gone a couple days without it ?\n[patient] yeah , yeah i have .\n[doctor] yeah , and had you been drinking for a while ?\n[patient] yep .\n[doctor] how much had- how much had you been drinking ?\n[patient] um , four or five times a week hard alcohol , so , you know .\n[doctor] okay . well it will certainly help your blood pressure if you're able to stop drinking .\n[patient] yeah , yeah i- i- i agree with you .\n[doctor] okay . are you taking your blood pressure medications ?\n[patient] yeah , but i'm only taking half of the lisinopril .\n[doctor] okay .\n[patient] i- b- well , the first time i took it i felt lethargic and tired , so i only took a half dose the next time . i felt much better and i did n't have the headaches or the swooshing that started in my left ear . so i feel like it's definitely helping but i do n't know ... i know it's not gon na be okay until i stop drinking .\n[doctor] and are you also taking the full dose of the hydrochlorothiazide ? do you have any , um , chest tightness or pressure or any shortness of breath ?\n[patient] yeah i'm taking the full dose of that medicine too , and no none of those symptoms .\n[doctor] okay . anything else i should be aware of or that we should be checking ?\n[patient] mm , no .\n[doctor] okay , good . are you doing the blood pressure checks at home ?\n[patient] yes . yes i am .\n[doctor] okay good . what kind of numbers are you seeing ?\n[patient] well , in the morning i'm seeing lower numbers than in the evening , um , where i run anywhere from like 130 to 145 or 150 over 95 to 100 on the bottom .\n[doctor] okay .\n[patient] but in the evenings if i sit there for a while and then take it , it goes down . kind of like when i come here it's always high but then it goes down . in the mornings it's generally more normal where it's supposed to be .\n[doctor] uh- .\n[patient] mm , also i'm taking my medicine in the morning when i get up instead of in the evening .\n[doctor] yeah , so it sounds like we are not too far out of where we wan na be .\n[patient] right , mm-hmm .\n[doctor] okay . well let me get a listen to your heart , go ahead and hop up here .\n[patient] okay .\n[doctor] use my general exam template . all right , go ahead and take some deep breaths . okay , good . any fever , cough , shortness of breath or sore throat ?\n[patient] no .\n[doctor] any recent travel or contact or exposure to the coronavirus ?\n[patient] nope .\n[doctor] have you received your coronavirus vaccine ?\n[patient] yes , on february 9th .\n[doctor] okay , great . all right well i'm just going to look at your ankles and feet , i'm looking for any signs of swelling .\n[patient] okay .\n[doctor] all right , well everything looks good . you can go ahead and sit up miss taylor . all right , so the good news is everything is looking okay . i think we both agree if you were able to stop drinking your blood pressure would cease to be an issue for you .\n[patient] yeah i agree with that .\n[doctor] so let us discuss the potential medicine to help you with that . what it does is it blocks some of the brain receptors that alcohol stimulates and it tricks the brain into thinking it does not need alcohol , thereby cutting down the urges .\n[patient] the urge to drink or the constant thinking about it ?\n[doctor] it actually will help with both .\n[patient] okay . so is it like a one-time thing ?\n[doctor] generally the shot is given about once a month , it can also be given as a daily pill , but the shot does tend to work a bit better .\n[patient] yeah i've taken things like this in the past and if it is a pill , i know i wo n't take it . with a shot , it's not like you can un-take it .\n[doctor] yeah that's true . and the shot has been shown to work , it is more just a matter of getting you in to get your shot a month later with the nurse .\n[patient] yeah , sure , sure .\n[doctor] okay , so it's called naltrexone . i think the other name might be vivitrol . like i've said , the research on it is pretty good .\n[patient] i think i may have taken the naltrexone before .\n[doctor] okay , yeah , maybe you have .\n[patient] yeah , if it was available in a pill form then i'm almost certain i've tried it b- before .\n[doctor] okay . if this sounds good though , we can go ahead get you started with the shot . i am looking and it looks like we have you coming back in on may 17th for your first shot , does that sound good ?\n[patient] yeah , yeah , that sounds great . are there any possible side effects ?\n[doctor] yeah , some people will experience some nausea , headache , dizziness , anxi- anxiety , tiredness and trouble sleeping , but generally the side effects are mild and should go away within a few days .\n[patient] okay .\n[doctor] then we can schedule you for a follow-up in june to see how you are doing .\n[patient] all right that sounds good .\n[doctor] all right great . well otherwise stay with your current medicines , keep checking your blood pressure , and let's see if we can stop the alcohol for good . let us know if you have any questions or any issues come up after you receive the first dose .\n[patient] all right , sounds good , thank you .\n[doctor] you are welcome , have a good rest of your day .\n[patient] you too .\n[doctor] miss taylor is drinking alcohol four to five days per week to excess . no tobacco , no substance abuse , skin is moist , good trigger . on exam she is alert , pleasant , in no acute distress . she is not diabetic , there is no tremor , no cva tenderness , chest clear to percussion and auscultation , unlabored breathing , cardiac rhythm regular , no murmur , no gallop , jvp flat , with a head at 90 degrees . she does not appear anxious , agitated or depressed . my impression , alcohol use disorder . she would like to start naltrexone which we have previously discussed . she will take the injectable form and start on may 17th . we reviewed side effects and risks . the potential benefit of alcohol cessation would be highly beneficial to her for many reasons . hypertension , she is taking lisinopril 10 milligrams daily and hydrochlorothiazide 12.5 milligrams daily . quite possibly her blood pressure will improve completely with cessation of alcohol . her target bp is 130 to 140 over 70 to 80 . i will see her back week of june 14th , which is likely around the time of her second naltrexone injection . i recommend upgrading influenza vaccination and shingrix . number two , she did defer this .\n\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:14:03 INFO             GoogleClient error: The result has not been uploaded to the cache for the following request: {'best_of': 1, 'echo': False, 'logprobs': 1, 'max_tokens': 4864, 'model': 'gemini-2.5-pro', 'n': 1, 'prompt': "Summarize the conversation to generate a clinical note with four sections:\n1. HISTORY OF PRESENT ILLNESS\n2. PHYSICAL EXAM\n3. RESULTS\n4. ASSESSMENT AND PLAN\n\nThe conversation is:\n\nConversation: Doctor-patient dialogue:\n\n[doctor] hi , alexander . how are you ?\n[patient] i'm doing really well . thank you .\n[doctor] so , i know the nurse told you a little bit about dax . i'd like to tell dax about you . okay ?\n[patient] sure .\n[doctor] so , alexander is a 62-year-old male , with a past medical history significant for reflux , who presents for follow-up of his chronic problems .\n[doctor] so , alexander , what's being going on ?\n[patient] well , i am so thankful you put me on that medicine for my , my reflux .\n[doctor] the protonix ?\n[patient] the protonix . that , i had , w- made an amazing change in my life .\n[doctor] yeah .\n[patient] i'm really comfortable now . i eat whatever i want , and i feel so much better .\n[doctor] okay , great . i'm glad to hear that . i know you were having a lot of discomfort there before , so that's good . okay . and how are you doing , kind of , managing your diet ? i know , you know , you have to do some lifestyle modifications , like cutting back on caffeine and spicy foods and alcohol . how are you doing with that ?\n[patient] i'm doing really well . i moved over from caffeine , over to green tea .\n[doctor] okay .\n[patient] and it , it is so , m- it does n't cause as much problem as it did with , when i was drinking so many energy drinks a day .\n[doctor] all right . good . i'm glad to hear that . great . all right .\n[patient] uh , i think getting that , rid of that reflux , really helped my attitude improve .\n[doctor] okay .\n[patient] uh , my job's going great . everything's phenomenal right now .\n[doctor] okay .\n[doctor] okay . and you have a , a good support system at home ? i know you have a big-\n[patient] yeah .\n[doctor] . family .\n[patient] yes . yes . all my kids-\n[doctor] okay .\n[patient] . call and check on me every day .\n[doctor] okay . great . i'm glad to hear that . now , i know you did a review of systems sheet when you checked in .\n[patient] yes .\n[doctor] i , are you having any symptoms ? any chest pain , shortness of breath , belly pain , of , nausea or vomiting ? anything like that ?\n[patient] no . no symptoms at all .\n[doctor] okay , great . um , well , let me go ahead . i wan na do a quick physical exam .\n[doctor] hey , dragon . show me the vital signs .\n[doctor] so , your vital signs here in the office look really good . so , you're doing a great job managing your , your blood pressure . your heart rate's nice and low . i'm gon na go ahead and take a listen to your heart and lungs .\n[patient] okay .\n[doctor] and i'll let you know what i find . okay ?\n[patient] okay .\n[doctor] okay . good . all right . so , on physical examination , i , i do n't hear any carotid bruits in your neck , which is really good . you know , your heart exam , i do hear a slight 2/6 systolic ejection murmur , which i've heard in the past , so that's stable . uh , your lungs are nice and clear , and you do have , you know , 1+ pitting edema bilaterally in your lower extremities .\n[patient] okay .\n[doctor] so , what does that mean ? you know , i , i think , you know , you're doing a ... it sounds like a doing a good job watching your diet . you could ... you just are retaining a little bit of fluid , maybe just from standing all day .\n[patient] okay .\n[doctor] okay ? let's take a look at some of your results . okay ?\n[patient] okay .\n[doctor] hey , dragon . show me the endoscope results .\n[doctor] so , this was the endoscopy that you had last year when you were having all that pain . it just showed that you had had some mild gastritis . so , it's good to hear that that , you know , protonix is helping you a lot . okay ?\n[patient] okay .\n[patient] i'll do a little more exercise too .\n[doctor] that sounds great . all right . so , let's talk just a little bit about , you know , my assessment and my plan for you .\n[doctor] for your reflux , i want you to continue on the protonix 40 mg a day , and continue with those lifestyle modifications with the dietary stuff-\n[patient] okay .\n[doctor] . okay ? do you have any questions ?\n[patient] no questions .\n[doctor] okay . all right . well , the nurse is gon na come in soon , and she's gon na check you , get you checked out . okay ?\n[patient] okay . thank you .\n[doctor] hey , dragon . finalize the note .\nClinical Note:", 'request_type': 'language-model-inference', 'stop': None, 'temperature': 0.0, 'top_p': 1}
2025-09-23T09:14:03 INFO             Request failed. Retrying (attempt #3) in 20 seconds... (See above for error details)

For some reason, your HELM installation is using `helm.clients.google_client.GoogleClient` for `google/gemini-2.5-pro`, but the correct client should be `helm.clients.vertexai_client.VertexAIChatClient`. Did you change the client in `model_deployments.yaml`?

no I did not know it uses vertex, i did figure it now and yes it works, thanks a lot