{ "edition": "2026-10-24", "publisher": "Hanah", "coverageFormula": "100 * (yes + 0.5 * partial) / inventory fact count; arithmetic mean across runs", "cardiology": [ { "product": "Hanah", "case": "day1_consultation06", "run": 1, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Okay.\n\n Hello.\n\n Hello there.\n\n Uh, hello. Can you hear me okay?\n\n Yes, I can hear you.\n\n Okay, great.\n\n Are you the doctor?\n\n Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n Um, I'm contacting you because I've been quite short of breath lately.\n\n Okay. Do you want to tell me a bit more about it? So when did it all start?\n\n Uh, well, it seems to have been slowly getting worse over the last couple of weeks, um, and it's become quite troublesome in the last few days.\n\n Okay.\n\n Uh, I kind of normally I can walk to the shop without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n Okay.\n\n And, uh, it's got me kind of worried. I don't really know what's going on.\n\n Okay. Okay. Is there anything you're particularly worried about?\n\n Um, well, I've, I've, uh, I've got, um, heart failure.\n\n Okay.\n\n Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed.\n\n Right.\n\n And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n Okay. Have you found yourself coughing, coughing at all?\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n Um, I'm feeling a little run down. Um, but otherwise, otherwise pretty normal.\n\n Okay.\n\n I've noticed my ankles have got a bit bigger.\n\n Okay. And what do you mean by that?\n\n Uh, it's just like they've sort of swollen up a bit.\n\n Okay. Um, is that is that both.\n\n Kind of.\n\n Both ankles?\n\n Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Last few days. Okay. And is this something that you've had before in the past?\n\n Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so you really in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had have you have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n\n No, not really.\n\n Okay. And any temperatures or fevers?\n\n Uh, no.\n\n Okay. And how about your appetite? Are you eating and drinking okay?\n\n Yeah, I'm, I'm that's fine.\n\n Okay. And your water work, are you passing urine okay?\n\n Uh, yeah, that yeah. I usually pee a lot.\n\n Yeah.\n\n A little bit since the drugs came out.\n\n Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to the hospital.\n\n Okay.\n\n And, um, they, uh but then I just got better.\n\n Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n Uh, I can't remember. They just called it a something like that, a small heart attack.\n\n Small heart attack. Okay. Was it something like angina or, um?\n\n Um, I know. They, they said they i-it seemed it was, like, more than angina.\n\n Okay.\n\n Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and.\n\n Okay.\n\n Uh, and yeah, I've been okay since then.\n\n You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise I'm okay.\n\n Okay.\n\n Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide.\n\n Furosemide. And do you know which dose you're taking?\n\n Uh, I can't remember. I'm sorry, doctor.\n\n That's okay.\n\n I'd have to check.\n\n No problems. Um, any other medications?\n\n Uh, yeah, I take aspirin.\n\n Okay.\n\n And, uh, bisoprolol.\n\n Is that metoprolol, was it? Or.\n\n Uh, bisoprolol.\n\n Sorry, the connection's not very good. Okay, thank you. Yep.\n\n Great.\n\n Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n Uh, no.\n\n No.\n\n No, no allergies.\n\n Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh, my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early 60s.\n\n Early 60s. Okay. Uh, anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n Okay. Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Uh, I've got two cats.\n\n You've got two cats. Okay, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n Uh, I work part-time as a, uh, lorry driver.\n\n Okay. And how is that? Is that quite stressful, long hours?\n\n Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n Hmm.\n\n Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n Oh, no. I, I, I, I only take shifts during the day.\n\n Okay.\n\n I don't like working at night.\n\n Okay. All right. And what about smoking and alcohol, sir? 'Cause they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n Not anymore.\n\n So you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day on average?\n\n Oh, it was about, about a pack a day. Back in the day.\n\n Um, and how many, how many years was that for?\n\n Oh, that was oof, a good 25 years.\n\n Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n I don't drink alcohol.\n\n Okay. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n Okay.\n\n Um, but, uh, that's about it. I've yeah, I don't I don't go running like I used to when I was young.\n\n Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless, even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know.\n\n That's.\n\n It's.\n\n What's going on?\n\n So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see and see how you're getting on.\n\n Okay, if you think that would be best.\n\n I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n Okay.\n\n Is that something you've had.\n\n I design.\n\n Yeah. So, um, an echo scan, it's a it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n Oh, yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now.\n\n You remember now. Okay, fine. That's something I can organise for you today, and, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day. But I'd really like we'd like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n Okay. I'll see how I get on.\n\n Okay. Do you have any questions for me?\n\n Uh, nothing else. All pretty clear. Thank you very much, doctor.\n\n Great. No, I wish you all the best.\n\n Thank you.\n\n Have a good day.\n\n Thank you. See you soon.\n\n Okay. Thank you.", "note": "## Subjective\n- Progressive breathlessness over 2 weeks, troublesome over the last few days. Previously walked to shops without difficulty; now needs to sit to catch breath and becomes breathless around the house.\n- Mild dry cough, feeling slightly run down, and bilateral ankle swelling over the last few days. Similar swelling during previous heart failure problems.\n- No chest pain, palpitations or fever. Eating and drinking normally. Passing urine without difficulty; usually urinates frequently since starting medication.\n- Known heart failure; initial breathlessness improved with medication. Worried heart failure is worsening.\n- Reported small heart attack 5 years ago, with chest pain and hospital admission for a few days; exact diagnosis unknown. Otherwise well since. No other reported medical history.\n- Medications: furosemide, aspirin, bisoprolol and simvastatin. Furosemide strength unknown.\n- No medication allergies.\n- Father died of heart attack in early 60s. Mother living, with osteoporosis.\n- Lives alone with 2 cats, regarded as family. Part-time lorry driver, daytime shifts only; work is exhausting. Worried worsening illness will affect ability to work.\n- Former smoker, approximately 1 pack daily for 25 years. No alcohol. Usually walks to shops at least daily; no other regular exercise.\n\n## Objective\n- Clinician stated chest, oxygen saturations and blood pressure were okay following examination. No values provided.\n\n## Assessment\n- Suspected flare-up of heart failure. Explained that the heart may not be pumping as well as it should.\n\n## Plan\n- Agreed to increase furosemide from 1 tablet daily to 1 tablet twice daily for the first few days for symptom relief; strength remains unconfirmed.\n- Arrange blood tests: full blood count to assess for anaemia and kidney function.\n- Arrange echocardiogram to assess heart pumping function; explained as an ultrasound scan of the heart. Expected scheduling within 1–2 weeks.\n- Review in 1 week.\n- Contact clinician sooner if more unwell, increasingly breathless, or developing chest pain, palpitations or dizziness; telephone discussion offered.\n- Acknowledged concern about work and aim to improve symptoms to limit impact on employment. Congratulated on smoking cessation.\n- Patient agreed with the plan and had no further questions.", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 0, 5, "" ], [ 62, 67, "OK?" ], [ 95, 100, "OK," ], [ 111, 137, "" ], [ 149, 157, "Nice to see you" ], [ 164, 170, "Oscar." ], [ 209, 209, "Are you the doctor?" ], [ 287, 292, "OK." ], [ 337, 339, "" ], [ 454, 457, "now" ], [ 513, 518, "" ], [ 563, 567, "shops," ], [ 655, 659, "really" ], [ 718, 723, "" ], [ 765, 766, "" ], [ 805, 816, "OK. 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Worried worsening illness will affect ability to work.\"" ], [ "yes", "\"Former smoker\"." ], [ "yes", "\"approximately 1 pack daily\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"No alcohol.\"" ], [ "yes", "\"Usually walks to shops at least daily\"." ], [ "yes", "\"chest ... okay following examination\"." ], [ "yes", "\"oxygen saturations ... okay\"." ], [ "yes", "\"blood pressure were okay\"." ], [ "no", "Clinician's statement that he is otherwise well at the moment is not recorded." ], [ "yes", "\"Suspected flare-up of heart failure ... heart may not be pumping as well as it should\"." ], [ "yes", "\"increase furosemide from 1 tablet daily to 1 tablet twice daily\"." ], [ "yes", "\"for the first few days\" with review to see progress." ], [ "yes", "\"full blood count to assess for anaemia\"." ], [ "yes", "\"and kidney function\"." ], [ "yes", "\"echocardiogram to assess heart pumping function\"." ], [ "partial", "\"scheduling within 1–2 weeks\" captured but not that it is requested today." ], [ "yes", "\"Review in 1 week.\"" ], [ "yes", "\"Contact clinician sooner if more unwell, increasingly breathless\"." ], [ "yes", "\"developing chest pain, palpitations or dizziness\"." ] ], "claims": [ { "claim": "Medications: ... and simvastatin", "reason": "The reference transcript never mentions simvastatin or any statin; only furosemide, aspirin and bisoprolol are named.", "fact": null } ], "significantMarks": [ { "i": 86, "reason": "Scribe transcript inserts 'simvastatin' as a current medication where the reference has 'a thousand'; invents a drug in the medication list." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day1_consultation06", "run": 2, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Okay.\n\n Hello,.\n\n Hello there.\n\n Uh, hello, can you hear me okay?\n\n Yes.\n\n I can hear you.\n\n Okay.\n\n Great.\n\n Are you the doctor?\n\n Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n Um, I'm contacting you because I've been quite short of breath lately.\n\n Okay. Do you want to tell me a bit more about it? So when did it all start?\n\n Uh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, it's become quite troublesome in the last few days.\n\n Okay.\n\n Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n Okay.\n\n And, uh, it's got me kind of worried. I don't really know what's going on.\n\n Okay. Okay. Is there anything you're particularly worried about?\n\n Um, well, I've, I've, uh, I've got, um, heart failure.\n\n Okay.\n\n Uh, I was told that, uh, a while ago. Um, and I got a bit breathless when I was first diagnosed.\n\n Right.\n\n And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n Okay. Have you found yourself coughing, coughing at all?\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n Um, I'm feeling a little rundown. Um, but otherwise, otherwise pretty normal.\n\n Okay.\n\n I've noticed my ankles have got a bit bigger.\n\n Okay. And what do you mean by that?\n\n Uh, it's just like they've sort of swollen up a bit.\n\n Okay. Um, is that is that both.\n\n Kind of.\n\n Both ankles?\n\n Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Last few days. Okay. And is this something that you've had before in the past?\n\n Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n Okay. Okay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat?\n\n No, not really.\n\n Okay. And any temperatures or fevers?\n\n Uh, no.\n\n Okay. And how about your appetite? Are you eating and drinking okay?\n\n Yeah, I'm, I'm that's fine.\n\n Okay. And your water work, are you passing urine okay?\n\n Uh, yeah, that yeah. I usually pee a lot.\n\n Yeah.\n\n A little bit since the drugs came out.\n\n Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to hospital.\n\n Okay.\n\n And, um, they, uh but then I just got better.\n\n Okay.\n\n Um.\n\n And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n Uh, I can't remember. They just called it a s it's something like that, a small heart attack.\n\n Small heart attack. Okay. Was it something like angina or, um?\n\n Um, uh, no. They, they said they i-it seemed it was, like, more than angina.\n\n Okay.\n\n Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and.\n\n Okay.\n\n Uh, and yeah, I've been okay since then.\n\n You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise I'm okay.\n\n Okay.\n\n Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide.\n\n Furosemide. And do you know which dose you're taking?\n\n Uh, I can't remember. I'm sorry, doctor.\n\n That's okay.\n\n I'd have to check.\n\n No problems. Um, any other medications?\n\n Uh, yeah, I take aspirin.\n\n Okay.\n\n And, uh, bisoprolol.\n\n Is that metoprolol, was this? Or.\n\n Uh, bisoprolol.\n\n Sorry, the connection's not very good. Okay, thank you. Yep.\n\n Great.\n\n Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n Uh, no.\n\n No.\n\n No, no allergies.\n\n Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh, my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early 60s.\n\n Early 60s. Okay. Uh, anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n Okay. Did your mother still with us?\n\n Uh, yeah, she's still living.\n\n Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Uh, I've got two cats.\n\n You've got two cats. Okay, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n Uh, I work part-time as a, uh, lorry driver.\n\n Okay. And how is that? Is that quite stressful, long hours?\n\n Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n Hmm.\n\n Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um.\n\n Yeah.\n\n Impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n Oh, no. I, I, I, I only take shifts.\n\n During the day.\n\n Thank you.\n\n I don't like working at night.\n\n Thank you. All right. And what about smoking and alcohol, though, because it can sometimes be very important when it comes to heart problems. Do you smoke at all?\n\n Not anymore.\n\n So you used to smoke.\n\n Yeah.\n\n And how many do you smoke a day, on average?\n\n Ooh, it was about a pack a day. Back in the day.\n\n And how many years was that for?\n\n Oh, that was.\n\n Oof. Good 25 years.\n\n Okay. Well done for stopping. I'm— I must have been very difficult for you, but well done for stopping. Um, and what about alcohol?\n\n I don't drink alcohol.\n\n Okay. Do you do much in the way of exercise, though?\n\n Uh, I try and walk to the shops at least once a day.\n\n Okay.\n\n Um, but, uh, that's about it. I've— yeah, I don't. I don't go running like I used to when I was young.\n\n Right. Okay. And sessions.\n\n She now, your symptoms— you said you're feeling more breathless even walking to the shop, she said. Right, so based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen, and you know it's.\n\n What's going on?\n\n So it seems like your heart's not pumping as well as it should be, and obviously having diagnosed with heart failure, that's obviously the first thing that comes to mind.\n\n To my mind. Now, there's a couple of options for us to move forward. Given that you're otherwise well at the moment, and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of furosemide. So maybe, rather than 1 tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n\n Okay. I do think that would be best.\n\n I think it's definitely worth treating your symptoms, but.\n\n What we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n Okay.\n\n Is that something you've had.\n\n I've designed.\n\n Yeah. So, um, an echo scan— it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good.\n\n Oh, yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now.\n\n You remember now, okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized, but I think.\n\n Sir, in the meantime, let's—let's get a blood test done. We can check your, you know, your full blood count and look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your furosemide to, you know, 1 tablet twice a day. But I'd really like—would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime, if you are getting more unwell—so if you're getting more breathless.\n\n So are you having any other symptoms like chest pain, or palpitations, or dizziness? Then you can say, \"I want you to give me a call sooner than that,\" and we can have a chat on the phone as well.\n\n Okay, I'll see how I get on.\n\n Okay. Do you have any questions for me?\n\n Uh, nothing. That's all pretty clear. Thank you very much, Doctor.\n\n Great. Now I wish you all the best. Have a good day.\n\n Okay, see you soon.\n\n Okay, thank you.", "note": "## Subjective\n- Breathlessness gradually worsening over 2 weeks, particularly troublesome over the last few days. Previously walked to shops without difficulty; now needs to sit to recover and becomes breathless around the house.\n- Mild dry cough, feeling slightly rundown, and bilateral ankle swelling over the last few days. Similar swelling during previous heart failure problems.\n- No chest pain, palpitations or fever. Eating and drinking normally. Passing urine normally; usually urinates frequently since starting medication.\n- Known heart failure; initial breathlessness improved with medication. Worried heart failure is worsening.\n- Reported small heart attack 5 years ago, requiring a few days in hospital after chest pain. Cannot recall diagnosis; recalls being told it was more than angina. Otherwise well since.\n- Medications: furosemide, aspirin, bisoprolol and simvastatin. Cannot recall furosemide dose.\n- No medication allergies.\n- Father died of a heart attack in his early 60s. Mother living with osteoporosis.\n- Lives alone with 2 cats, regarded as family. Works part-time as a lorry driver, daytime shifts only. Work is exhausting; concerned worsening illness will affect ability to work.\n- Former smoker: approximately 1 pack daily for 25 years. No alcohol. Usually walks to shops daily; little other exercise.\n\n## Objective\n- Clinician stated chest examination, oxygen saturations and blood pressure were all okay. No values provided.\n\n## Assessment\n- Possible flare-up of heart failure. Explained that the heart may not be pumping as well as it should.\n\n## Plan\n- Agreed to increase furosemide from 1 tablet daily to 1 tablet twice daily for the first few days for symptom relief.\n- Arrange full blood count to assess for anemia and kidney function testing.\n- Arrange echocardiogram to assess heart pumping function; explained this is a jelly scan of the heart. Patient recalled having this previously. Expected arrangement within 1–2 weeks.\n- Review in 1 week.\n- Contact clinician sooner if more unwell, increasingly breathless, or developing chest pain, palpitations or dizziness; telephone discussion offered.\n- Congratulated on smoking cessation. Patient agreed with plan and had no further questions.", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 0, 5, "" ], [ 63, 68, "OK?" ], [ 99, 104, "OK," ], [ 118, 144, "" ], [ 156, 164, "Nice to see you" ], [ 171, 177, "Oscar." ], [ 216, 216, "Are you the doctor?" ], [ 294, 299, "OK." ], [ 344, 346, "" ], [ 460, 460, "now" ], [ 516, 521, "" ], [ 659, 663, "really" ], [ 722, 727, "" ], [ 769, 770, "" ], [ 809, 820, "OK. 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Is" ], [ 5528, 5544, "OK, alright." ], [ 5675, 5683, "Well, I" ], [ 5722, 5727, "OK," ], [ 5843, 5848, "OK." ], [ 5856, 5863, "it's just" ], [ 5904, 5915, "day to day," ], [ 5998, 6003, "OK." ], [ 6070, 6075, "OK." ], [ 6093, 6098, "" ], [ 6144, 6148, "Mm." ], [ 6278, 6286, "that's" ], [ 6399, 6404, "" ], [ 6437, 6441, "No. Uh," ], [ 6501, 6503, "" ], [ 6511, 6516, "" ], [ 6571, 6574, "Ohh" ], [ 6628, 6638, "" ], [ 6674, 6695, "OK. OK, alright." ], [ 6732, 6750, "So, 'cause that" ], [ 6815, 6815, "Do you," ], [ 6843, 6851, "any more." ], [ 6899, 6901, "did" ], [ 6944, 6944, "about," ], [ 6981, 6981, "Um," ], [ 6987, 6987, "how many," ], [ 7019, 7022, "Ohh" ], [ 7045, 7047, "twenty five" ], [ 7057, 7093, "OK. And what about the stopping? That" ], [ 7109, 7113, "" ], [ 7133, 7150, "" ], [ 7168, 7168, "what," ], [ 7216, 7221, "OK." ], [ 7261, 7268, "sir?" ], [ 7326, 7331, "OK." ], [ 7436, 7436, "OK." ], [ 7446, 7451, "OK." ], [ 7456, 7471, "certainly" ], [ 7491, 7491, "you, you're," ], [ 7544, 7544, "to the uh," ], [ 7567, 7567, "Um," ], [ 7575, 7577, "Ohh um," ], [ 7591, 7591, "based on you" ], [ 7634, 7634, "I," ], [ 7701, 7701, "Um," ], [ 7730, 7767, "Um, um, and uh, Mmm. That. It's" ], [ 7836, 7836, "Um," ], [ 7888, 7894, "there's" ], [ 7904, 7904, "What's going on. Um, that's" ], [ 7932, 7940, "" ], [ 7954, 7954, "Um," ], [ 7988, 8011, "move forward. Um, Mmm." ], [ 8144, 8149, "OK," ], [ 8203, 8205, "" ], [ 8225, 8226, "one" ], [ 8248, 8258, "do two" ], [ 8295, 8295, "Um, and see," ], [ 8329, 8339, "OK. If you" ], [ 8346, 8365, "that'll be better. 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See you soon." ] ], "grade": { "facts": [ [ "yes", "'Breathlessness' with walking to shops/around house captured." ], [ "yes", "'gradually worsening over 2 weeks'." ], [ "yes", "'particularly troublesome over the last few days'." ], [ "yes", "'now needs to sit to recover' when walking to shops." ], [ "yes", "'becomes breathless around the house'." ], [ "yes", "'Worried heart failure is worsening'." ], [ "yes", "'No chest pain'." ], [ "yes", "'Mild dry cough'." ], [ "yes", "'feeling slightly rundown'." ], [ "yes", "'bilateral ankle swelling'." ], [ "yes", "Ankle swelling 'over the last few days'." ], [ "yes", "'Similar swelling during previous heart failure problems'." ], [ "yes", "'No ... palpitations'." ], [ "yes", "'No ... fever'." ], [ "yes", "'Eating and drinking normally'." ], [ "yes", "'usually urinates frequently since starting medication'." ], [ "yes", "'Known heart failure'." ], [ "yes", "'initial breathlessness improved with medication'." ], [ "yes", "'small heart attack 5 years ago... more than angina', diagnosis not recalled." ], [ "yes", "'requiring a few days in hospital after chest pain'." ], [ "yes", "'Otherwise well since'." ], [ "yes", "'Patient recalled having this previously' re echocardiogram." ], [ "no", "Note does not state absence of other past medical history." ], [ "yes", "Furosemide listed." ], [ "yes", "'Cannot recall furosemide dose'; plan states current '1 tablet daily'." ], [ "yes", "Aspirin listed." ], [ "yes", "Bisoprolol listed." ], [ "yes", "'No medication allergies'." ], [ "yes", "'Father died of a heart attack'." ], [ "yes", "'in his early 60s'." ], [ "yes", "'Mother living with osteoporosis'." ], [ "yes", "'Lives alone with 2 cats'." ], [ "yes", "'Works part-time as a lorry driver'." ], [ "yes", "'Work is exhausting; concerned worsening illness will affect ability to work'." ], [ "yes", "'Former smoker'." ], [ "yes", "'approximately 1 pack daily'." ], [ "yes", "'for 25 years'." ], [ "yes", "'No alcohol'." ], [ "yes", "'Usually walks to shops daily'." ], [ "yes", "'chest examination ... okay'." ], [ "yes", "'oxygen saturations ... okay'." ], [ "yes", "'blood pressure ... okay'." ], [ "no", "Clinician's 'otherwise well at the moment' is not recorded." ], [ "yes", "'Possible flare-up of heart failure... not pumping as well as it should'." ], [ "yes", "'from 1 tablet daily to 1 tablet twice daily'." ], [ "yes", "'for the first few days'; review planned." ], [ "yes", "'full blood count to assess for anemia'." ], [ "yes", "'kidney function testing'." ], [ "yes", "'echocardiogram to assess heart pumping function'." ], [ "partial", "'within 1-2 weeks' captured but not that it is being requested today." ], [ "yes", "'Review in 1 week'." ], [ "yes", "'Contact clinician sooner if more unwell, increasingly breathless'." ], [ "yes", "'chest pain, palpitations or dizziness'." ] ], "claims": [ { "claim": "Medications include simvastatin", "reason": "Reference transcript never mentions simvastatin or any statin (only furosemide, aspirin, bisoprolol); garbled 'a thousand' does not support it.", "fact": null } ], "significantMarks": [ { "i": 83, "reason": "Scribe transcript inserts drug name 'simvastatin' where reference has 'a thousand'; adds a medication to the record." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day1_consultation06", "run": 3, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello.\n\n Hello there.\n\n Uh, hello, can you hear me okay?\n\n Yes, I can hear you.\n\n Okay.\n\n Great.\n\n Are you a doctor? Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n Um, I'm contacting you because I've been quite short of breath lately.\n\n Okay. Do you want to tell me a bit more about you? When did it all start?\n\n Uh, well, it seems to have been slowly getting worse over the last couple of weeks, um, and it's become quite troublesome in the last few days.\n\n Okay.\n\n Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n Okay.\n\n And, uh, it's got me kind of worried. I don't really know what's going on.\n\n Okay. Okay. Is there anything you're particularly worried about?\n\n Um, well, I've, I've, uh, I've got, um, heart failure.\n\n Okay.\n\n Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed.\n\n Right.\n\n And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days it's got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n Okay. Have you found yourself coughing, coughing at all?\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n Um, I'm feeling a little run down. Um, but otherwise, otherwise pretty normal.\n\n Okay.\n\n I've noticed my ankles have got a bit bigger.\n\n Okay. And what do you mean by that?\n\n Uh, it's just like they've sort of swollen up a bit.\n\n Okay. Um, is that, is that both.\n\n Kind of.\n\n Both ankles?\n\n Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Last few days. Okay. And is this something that you've had before in the past?\n\n Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n Okay. Okay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat?\n\n No, not really.\n\n Okay. And any temperatures or fevers?\n\n Uh, no.\n\n Okay. And how about your appetite? Are you eating and drinking okay?\n\n Yeah, I'm, I'm, that's fine.\n\n Okay. And your water work, are you passing urine okay?\n\n Uh, yeah, that, yeah. I usually pee a lot.\n\n Yeah.\n\n A little bit since the drugs came out.\n\n Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well, I was told I had, like, uh, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to the hospital.\n\n Okay.\n\n And, um, they, uh, but then I just got better.\n\n Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n Uh, I can't remember. They just called it a s-something like that, a small heart attack.\n\n Small heart attack. Okay. Was it something like angina or, um?\n\n Um, uh, no. They, they said they i-it seemed it was, like, more than angina.\n\n Okay.\n\n Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and.\n\n Okay.\n\n Uh, and yeah, I've been okay since then.\n\n You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise I'm okay.\n\n Okay.\n\n Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide.\n\n Furosemide. And do you know which dose you're taking?\n\n Uh, I can't remember. I'm sorry, doctor.\n\n That's okay.\n\n I have to check.\n\n No problems. Um, any other medications?\n\n Uh, yeah, I take aspirin.\n\n Okay.\n\n And, uh, bisoprolol.\n\n Is that metoprolol, was this? Or.\n\n Uh, bisoprolol.\n\n Sorry, the connection's not very good. Okay, thank you. Yep.\n\n Great.\n\n Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n Uh, no, no allergies.\n\n Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh, my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early 60s.\n\n Early 60s. Okay. Uh, anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n Okay. Did your mother still with us?\n\n Uh, yeah, she's still living.\n\n Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. I mean, I've got two cats.\n\n You've got two cats. Okay, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n Uh, I work part-time as a, uh, lorry driver.\n\n Okay. And how is that? Is that quite stressful, long hours?\n\n Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n Hmm.\n\n Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n Yeah, this is certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n Oh, no. I, I, I, I only take shifts during the day.\n\n Okay.\n\n I don't like working at night.\n\n Okay. All right. And what about smoking and alcohol, sir? Because it, it can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n Not anymore.\n\n So you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh, it was about, about a pack a day. Back in the day.\n\n Um, and how many, how many years was that for?\n\n Oh, that was, oof, a good 25 years.\n\n Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n I don't drink alcohol.\n\n Okay. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops at least once a day.\n\n Okay.\n\n Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young.\n\n Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless, even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know.\n\n That's.\n\n It's.\n\n What's going on?\n\n So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\n\n Okay. If you think that would be best.\n\n I think, I think it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n Okay.\n\n Is that something you've had.\n\n What does that.\n\n Yeah. So, um, an echo sca uh, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n Oh, yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now.\n\n You remember now. Okay, fine. That's something I can organise for you today. And, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day. But I'd really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n Okay. I'll see how I get on.\n\n Okay. Do you have any questions for me?\n\n Uh, nothing. That's all pretty clear. Thank you very much, doctor.\n\n Great. No, I wish you all the best. Have a good day.\n\n Okay. See you soon.\n\n Okay. Thank you.", "note": "## Subjective\n- Breathlessness worsening over 2 weeks, particularly troublesome over the last few days. Previously walked to shops without difficulty; now needs to sit and catch breath and becomes breathless around the house.\n- Mild dry cough, feeling slightly run down, and bilateral ankle swelling for a few days. Similar swelling during previous heart failure symptoms. No chest pain, palpitations or fever. Eating, drinking and passing urine normally; frequent urination since starting medication.\n- Known heart failure; initial breathlessness improved with medication. Worried heart failure is worsening.\n- Describes a “small heart attack” 5 years ago, with chest pain and hospital admission for a few days; exact diagnosis unknown. Well since. No other reported medical history.\n- Medications: furosemide, aspirin, bisoprolol and simvastatin. Cannot recall furosemide dose. No medication allergies.\n- Father died of a heart attack in his early 60s. Mother living with osteoporosis.\n- Lives alone with 2 cats, regarded as family. Part-time lorry driver, daytime shifts only; work is exhausting. Worried worsening illness will affect ability to work.\n- Former smoker, approximately 1 pack daily for 25 years. No alcohol. Usually walks to shops at least daily; no longer runs.\n\n## Objective\n- Clinician states chest examination, oxygen saturations and blood pressure are all okay; no measurements provided.\n\n## Assessment\n- Suspected flare-up of heart failure. Explained that the heart may not be pumping as well as it should.\n\n## Plan\n- Agreed to increase furosemide to 1 tablet twice daily for the first few days; tablet strength unspecified.\n- Arrange blood tests: full blood count to look for anaemia and kidney function.\n- Arrange echocardiogram to assess heart pumping function; explained as a jelly scan of the heart. Patient recalled having this previously. Advised organisation may take 1–2 weeks.\n- Review in 1 week.\n- Call sooner if increasingly unwell, more breathless, or developing chest pain, palpitations or dizziness; telephone discussion offered.\n- Acknowledged concern about work and aim to improve symptoms before further occupational impact. Praised smoking cessation. Patient agreed with plan and had no further questions.", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 53, 58, "OK?" ], [ 86, 91, "OK," ], [ 105, 126, "" ], [ 138, 146, "Nice to see you" ], [ 153, 159, "Oscar." ], [ 198, 198, "Are you the doctor?" ], [ 276, 281, "OK." ], [ 322, 326, "it?" ], [ 441, 444, "now" ], [ 500, 505, "" ], [ 643, 647, "really" ], [ 706, 711, "" ], [ 753, 754, "" ], [ 793, 804, "OK. 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Alright." ], [ 3223, 3241, "your uh," ], [ 3388, 3391, "a," ], [ 3522, 3528, "into" ], [ 3542, 3547, "OK." ], [ 3601, 3606, "OK." ], [ 3629, 3629, "a" ], [ 3719, 3719, "Um." ], [ 3764, 3764, "something" ], [ 3767, 3778, "uh, something" ], [ 3815, 3840, "It's more hard to say. OK." ], [ 3848, 3857, "" ], [ 3909, 3918, "that it, uh, it" ], [ 3961, 3966, "OK." ], [ 4054, 4066, "uh. OK. OK." ], [ 4087, 4091, "OK" ], [ 4119, 4123, "OK" ], [ 4136, 4152, "OK, alright." ], [ 4304, 4318, "OK. OK." ], [ 4378, 4383, "" ], [ 4413, 4413, "And" ], [ 4472, 4483, "" ], [ 4499, 4502, "" ], [ 4544, 4547, "" ], [ 4588, 4600, "" ], [ 4620, 4620, "That's OK." ], [ 4696, 4701, "OK." ], [ 4729, 4736, "The" ], [ 4753, 4758, "it?" ], [ 4824, 4829, "OK." ], [ 4841, 4855, "yeah." ], [ 4868, 4914, "a thousand, OK. Alright." ], [ 4937, 4939, "" ], [ 4985, 4990, "No. OK." ], [ 5322, 5326, "sixties." ], [ 5336, 5350, "sixties, OK. Alright." ], [ 5425, 5434, "OK. Is" ], [ 5498, 5514, "OK, alright." ], [ 5645, 5657, "Well, I" ], [ 5696, 5701, "OK," ], [ 5817, 5822, "OK." ], [ 5830, 5837, "it's just" ], [ 5878, 5889, "day to day," ], [ 5972, 5977, "OK." ], [ 6044, 6049, "OK." ], [ 6067, 6072, "" ], [ 6118, 6122, "Mm." ], [ 6252, 6259, "that's" ], [ 6398, 6402, "No. Uh," ], [ 6462, 6464, "" ], [ 6472, 6477, "" ], [ 6532, 6535, "Ohh" ], [ 6587, 6592, "" ], [ 6630, 6646, "OK. OK, alright." ], [ 6683, 6702, "So, 'cause that" ], [ 6768, 6770, "" ], [ 6807, 6815, "any more." ], [ 7011, 7014, "Ohh" ], [ 7030, 7039, "good twenty five" ], [ 7050, 7086, "OK. And what about the stopping? That" ], [ 7092, 7099, "have been" ], [ 7119, 7136, "" ], [ 7161, 7164, "" ], [ 7214, 7219, "OK." ], [ 7323, 7328, "OK." ], [ 7434, 7434, "OK." ], [ 7445, 7450, "OK." ], [ 7469, 7473, "" ], [ 7493, 7493, "you're," ], [ 7555, 7558, "" ], [ 7570, 7580, "shop, she" ], [ 7598, 7601, "Ohh" ], [ 7630, 7634, "you" ], [ 7678, 7681, "" ], [ 7756, 7758, "Which" ], [ 7794, 7814, "uh, Mmm. That." ], [ 7827, 7843, "" ], [ 7988, 7988, "What's going on." ], [ 7993, 7997, "that's" ], [ 8074, 8083, "" ], [ 8101, 8101, "Mmm." ], [ 8113, 8116, "you're" ], [ 8127, 8130, "" ], [ 8225, 8225, "are" ], [ 8230, 8235, "OK," ], [ 8289, 8291, "" ], [ 8335, 8343, "do" ], [ 8433, 8438, "OK." ], [ 8452, 8471, "that'll be better. Uh," ], [ 8727, 8732, "OK." ], [ 8769, 8784, "before?" ], [ 8805, 8817, "" ], [ 8833, 8838, "general" ], [ 8863, 8866, "might" ], [ 8876, 8878, "this" ], [ 8948, 8951, "What does that? Ohh" ], [ 9028, 9038, "that. OK," ], [ 9068, 9076, "organize" ], [ 9101, 9107, "that might" ], [ 9148, 9158, "organized." ], [ 9319, 9327, "anemia." ], [ 9481, 9484, "I" ], [ 9560, 9562, "" ], [ 9590, 9594, "" ], [ 9726, 9731, "feel like" ], [ 9865, 9874, "" ], [ 9970, 9975, "OK." ], [ 10002, 10007, "OK?" ], [ 10049, 10057, "I think" ], [ 10122, 10125, "and then well" ], [ 10171, 10180, "OK. Thank" ], [ 10185, 10210, "OK. See you soon." ] ], "grade": { "facts": [ [ "yes", "\"Breathlessness worsening over 2 weeks\"." ], [ "yes", "\"Breathlessness worsening over 2 weeks\" captures gradual worsening." ], [ "yes", "\"particularly troublesome over the last few days\"." ], [ "yes", "\"Previously walked to shops without difficulty; now needs to sit and catch breath\"." ], [ "yes", "\"becomes breathless around the house\"." ], [ "yes", "\"Worried heart failure is worsening.\"" ], [ "yes", "\"No chest pain\"." ], [ "yes", "\"Mild dry cough\"." ], [ "partial", "\"feeling slightly run down\" captured, but 'otherwise normal' not stated." ], [ "yes", "\"bilateral ankle swelling\"." ], [ "yes", "\"bilateral ankle swelling for a few days\"." ], [ "yes", "\"Similar swelling during previous heart failure symptoms.\"" ], [ "yes", "\"No ... palpitations\"." ], [ "yes", "\"No ... fever\"." ], [ "yes", "\"Eating, drinking ... normally\"." ], [ "yes", "\"passing urine normally; frequent urination since starting medication\"." ], [ "yes", "\"Known heart failure\"." ], [ "yes", "\"initial breathlessness improved with medication\"." ], [ "partial", "Small heart attack 5 years ago, diagnosis unknown, but 'more than angina' omitted." ], [ "yes", "\"with chest pain and hospital admission for a few days\"." ], [ "yes", "\"Well since.\"" ], [ "yes", "\"Patient recalled having this previously.\"" ], [ "yes", "\"No other reported medical history.\"" ], [ "yes", "Furosemide listed in medications." ], [ "partial", "\"Cannot recall furosemide dose\" captured, but current one tablet daily not stated." ], [ "yes", "Aspirin listed." ], [ "yes", "Bisoprolol listed." ], [ "yes", "\"No medication allergies.\"" ], [ "yes", "\"Father died of a heart attack\"." ], [ "yes", "\"in his early 60s\"." ], [ "yes", "\"Mother living with osteoporosis.\"" ], [ "yes", "\"Lives alone with 2 cats\"." ], [ "yes", "\"Part-time lorry driver\"." ], [ "yes", "\"work is exhausting. Worried worsening illness will affect ability to work.\"" ], [ "yes", "\"Former smoker\"." ], [ "yes", "\"approximately 1 pack daily\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"No alcohol.\"" ], [ "yes", "\"Usually walks to shops at least daily\"." ], [ "yes", "\"chest examination ... all okay\"." ], [ "yes", "\"oxygen saturations ... all okay\"." ], [ "yes", "\"blood pressure ... all okay\"." ], [ "no", "Note does not state that the patient is otherwise well at the moment." ], [ "yes", "\"Suspected flare-up of heart failure... heart may not be pumping as well as it should.\"" ], [ "yes", "\"increase furosemide to 1 tablet twice daily\"." ], [ "partial", "\"for the first few days\" captured, but 'see how he gets on' not explicitly stated." ], [ "yes", "\"full blood count to look for anaemia\"." ], [ "yes", "\"kidney function\"." ], [ "yes", "\"echocardiogram to assess heart pumping function\"." ], [ "partial", "\"may take 1-2 weeks\" captured, but requesting it today is not stated." ], [ "yes", "\"Review in 1 week.\"" ], [ "yes", "\"Call sooner if increasingly unwell, more breathless\"." ], [ "yes", "\"developing chest pain, palpitations or dizziness\"." ] ], "claims": [ { "claim": "Medications: ... and simvastatin", "reason": "Reference transcript never mentions simvastatin (only aspirin, bisoprolol, furosemide; the relevant turn reads 'And a thousand'); medication is unsupported.", "fact": null } ], "significantMarks": [ { "i": 84, "reason": "Scribe transcript has the drug name 'simvastatin' where the reference has 'a thousand'; an added medication changes the drug list." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day1_consultation06", "run": 4, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Okay.\n\n Hello.\n\n Hello there.\n\n Uh, hello. Can you hear me okay?\n\n Yes, I can hear you.\n\n Okay.\n\n Great.\n\n Are you the doctor? Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n Um, I'm contacting you because I've been quite short of breath lately.\n\n Okay. Do you want to tell me a bit more about it? So when did it all start?\n\n Uh, well, it seems to have been slowly getting worse over the last couple of weeks, um, and it's become quite troublesome in the last few days.\n\n Okay.\n\n Uh, I kind of normally I can walk to the shop without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n Okay.\n\n And, uh, it's got me kind of worried. I don't really know what's going on.\n\n Okay. Okay. Is there anything you're particularly worried about?\n\n Um, well, I've, I've, uh, I've got, um, heart failure.\n\n Okay.\n\n Uh, I was told that, uh, a while ago.\n\n Okay.\n\n Um, and I got a bit breathless when I was first diagnosed.\n\n Right.\n\n And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n Okay. Have you found yourself coughing, coughing at all?\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n Um, I'm feeling a little run down. Um, but otherwise, otherwise pretty normal.\n\n Okay.\n\n I've noticed my ankles have got a bit bigger.\n\n Okay. And what do you mean by that?\n\n Uh, it's just like they've sort of swollen up a bit.\n\n Okay. Um, is that is that both.\n\n Kind of.\n\n Both ankles?\n\n Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Last few days. Okay. And is this something that you've had before in the past?\n\n Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so you really in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any have you have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n\n No, not really.\n\n Okay. And any temperatures or fevers?\n\n Uh, no.\n\n Okay. And how about your appetite? Are you eating and drinking okay?\n\n Yeah, I'm, I'm that's fine.\n\n Okay. And your water work, are you passing urine okay?\n\n Uh, yeah, that yeah, I usually pee a lot.\n\n Yeah.\n\n A little bit.\n\n Okay.\n\n A little bit since the drugs came out.\n\n Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to the hospital.\n\n Okay.\n\n And, um, they, uh but then I just got better.\n\n Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n Uh, I can't remember. They just called it a something like that, a small heart attack.\n\n A small heart attack. Okay. Was it something like angina or, um?\n\n Um, I know. They, they said they i-it seemed it was, like, more than angina.\n\n Okay.\n\n Um, uh, but, um, I didn't but I only had to stay in the hospital for a few days.\n\n Okay.\n\n Uh, okay. And yeah, I've been okay since then.\n\n You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise I'm okay.\n\n Okay. Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones?\n\n Uh, yeah, I take something called furosemide.\n\n Furosemide. And do you know which dose you're taking?\n\n Uh, I can't remember. I'm sorry, doctor.\n\n That's okay.\n\n I'd have to check.\n\n No problems. Um, any other medications?\n\n Uh, yeah, I take aspirin.\n\n Okay.\n\n And, uh, bisoprolol.\n\n Is that metoprolol, was it? Or.\n\n Uh, bisoprolol.\n\n Sorry, the connection's not very good. Okay, thank you. Yep.\n\n Great.\n\n Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n Uh, no.\n\n No.\n\n No, no allergies.\n\n Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh, my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early 60s.\n\n Early 60s. Okay. Uh, anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n Okay. Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. I mean, I've got two cats.\n\n You've got two cats. Okay, great. Do they have names?\n\n They're my family. Uh, they're, they're called um, they're called Polly and Tim.\n\n Okay. Um, so this is junior cats. And, um, in terms of day-to-day, are you working at the moment?\n\n Uh, I work part-time, as a, uh, lorry driver.\n\n Okay. And how is that? Is that quite stressful, long hours?\n\n Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n Hmm.\n\n Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n Oh, no, I, I, I I only take shifts during the day.\n\n Okay.\n\n I don't like working at night.\n\n Okay. All right. And what about smoking and alcohol, sir? Because they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n Not anymore.\n\n So you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day on average?\n\n Oh, it was about, about a pack a day. Back in the day.\n\n Um, and how many, how many years was that for?\n\n Oh, that was oof, a good 25 years.\n\n Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n I don't drink alcohol.\n\n Okay. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n Okay.\n\n Um, but, uh, that's about it. I've yeah, I don't I don't go running like I used to when I was young.\n\n Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless even walking to the st uh, to the shops, you said. Um, right. So, um, based on your based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know, it's.\n\n What's going on?\n\n So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\n\n Okay, if you think that would be best.\n\n I think, I think it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n Okay.\n\n Is that something you've had. Yeah. So, um, an echo scan it's, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n Oh, yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now.\n\n You remember now. Okay, fine. That's something I can organize for you today. And, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide to, you know, one tablet twice a day. But I'd really like we'd like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n Okay. I'll see how I get on.\n\n Okay. Do you have any questions for me?\n\n Uh, nothing else. All pretty clear. Thank you very much, doctor.\n\n Great. No, I wish you all the best.\n\n Thank you.\n\n Have a good day.\n\n See you soon.\n\n Okay. Thank you.", "note": "## Subjective\n- Progressive breathlessness over 2 weeks, troublesome over the last few days. Previously walked to shops without difficulty; now needs to sit and catch breath and becomes breathless around the house.\n- Mild dry cough, feeling slightly run down, and bilateral ankle swelling for the last few days. Similar ankle swelling when heart failure was previously problematic.\n- No chest pain, palpitations or fever. Eating and drinking normally. Passing urine without difficulty; usually urinates frequently since starting medication.\n- Known heart failure; initial breathlessness improved with medication. Worried heart failure is worsening.\n- Reported small heart attack 5 years ago, with chest pain and hospital admission for a few days. Cannot recall exact diagnosis; told it was more than angina. Well since. No other reported medical history.\n- Medications: furosemide, dose unknown; aspirin; bisoprolol; simvastatin. No medication allergies.\n- Father died of a heart attack in his early 60s. Mother living with osteoporosis.\n- Lives alone with 2 cats, regarded as family. Works part-time as a lorry driver, daytime shifts only; work is exhausting. Worried worsening illness will affect ability to work.\n- Former smoker, approximately 1 pack daily for 25 years. No alcohol. Usually walks to shops at least once daily; no other current exercise.\n\n## Objective\n- Clinician stated chest examination, oxygen saturations and blood pressure were okay. No values provided.\n\n## Assessment\n- Possible flare-up of heart failure. Explained that the heart may not be pumping as well as it should.\n\n## Plan\n- Agreed to increase furosemide from 1 tablet daily to 1 tablet twice daily for the first few days to treat symptoms. Tablet strength unknown.\n- Arrange blood tests: full blood count to look for anemia and kidney function.\n- Arrange echocardiogram to assess heart pumping function; explained this is an ultrasound scan of the heart. Expected scheduling timeframe 1–2 weeks.\n- Follow-up in 1 week.\n- Call sooner if increasingly unwell, more breathless, or developing chest pain, palpitations or dizziness; telephone discussion offered.\n- Acknowledged concern about work and aim to improve symptoms to avoid impact on employment. Congratulated smoking cessation.\n- Patient agreed with plan and had no further questions.", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 0, 5, "" ], [ 62, 67, "OK?" ], [ 95, 100, "OK," ], [ 114, 137, "" ], [ 149, 157, "Nice to see you" ], [ 164, 170, "Oscar." ], [ 209, 209, "Are you the doctor?" ], [ 287, 292, "OK." ], [ 337, 339, "" ], [ 454, 457, "now" ], [ 513, 518, "" ], [ 563, 567, "shops," ], [ 655, 659, "really" ], [ 718, 723, "" ], [ 765, 766, "" ], [ 805, 816, "OK. 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See you soon." ] ], "grade": { "facts": [ [ "yes", "\"Progressive breathlessness\"." ], [ "yes", "\"Progressive breathlessness over 2 weeks\"." ], [ "yes", "\"troublesome over the last few days\"." ], [ "yes", "\"Previously walked to shops without difficulty; now needs to sit and catch breath\"." ], [ "yes", "\"becomes breathless around the house\"." ], [ "yes", "\"Worried heart failure is worsening\"." ], [ "yes", "\"No chest pain\"." ], [ "yes", "\"Mild dry cough\"." ], [ "partial", "\"feeling slightly run down\" captured; 'otherwise normal' not stated." ], [ "yes", "\"bilateral ankle swelling\"." ], [ "yes", "\"for the last few days\"." ], [ "yes", "\"Similar ankle swelling when heart failure was previously problematic\"." ], [ "yes", "\"No ... palpitations\"." ], [ "yes", "\"No ... fever\"." ], [ "yes", "\"Eating and drinking normally\"." ], [ "yes", "\"usually urinates frequently since starting medication\"." ], [ "yes", "\"Known heart failure\"." ], [ "yes", "\"initial breathlessness improved with medication\"." ], [ "yes", "\"small heart attack 5 years ago... told it was more than angina\"; cannot recall diagnosis." ], [ "yes", "\"with chest pain and hospital admission for a few days\"." ], [ "yes", "\"Well since\"." ], [ "no", "Note does not say he has had an echocardiogram before." ], [ "yes", "\"No other reported medical history\"." ], [ "yes", "\"Medications: furosemide\"." ], [ "yes", "Plan states \"from 1 tablet daily\"; \"dose unknown\" / \"Tablet strength unknown\"." ], [ "yes", "\"aspirin\"." ], [ "yes", "\"bisoprolol\"." ], [ "yes", "\"No medication allergies\"." ], [ "yes", "\"Father died of a heart attack\"." ], [ "yes", "\"in his early 60s\"." ], [ "yes", "\"Mother living with osteoporosis\"." ], [ "yes", "\"Lives alone with 2 cats\"." ], [ "yes", "\"Works part-time as a lorry driver\"." ], [ "yes", "\"work is exhausting. Worried worsening illness will affect ability to work\"." ], [ "yes", "\"Former smoker\"." ], [ "yes", "\"approximately 1 pack daily\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"No alcohol\"." ], [ "yes", "\"Usually walks to shops at least once daily\"." ], [ "yes", "\"chest examination... okay\"." ], [ "yes", "\"oxygen saturations... okay\"." ], [ "yes", "\"blood pressure were okay\"." ], [ "no", "Clinician's statement that he is otherwise well at the moment is not recorded." ], [ "yes", "\"Possible flare-up of heart failure... heart may not be pumping as well as it should\"." ], [ "yes", "\"increase furosemide from 1 tablet daily to 1 tablet twice daily\"." ], [ "yes", "\"for the first few days\" with review planned." ], [ "yes", "\"full blood count to look for anemia\"." ], [ "yes", "\"and kidney function\"." ], [ "yes", "\"echocardiogram to assess heart pumping function\"." ], [ "partial", "\"scheduling timeframe 1-2 weeks\" captured; requesting it today is not." ], [ "yes", "\"Follow-up in 1 week\"." ], [ "yes", "\"Call sooner if increasingly unwell, more breathless\"." ], [ "yes", "\"developing chest pain, palpitations or dizziness\"." ] ], "claims": [ { "claim": "Medications: ... simvastatin", "reason": "Simvastatin is never mentioned in the reference transcript (only an unclear 'And a thousand'); the medication list there is furosemide, aspirin and bisoprolol.", "fact": null } ], "significantMarks": [ { "i": 88, "reason": "Scribe transcript inserts the drug name simvastatin where the reference has 'a thousand', which adds a medication to the record." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day1_consultation06", "run": 5, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Normally I can walk to the shops, without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n Okay.\n\n And, uh, it's got me kind of worried. I don't really know what's going on.\n\n Okay, okay. Is there anything you're particularly worried about?\n\n Um, well, I've, I've, uh, I've got, um, heart failure.\n\n Okay.\n\n Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed.\n\n Right.\n\n And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n Right, okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n Okay. Have you found yourself coughing, coughing at all?\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n Um, I'm feeling a little rundown. Um, but otherwise, otherwise pretty normal.\n\n Okay.\n\n I've noticed my ankles have got a bit bigger.\n\n Okay. And what do you mean by that?\n\n Uh, it's just like they've sort of swollen up a bit.\n\n Okay. Um, is that, is that both.\n\n Kind of.\n\n Both ankles?\n\n Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Okay. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Last few days, okay. And is this something that you've had before in the past?\n\n Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n Okay. Okay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any, have you, have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n\n No, not really.\n\n Okay. And any temperatures or fevers?\n\n Uh, no.\n\n Okay. And how about your appetite? Are you eating and drinking okay?\n\n Yeah, I'm, I'm, that's fine.\n\n Okay. And your water work, are you passing urine okay?\n\n Uh, yeah, that, yeah. I usually pee a lot.\n\n Yeah.\n\n A little bit since the drugs came out.\n\n Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well, I was told I had, like, a, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to hospital.\n\n Okay.\n\n And, um, they, uh, but then I just got better.\n\n Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n Uh, I can't remember. They just called it a, something like that, a small heart attack.\n\n Small heart attack, okay. Was it something like angina or, um?\n\n Um, I know. They, they said they, it seemed it was, like, more than angina.\n\n Okay.\n\n Um, uh, but, um, I didn't, but I only had to stay in hospital for a few days and.\n\n Okay.\n\n Uh, and yeah, I've been okay since then.\n\n You've been okay since then, okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise I'm okay.\n\n Okay. Um, do you take any regular medications apart from your, is it diuretics that you're taking? Do you know which ones?\n\n Uh, yeah, I take something called furosemide.\n\n Furosemide. And do you know which dose you're taking?\n\n Uh, I can't remember. I'm sorry, doctor.\n\n That's okay.\n\n I'd have to check.\n\n No problems. Um, any other medications?\n\n Uh, yeah, I take aspirin.\n\n Okay.\n\n And, uh, bisoprolol.\n\n Is that metoprolol, was this? Or.\n\n Uh, bisoprolol.\n\n Sorry, the connection's not very good. Okay, thank you. Yep.\n\n Great.\n\n Um, and, uh, simvastatin. Simvastatin, okay. All right. Any allergies at all? To any medications?\n\n Uh, no, no allergies.\n\n Okay. And is there anything in the family that's, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh, my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early 60s.\n\n Early 60s, okay. Uh, anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n Okay. Did your mother still with us?\n\n Uh, yeah, she's still living.\n\n Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. I mean, I've got two cats.\n\n You've got two cats, okay. Great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n Uh, I work part-time, as a, uh, lorry driver.\n\n Okay. And how is that? Is that quite stressful, long hours?\n\n Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n Hmm.\n\n Um, I guess I'm a bit worried that if I get sick, I won't, if I get more sick, then I won't be able to work properly.\n\n Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you self, do, do you do a lot of night driving, weekend driving?\n\n Oh, no, I, I, I only take shifts during the day.\n\n Okay.\n\n I don't like working at night.\n\n Okay. All right. And what about smoking and alcohol, sir? Because they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n Not anymore.\n\n So you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day on average?\n\n Ooh, it was about, about a pack a day. Back in the day.\n\n Um, and how many, how many years was that for?\n\n Oh, that was, oof, a good 25 years.\n\n Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n I don't drink alcohol.\n\n Okay. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n Okay.\n\n Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young.\n\n Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a bit of a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know, it's.\n\n What's going on?\n\n So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\n\n Okay, if you think that would be best.\n\n I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n Okay.\n\n Is that something you've had.\n\n What does that.\n\n Yeah. So, um, an echo scan, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n Oh, yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now.\n\n You remember now. Okay, fine. That's something I can organize for you today and, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide to, you know, one tablet twice a day. But I'd really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n Okay. I'll see how I get on.\n\n Okay. Do you have any questions for me?\n\n Uh, nothing else. All pretty clear. Thank you very much, doctor.\n\n Great. No, I wish you all the best.\n\n Thank you.\n\n Have a good day.\n\n See you soon.\n\n Okay. Thank you.", "note": "## Subjective\n- Breathlessness for 2 weeks, worse over the last few days. Previously walked to shops without difficulty; now needs to stop and catch breath, with breathlessness even around the house.\n- Mild dry cough, not troublesome. Feels slightly rundown; otherwise usual health. Bilateral ankle swelling for several days, similar to previous heart failure symptoms.\n- No chest pain, palpitations or fever. Eating and drinking normally. Passing urine normally; frequent urination since starting medication.\n- Known heart failure; initial breathlessness improved with medication. Concerned heart failure is worsening.\n- Reported small heart attack 5 years ago, described as more than angina; exact diagnosis unknown. Hospitalised for several days after chest pain; well since. No other reported medical history.\n- Medications: furosemide, dose unknown; aspirin; bisoprolol; simvastatin. No medication allergies.\n- Father died of heart attack in early 60s. Mother living, with osteoporosis.\n- Lives alone with 2 cats, regarded as family. Part-time lorry driver, daytime shifts only; work exhausting. Worried worsening illness will impair ability to work.\n- Former smoker, approximately 1 pack daily for 25 years. No alcohol. Usually walks to shops at least daily; no longer runs.\n\n## Objective\n- Chest, oxygen saturations and blood pressure described as okay following examination. No numerical measurements provided.\n\n## Assessment\n- Suspected flare-up of heart failure.\n\n## Plan\n- Explained that heart may not be pumping as well as it should.\n- Agreed to increase furosemide from 1 tablet daily to 1 tablet twice daily for the first few days; tablet strength unknown.\n- Arrange full blood count to assess for anaemia and blood test for kidney function.\n- Arrange echocardiogram to assess heart pumping function; explained as an ultrasound scan of the heart. Anticipated scheduling within 1–2 weeks.\n- Review in approximately 1 week.\n- Call sooner if increasingly unwell, worsening breathlessness, chest pain, palpitations or dizziness; telephone discussion available.\n- Acknowledged work concerns and aim to improve symptoms to limit impact on employment. Patient agreed with plan and had no further questions.", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 0, 0, "Hello? Hello there. Uh, hello. Can you hear me OK? Yes, I can hear you. OK, great. I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon? Are you the doctor? Um, I'm, contacting you because I've been, quite short of breath lately. OK. Do you want to tell me a bit more about it? When did it all start? Uh, well it seems to have been, slowly getting worse over the last couple of weeks. Um, now it's, become quite troublesome, in the last few days. Uh, I kind of," ], [ 121, 125, "really" ], [ 184, 189, "" ], [ 231, 232, "" ], [ 271, 282, "OK. OK. OK." ], [ 397, 402, "OK." ], [ 506, 512, "" ], [ 616, 616, "OK. Right." ], [ 627, 632, "OK." ], [ 650, 661, "you're" ], [ 691, 695, "for" ], [ 757, 760, "it's" ], [ 781, 781, "uh," ], [ 920, 920, "uh," ], [ 1011, 1016, "OK. And" ], [ 1067, 1067, "Um." ], [ 1139, 1150, "OK. 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See you soon." ] ], "grade": { "facts": [ [ "yes", "\"Breathlessness for 2 weeks\"." ], [ "partial", "Two-week duration captured but gradual worsening over the weeks not stated, only \"worse over the last few days\"." ], [ "yes", "\"worse over the last few days\"." ], [ "yes", "\"Previously walked to shops without difficulty; now needs to stop and catch breath\"." ], [ "yes", "\"breathlessness even around the house\"." ], [ "yes", "\"Concerned heart failure is worsening\"." ], [ "yes", "\"No chest pain\"." ], [ "yes", "\"Mild dry cough, not troublesome\"." ], [ "yes", "\"Feels slightly rundown; otherwise usual health\"." ], [ "yes", "\"Bilateral ankle swelling\"." ], [ "yes", "\"for several days\"." ], [ "yes", "\"similar to previous heart failure symptoms\"." ], [ "yes", "\"No ... palpitations\"." ], [ "yes", "\"No ... fever\"." ], [ "yes", "\"Eating and drinking normally\"." ], [ "yes", "\"Passing urine normally; frequent urination since starting medication\"." ], [ "yes", "\"Known heart failure\"." ], [ "yes", "\"initial breathlessness improved with medication\"." ], [ "yes", "\"small heart attack 5 years ago, described as more than angina; exact diagnosis unknown\"." ], [ "yes", "\"Hospitalised for several days after chest pain\"." ], [ "yes", "\"well since\"." ], [ "no", "Note does not mention a previous echocardiogram." ], [ "yes", "\"No other reported medical history\"." ], [ "yes", "\"furosemide\"." ], [ "yes", "\"dose unknown\" and plan \"from 1 tablet daily\"." ], [ "yes", "\"aspirin\"." ], [ "yes", "\"bisoprolol\"." ], [ "yes", "\"No medication allergies\"." ], [ "yes", "\"Father died of heart attack\"." ], [ "yes", "\"in early 60s\"." ], [ "yes", "\"Mother living, with osteoporosis\"." ], [ "yes", "\"Lives alone with 2 cats\"." ], [ "yes", "\"Part-time lorry driver\"." ], [ "yes", "\"work exhausting. Worried worsening illness will impair ability to work\"." ], [ "yes", "\"Former smoker\"." ], [ "yes", "\"approximately 1 pack daily\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"No alcohol\"." ], [ "yes", "\"Usually walks to shops at least daily\"." ], [ "yes", "\"Chest ... described as okay following examination\"." ], [ "yes", "\"oxygen saturations ... okay\"." ], [ "yes", "\"blood pressure ... okay\"." ], [ "partial", "Only \"otherwise usual health\" in the context of feeling run-down; clinician's 'otherwise well at the moment' not clearly recorded." ], [ "yes", "\"Suspected flare-up of heart failure\" and \"heart may not be pumping as well as it should\"." ], [ "yes", "\"increase furosemide from 1 tablet daily to 1 tablet twice daily\"." ], [ "yes", "\"for the first few days\" with review to see progress." ], [ "yes", "\"full blood count to assess for anaemia\"." ], [ "yes", "\"blood test for kidney function\"." ], [ "yes", "\"echocardiogram to assess heart pumping function\"." ], [ "partial", "\"scheduling within 1–2 weeks\" captured; that it is requested today is not stated." ], [ "yes", "\"Review in approximately 1 week\"." ], [ "yes", "\"Call sooner if increasingly unwell, worsening breathlessness\"." ], [ "yes", "\"chest pain, palpitations or dizziness\"." ] ], "claims": [ { "claim": "Medications: ... simvastatin", "reason": "Reference transcript never mentions simvastatin (the corresponding passage reads 'And a thousand'); no statin is named anywhere.", "fact": null } ], "significantMarks": [ { "i": 0, "reason": "Opening of the consultation missed: chief complaint of shortness of breath, onset over a couple of weeks and worsening in last few days." }, { "i": 76, "reason": "Inserts the drug name simvastatin where the reference has 'a thousand', adding a medication to the record." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day2_consultation07", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Then all of that stuff is very different than that.\n\n Uh, hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Dr. Dean Merzer from GP at home, nice to see you.\n\n Nice to see you too.\n\n Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah, sure. Um, my name is Dean Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n That's great, thank you so much for that. Um, you look a lot younger, so—\n\n Yeah.\n\n So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct, or?\n\n Yeah, yeah, around that. Yeah, about 60, yeah.\n\n 60, okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n Yes, I am, yeah.\n\n Okay, fantastic. So, um, how can I help you today?\n\n Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n Um, no, they're still present.\n\n Okay. So you've still got the chest discomfort right now?\n\n Yes.\n\n Okay. Um, we're probably going to have to call an ambulance for you.\n\n Okay.\n\n To take you to the hospital, okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n Yeah, sure.\n\n It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n Sure.\n\n So just to— just to double-check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n Okay.\n\n Um, and it's quite a diffuse pain.\n\n Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n Yeah, it's— it's, um, mainly in my left arm, uh, it's feeling a little bit— um, uh, painful, and— and in my shoulder as well.\n\n Right, okay. Do you remember what you were doing at the time?\n\n Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything, it wasn't doing any physical exercise.\n\n Sure, okay. And— and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n No, I don't— I— I generally don't do much activity at all.\n\n Okay.\n\n Um, yeah.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, okay. Can you—\n\n Yeah.\n\n Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Um, yeah, it's— it's beating a bit faster now, I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n Okay.\n\n Um, today.\n\n So I— I know you're stressed, but we've got an ambulance coming on the way, okay?\n\n Yeah.\n\n So, um, we'll take care of everything, so don't— don't worry.\n\n Okay.\n\n Thank you for being in the house with you at the moment.\n\n Uh, no, no one's in the house at the moment.\n\n Okay. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n Okay, so maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you.\n\n Yeah.\n\n All right.\n\n Yeah.\n\n Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n How— how long have you been smoking for?\n\n Uh, for the past 15 years.\n\n 15 years, okay. Um.\n\n Yeah.\n\n Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n Yeah, I have high blood— uh, blood pressure, but, um, not diabetes.\n\n Okay. Have you ever had your cholesterol checked?\n\n No.\n\n Okay, okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did—\n\n Yes.\n\n —did either of them have any heart problems or heart attacks or anything like that?\n\n Um, yes, so my, um, father died of a heart attack.\n\n Okay.\n\n Um, and my mother had some heart problems.\n\n Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n Um, he was about my age.\n\n Right, so about just under 6— around 60.\n\n Yes, around 60, yes.\n\n Yeah, okay. All right. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n Okay, is that a— a beer you're talking about?\n\n Oh, beer, yes.\n\n Okay. Um, I— I can't tell from the video. Are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right.\n\n Yeah.\n\n Okay, all right. Um, uh, now, um, you're— do you normally live alone?\n\n Uh, yeah, I live alone, uh, at the moment, yeah.\n\n Okay.\n\n Uh, it's just me in the house.\n\n Sure, okay. And— and, uh, are you working at the moment?\n\n Yeah, yeah, I— I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner.\n\n Okay.\n\n So I own a sushi shop.\n\n Right, okay.\n\n Yeah.\n\n All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay.\n\n Okay.\n\n So, I'm not saying you definitely have a heart attack, but we— that— so our number one priority to exclude that, okay?\n\n Okay.\n\n So.\n\n Yeah.\n\n —ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n Okay.\n\n All right.\n\n Yeah, thank you.\n\n When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then.\n\n Okay.\n\n —they'll decide where to take you after that, okay?\n\n Okay.\n\n All right. And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, okay.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a— an allergic reaction?\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n Okay.\n\n Yeah.\n\n All right. It's very important that you communicate that to the hospital.\n\n Okay.\n\n —as detailed as you've just told me, because, um, we— we may need to consider aspirin despite.\n\n Oh, okay.\n\n —allergy, okay? Um.\n\n Okay.\n\n All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need, okay?\n\n Okay.\n\n Um, what I'm going to do is we'll stay on the line for the time being.\n\n Okay.\n\n Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on, all right?\n\n Okay. Okay, sure.\n\n Okay.\n\n Yeah, thank you.\n\n Thank you. Is it now? We'll— we'll end the conversation now for the purposes of.\n\n Yeah.\n\n —is that okay?\n\n That's okay. Okay, thank you very much.\n\n Okay, thanks. Bye-bye.\n\n Thank you, bye.", "note": "## Subjective\n- First episode of ongoing diffuse central chest pressure beginning a couple of hours ago while kneeling and gardening without strenuous exertion. Describes a heavy pressure rather than definite pain, with pain in the left arm and shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Feels heart beating faster now, attributed to stress; had not noticed this earlier today.\n- History of high blood pressure. No diabetes. Cholesterol never checked. Reports being overweight.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly. Generally inactive.\n- Father died of a heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes mild swelling, described as non-life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone and currently alone at home. Front door open. Owns a sushi restaurant.\n\n## Objective\n- Video consultation. No measured vital signs or examination findings documented.\n\n## Assessment\n- Possible heart attack; urgent exclusion prioritised. Diagnosis not confirmed.\n\n## Plan\n- Ambulance arranged and reported en route for urgent assessment and hospital transfer.\n- Reassured that help was coming. Planned to remain on the line until ambulance arrival and hand over to the crew.\n- Advised remaining near the hallway/front door and keeping the door open for access.\n- Explained that ambulance staff would perform an electrocardiogram; destination hospital would depend on findings and treatment required.\n- Advised communicating the aspirin reaction to hospital staff in detail. Explained that aspirin might still need consideration despite the reported allergy.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 58, "Hi," ], [ 115, 118, "Doctor" ], [ 124, 130, "Resor" ], [ 136, 147, "" ], [ 168, 197, "That's the same thing. 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OK," ], [ 7589, 7594, "" ], [ 7603, 7611, "Bye!" ] ], "grade": { "facts": [ [ "yes", "\"beginning a couple of hours ago\"." ], [ "yes", "\"heavy pressure rather than definite pain\" preserves the pressure-not-pain description." ], [ "yes", "\"Associated nausea\"." ], [ "yes", "\"No vomiting\"." ], [ "yes", "\"sweating\" listed." ], [ "yes", "\"shortness of breath\" listed." ], [ "yes", "\"ongoing\" chest pressure captures symptoms still present." ], [ "yes", "\"central chest pressure\" captures middle of chest, not to one side." ], [ "yes", "\"diffuse central chest pressure\"." ], [ "yes", "\"pain in the left arm\"." ], [ "yes", "\"and shoulder\"." ], [ "yes", "\"while kneeling and gardening without strenuous exertion\"." ], [ "yes", "\"First episode\"." ], [ "yes", "\"Feels heart beating faster now, attributed to stress\"." ], [ "yes", "\"Generally inactive\"." ], [ "yes", "\"Smokes 10 cigarettes daily\"." ], [ "yes", "\"for 15 years\"." ], [ "yes", "\"Drinks 7-8 pints of beer weekly\"." ], [ "yes", "\"Reports being overweight\"." ], [ "yes", "\"History of high blood pressure\"." ], [ "yes", "\"No diabetes\"." ], [ "yes", "\"Cholesterol never checked\"." ], [ "yes", "\"Father died of a heart attack around age 60\"." ], [ "yes", "\"Mother had heart problems\"." ], [ "yes", "\"Aspirin allergy\" documented." ], [ "yes", "\"causes mild swelling, described as non-life-threatening\"." ], [ "yes", "\"No other allergies\"." ], [ "yes", "\"Possible heart attack; urgent exclusion prioritised. Diagnosis not confirmed.\"" ], [ "yes", "\"Ambulance arranged and reported en route\"." ], [ "yes", "\"ambulance staff would perform an electrocardiogram\"." ], [ "yes", "\"destination hospital would depend on findings and treatment required\"." ], [ "yes", "\"Advised communicating the aspirin reaction to hospital staff in detail... might still need consideration despite the reported allergy\"." ], [ "yes", "\"remain on the line until ambulance arrival and hand over to the crew\"." ] ], "claims": [], "significantMarks": [ { "i": 2, "reason": "Clinician surname transcribed as Merzer instead of Resor; wrong name in the record." }, { "i": 5, "reason": "Patient first name transcribed as Dean instead of Jim; patient identity error in the record." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day2_consultation07", "run": 2, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Thanks. Good afternoon. It's very different than that.\n\n Uh, hi there. Good morning.\n\n Hi. Good morning.\n\n Um, I'm Dr.\n\n Dr. Dean Merzer from GP at home. Nice to see you.\n\n Nice to see you too.\n\n Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah, sure. Um, my name is Dean Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n Yeah.\n\n So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct?\n\n Yeah. Yeah, around that. Yeah, about 60, yeah.\n\n 60. Okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n Yes, I am. Yeah.\n\n Okay, fantastic. So, um, how can I help you today?\n\n Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right. Okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n Um, no, they're still present.\n\n Okay. So you've still got the chest discomfort right now?\n\n Yes.\n\n Okay. Um, we're probably going to have to call an ambulance for you.\n\n Okay.\n\n To take you to the hospital. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n Yeah, sure.\n\n It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n Sure.\n\n So just to— just to double-check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n Okay.\n\n Um, and it's quite a diffuse pain.\n\n Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n Yeah, it's— it's, um, mainly in my left arm, uh, it's feeling a little bit— um, uh, painful, and— and in my shoulder as well.\n\n Right. Okay. Do you remember what you were doing at the time?\n\n Uh, yeah, so it started, uh, just when I was gardening. So nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything, it wasn't doing any physical exercise.\n\n Sure. Okay. And— and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n No, I don't. I— I generally don't do much activity at all.\n\n Okay.\n\n Um, yeah.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right. Okay. Can— um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Um, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n Okay.\n\n Um, today.\n\n So I— I know you're stressed. We've got an ambulance coming on the way. Okay?\n\n Yeah.\n\n So, um, we'll take care of everything, so don't— don't worry.\n\n Okay.\n\n Thank you for being in the house with you at the moment.\n\n Uh, no, no one's in the house at the moment.\n\n Okay. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n Okay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you.\n\n Yeah.\n\n All right.\n\n Yeah.\n\n Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n How— how long have you been smoking for?\n\n Uh, for the past 15 years.\n\n 15 years. Okay. Um.\n\n Yeah.\n\n Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n Okay. Have you ever had your cholesterol checked?\n\n No.\n\n Okay. Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did.\n\n Yes.\n\n Did either of them have any heart problems or heart attacks or anything like that?\n\n Um, yes. So my, um, father died of a heart attack.\n\n Okay.\n\n Um, and my mother had some heart problems.\n\n Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n Um, he was about my age.\n\n Right. So about just under 6— around 60.\n\n Yes, around 60, yes.\n\n Yeah. Okay. All right. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n Okay. Is that a— a beer you're talking about?\n\n Oh, beer, yes.\n\n Okay. Um, I— I can't tell from the video. Are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right.\n\n Yeah.\n\n Okay. All right. Um, uh, now, um, you're— do you normally live alone?\n\n Uh, yeah, I live alone, uh, at the moment, yeah.\n\n Okay.\n\n Uh, it's just me in the house.\n\n Sure. Okay. And— and, uh, are you working at the moment?\n\n Yeah, yeah, I— I work, yeah.\n\n Right. What do you work as?\n\n Um, I work as a restaurant owner, so I own a sushi shop.\n\n Right. Okay.\n\n Yeah.\n\n All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n Okay.\n\n So I'm not saying you definitely have a heart attack, but we— that— so our number-one priority to exclude that, okay?\n\n Okay.\n\n So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n Okay.\n\n Yeah.\n\n Yeah, thank you.\n\n When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then.\n\n Okay.\n\n They'll decide where to take you after that, okay?\n\n Okay.\n\n And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n Yes, actually. I have, um, an allergy to aspirin.\n\n Right. Okay.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it, like, a— an allergic reaction?\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n Okay. All right.\n\n Yeah.\n\n It's very important that you communicate that to the hospital.\n\n Okay.\n\n And that detail you've just told me, because, um, we— we may need to consider aspirin despite.\n\n Oh, okay.\n\n Allergy, okay? Um.\n\n Okay.\n\n All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what the ECG looks like and what kind of treatment you might need, okay? Um.\n\n Okay.\n\n What I'm going to do is we'll stay on the line for the time being.\n\n Okay.\n\n Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right?\n\n Okay. Okay, sure.\n\n Okay.\n\n Yeah, thank you.\n\n Thank you. Is it now? We'll— we'll end the conversation now for the purposes?\n\n Yeah.\n\n Is that okay?\n\n That's okay. Okay, thank you very much.\n\n Okay, thanks. Bye.\n\n Thank you, bye.", "note": "## Subjective\n- First episode of ongoing diffuse central chest pressure, beginning while kneeling and gardening a couple of hours ago without strenuous exertion. Feels like someone sitting on chest, with pain spreading mainly to left arm and shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Heart feels faster now, attributed to stress about the situation; no faster heartbeat noticed earlier today.\n- History of high blood pressure. No diabetes. Cholesterol never checked.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly. Generally inactive; describes self as overweight.\n- Father died of heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes mild swelling, described as non-life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone; nobody currently in house. Front door open. Owns a sushi restaurant.\n\n## Objective\n- Video consultation. No measured observations or examination findings documented.\n\n## Assessment\n- Possible heart attack; urgent exclusion is the priority. Diagnosis not confirmed.\n\n## Plan\n- Ambulance requested through colleague; subsequently confirmed en route for urgent assessment and hospital transfer.\n- Explained possible heart attack and reassured patient that help was coming.\n- Advised remaining near the front door with door open for emergency access.\n- Plan to remain on the line until ambulance arrival and hand over directly to ambulance team.\n- Explained ambulance team will perform an electrocardiogram; hospital destination will depend on findings and treatment required.\n- Advised communicating aspirin allergy and reaction details to hospital. Explained aspirin may still need consideration despite reported allergy.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 61, "Hi," ], [ 118, 128, "Doctor" ], [ 134, 140, "Resor" ], [ 146, 157, "" ], [ 178, 207, "That's the same thing. 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OK," ], [ 7519, 7524, "" ] ], "grade": { "facts": [ [ "yes", "'beginning ... a couple of hours ago'" ], [ "yes", "'chest pressure ... Feels like someone sitting on chest'" ], [ "yes", "'Associated nausea'" ], [ "yes", "'No vomiting'" ], [ "yes", "'sweating'" ], [ "yes", "'shortness of breath'" ], [ "yes", "'ongoing' chest pressure captures still present" ], [ "yes", "'central chest pressure'" ], [ "yes", "'diffuse central chest pressure'" ], [ "yes", "'spreading mainly to left arm'" ], [ "yes", "'and shoulder'" ], [ "yes", "'while kneeling and gardening ... without strenuous exertion'" ], [ "yes", "'First episode'" ], [ "yes", "'Heart feels faster now, attributed to stress'" ], [ "yes", "'Generally inactive'" ], [ "yes", "'Smokes 10 cigarettes daily'" ], [ "yes", "'for 15 years'" ], [ "yes", "'Drinks 7-8 pints of beer weekly'" ], [ "yes", "'describes self as overweight'" ], [ "yes", "'History of high blood pressure'" ], [ "yes", "'No diabetes'" ], [ "yes", "'Cholesterol never checked'" ], [ "yes", "'Father died of heart attack around age 60'" ], [ "yes", "'Mother had heart problems'" ], [ "yes", "'Aspirin allergy'" ], [ "yes", "'mild swelling, described as non-life-threatening'" ], [ "yes", "'No other allergies'" ], [ "yes", "'Possible heart attack; urgent exclusion is the priority. Diagnosis not confirmed.'" ], [ "yes", "'Ambulance requested through colleague'" ], [ "yes", "'ambulance team will perform an electrocardiogram'" ], [ "yes", "'hospital destination will depend on findings and treatment required'" ], [ "yes", "'Advised communicating aspirin allergy ... aspirin may still need consideration'" ], [ "yes", "'remain on the line until ambulance arrival and hand over directly'" ] ], "claims": [], "significantMarks": [ { "i": 5, "reason": "Patient's first name transcribed as 'Dean' instead of 'Jim'; wrong patient identity in the record." }, { "i": 2, "reason": "Clinician surname 'Resor' transcribed as 'Merzer'; wrong clinician identity in the record." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day2_consultation07", "run": 3, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Senti, ragazzo, this is very different than that.\n\n Uh, hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Dr. Dean Merzer from GP at Home, nice to see you.\n\n Nice to see you too.\n\n Okay, great. So, before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah, sure. Um, my name is Tim Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n Yeah.\n\n So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct, or—\n\n Yeah, yeah, around that. Yeah, about 60, yeah.\n\n About 60. Okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n Yes, I am, yeah.\n\n Okay, fantastic. So, um, how can I help you today?\n\n Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n-not exactly a pain, but, um, like a, a pressure on my chest, um, it feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, okay. Now, do you have those, these symptoms right now, or have they gone off now?\n\n Um, no, they're still present.\n\n Okay. So you've still got the chest discomfort right now?\n\n Yes.\n\n Okay. Um, we're probably going to have to call an ambulance for you, to take—\n\n Okay.\n\n Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n Yeah, sure.\n\n It'll be a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um—\n\n Sure.\n\n So, just to, just to double-check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my, my pecs, so, um, yeah, but not, not necessarily to one side.\n\n Okay.\n\n Um, and it's quite a diffuse pain.\n\n Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n Yeah, it's, it's, um, mainly in my left arm, uh, it's feeling a little bit, um, uh, painful.\n\n Okay.\n\n And, and in my shoulder as well.\n\n Right, okay. Do you remember what you were doing at the time?\n\n Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, it wasn't running or anything, it wasn't doing any physical exercise.\n\n Sure, okay. A-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to, do anything?\n\n No, I don't, I, I generally don't do much activity at all.\n\n Okay.\n\n Um, yeah.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, okay. Can you—\n\n Yeah.\n\n Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Um, yeah, it's, it's beating a bit faster now, I think that's because I'm a little bit stressed.\n\n Okay.\n\n Um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n Okay.\n\n Um, today.\n\n So, I know you're stressed. We've got an ambulance coming on the way, okay?\n\n Yeah.\n\n So, um, we'll take care of everything, so don't, don't worry.\n\n Okay, thank you.\n\n If you're in the house with you at the moment?\n\n Uh, no, no one's in the house at the moment.\n\n Okay. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you.\n\n Yeah.\n\n All right.\n\n Yeah.\n\n Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n Uh, how long have you been smoking for?\n\n Uh, for the past 15 years.\n\n 15 years, okay. Um—\n\n Yeah.\n\n Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n Okay. Have you ever had your cholesterol checked?\n\n No.\n\n Okay, okay. All right. Um, now, anyone in your wider family, in your family, sorry, in your parents, did—\n\n Yes.\n\n —did either of them have any heart problems or heart attacks or anything like that?\n\n Um, yes, so my, um, father died of a heart attack.\n\n Okay.\n\n Um, and my mother had some heart problems.\n\n Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he, he had that heart attack?\n\n Um, he was about my age.\n\n Right, so about just under six, around 60?\n\n Yes, around 60, yes.\n\n Yeah, okay. All right. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n Okay, is that a, a beer you're talking about?\n\n Oh, beer, yes.\n\n Okay. Um, I, I can't tell from the video. Are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right.\n\n Yeah.\n\n Okay, all right. Um, uh, now, um, you're do you normally live alone?\n\n Uh, yeah, I live alone, uh, at the moment, yeah.\n\n Okay.\n\n Uh, it's just me in the house.\n\n Sure, okay. And, and, uh, are you working at the moment?\n\n Yeah, yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner.\n\n Okay.\n\n So I own a sushi shop.\n\n Right, okay.\n\n Yeah.\n\n All right. Um, so, um, the, the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n Okay.\n\n So, I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that.\n\n Okay.\n\n Okay?\n\n Okay.\n\n So, ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n Okay.\n\n Yeah.\n\n Yeah, thank you.\n\n When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then—\n\n Okay.\n\n —decide where to take you after that, okay?\n\n Okay.\n\n And, um, what, what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, okay.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you does it, does it cause you heartburn, or is it like a, a allergic reaction?\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've I sometimes even have it and it's, it's a it's a mild reaction to it.\n\n Okay. All right.\n\n Yeah.\n\n It's, it's very important that you communicate that to the hospital.\n\n Okay.\n\n Uh, detail you've just told me, because, um, we, we may need to consider aspirin despite—\n\n Oh, okay.\n\n —allergy, okay? Um, all right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need, okay?\n\n Okay.\n\n Um, what I'm going to do is we'll stay on the line for the time being.\n\n Okay.\n\n Uh, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, all right?\n\n Okay. Okay, sure.\n\n Okay.\n\n Yeah, thank you.\n\n Thank you. Isn't that we'll, we'll end the conversation now for the purposes—\n\n Yeah.\n\n —is that okay?\n\n That's okay. Okay, thank you very much.\n\n Okay, thanks. Bye.\n\n Thank you, bye.", "note": "## Subjective\n- First episode of ongoing diffuse central chest pressure, described as someone sitting on the chest. Started a couple of hours ago while kneeling and gardening without strenuous exertion. Pain extends mainly into left arm and also shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Heart feels faster now, attributed to stress about the situation; no faster heartbeat noticed earlier today.\n- History of high blood pressure. No diabetes. Cholesterol never checked. Describes being overweight and generally inactive.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly.\n- Father died of a heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes mild swelling, described as not life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone; nobody currently in the house. Front door open. Works as a restaurant owner, owning a sushi shop.\n\n## Objective\n- Video consultation. No measured observations or examination findings documented.\n\n## Assessment\n- Possible heart attack; priority is to exclude this. Diagnosis not confirmed.\n\n## Plan\n- Ambulance arranged and reported to be on its way for urgent assessment.\n- Advised speaking near the front door and keeping it open to allow emergency access.\n- Reassured that help was coming. Planned to remain on the line until ambulance arrival and hand over to the crew.\n- Explained that ambulance crew would perform an electrocardiogram and determine hospital destination according to findings and treatment needs.\n- Advised communicating the details of the aspirin reaction to hospital staff; explained that aspirin might still need consideration despite the allergy.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 56, "Hi," ], [ 113, 116, "Doctor" ], [ 122, 128, "Resor" ], [ 134, 145, "" ], [ 166, 195, "That's the same thing. 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OK," ], [ 7553, 7558, "" ] ], "grade": { "facts": [ [ "yes", "\"Started a couple of hours ago\"." ], [ "yes", "\"diffuse central chest pressure, described as someone sitting on the chest\"." ], [ "yes", "\"Associated nausea\"." ], [ "yes", "\"No vomiting.\"" ], [ "yes", "\"sweating\" listed as associated symptom." ], [ "yes", "\"shortness of breath\" listed." ], [ "yes", "\"ongoing\" chest pressure; consistent with symptoms still present." ], [ "yes", "\"central chest pressure\"; central location captured, not one-sided implied." ], [ "yes", "\"diffuse central chest pressure\"." ], [ "yes", "\"extends mainly into left arm\"." ], [ "yes", "\"and also shoulder\"." ], [ "yes", "\"while kneeling and gardening without strenuous exertion\"." ], [ "yes", "\"First episode\"." ], [ "yes", "\"Heart feels faster now, attributed to stress\"." ], [ "yes", "\"generally inactive\"." ], [ "yes", "\"Smokes 10 cigarettes daily\"." ], [ "yes", "\"for 15 years\"." ], [ "yes", "\"Drinks 7-8 pints of beer weekly\"." ], [ "yes", "\"Describes being overweight\"." ], [ "yes", "\"History of high blood pressure\"." ], [ "yes", "\"No diabetes.\"" ], [ "yes", "\"Cholesterol never checked.\"" ], [ "yes", "\"Father died of a heart attack around age 60\"." ], [ "yes", "\"Mother had heart problems.\"" ], [ "yes", "\"Aspirin allergy\"." ], [ "yes", "\"causes mild swelling, described as not life-threatening\"." ], [ "yes", "\"No other allergies.\"" ], [ "yes", "\"Possible heart attack; priority is to exclude this. Diagnosis not confirmed.\"" ], [ "yes", "\"Ambulance arranged and reported to be on its way\"." ], [ "yes", "\"ambulance crew would perform an electrocardiogram\"." ], [ "yes", "\"determine hospital destination according to findings and treatment needs\"." ], [ "yes", "\"Advised communicating the details of the aspirin reaction... aspirin might still need consideration\"." ], [ "yes", "\"remain on the line until ambulance arrival and hand over to the crew\"." ] ], "claims": [], "significantMarks": [ { "i": 5, "reason": "Patient name Jim transcribed as Tim; identity error in the record." }, { "i": 54, "reason": "Reference 'and I did today' (noticed faster heartbeat) lost; scribe transcript reads as not noticed today, altering palpitation history." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day2_consultation07", "run": 4, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Thanks. Good afternoon. It's very different than that.\n\n Uh, hi there. Good morning.\n\n Hi. Good morning.\n\n Um, I'm Dr. De\n\n an Mercer from GP at Home. Nice to see you.\n\n Nice to see you too.\n\n Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah, sure. Um, my name is Dean Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n Yeah.\n\n So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct?\n\n Yeah. Yeah, around that. Yeah, about 60, yeah.\n\n 60. Okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n Yes, I am. Yeah.\n\n Okay, fantastic. So, um, how can I help you today?\n\n Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right. Okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n Um, no, they're still present.\n\n Okay. So you've still got the chest discomfort right now?\n\n Yes.\n\n Okay. Um, and. We're probably going to have to call an ambulance for you.\n\n Okay.\n\n To take you. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n Yeah, sure.\n\n It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n Sure.\n\n So just to— just to double-check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n Okay.\n\n Um, and it's quite a diffuse pain.\n\n Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and— and in my shoulder as well.\n\n Right. Okay. Do you remember what you were doing at the time?\n\n Uh, yeah. So it started, uh, just when I was gardening. So nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, it wasn't running or anything. It wasn't doing any physical exercise.\n\n Sure. Okay. A-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n No, I don't— I— I generally don't do much activity at all.\n\n Okay.\n\n Um, yeah.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right. Okay. Can you—\n\n Yeah.\n\n Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Um, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed.\n\n Okay.\n\n Um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n Okay.\n\n Um, today.\n\n So I— I know you're stressed. We've got an ambulance coming on the way. Okay?\n\n Yeah.\n\n So, um, we'll take care of everything. So don't— don't worry.\n\n Okay.\n\n Thank you. You're in the house with you at the moment?\n\n Uh, no, no one's in the house at the moment.\n\n Okay. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n Okay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they— they can access you.\n\n Yeah.\n\n All right.\n\n Yeah.\n\n Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n How— how long have you been smoking for?\n\n Uh, for the past 15 years.\n\n 15 years. Okay. Um.\n\n Yeah.\n\n Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n Okay. Have you ever had your cholesterol checked?\n\n No.\n\n Okay. Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did.\n\n Yes.\n\n Did either of them have any heart problems or heart attacks or anything like that?\n\n Um, yes. So my, um, father died of a heart attack.\n\n Okay.\n\n Um, and my mother had some heart problems.\n\n Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n Um, he was about my age.\n\n Right. So a— a just under 6, around 60.\n\n Yes, around 60, yes.\n\n Yeah. Okay. All right. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n Okay. Is that a— a beer you're talking about?\n\n Oh, beer, yes.\n\n Okay. Um, I— I can't tell from the video. Are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right.\n\n Yeah.\n\n Okay. All right. Um, uh, now, um, you're— do you normally live alone?\n\n Uh, yeah, I live alone, uh, at the moment, yeah.\n\n Okay.\n\n Uh, it's just me in the house.\n\n Sure. Okay. And— and, uh, are you working at the moment?\n\n Yeah, yeah, I— I work, yeah.\n\n Right. What do you work as?\n\n Um, I work as a restaurant owner.\n\n Okay.\n\n So I own a sushi shop.\n\n Right. Okay.\n\n Yeah.\n\n All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n Okay.\n\n So I'm not saying you definitely have a heart attack, but we— that's our number-one priority to exclude that.\n\n Okay.\n\n Okay?\n\n Okay.\n\n So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n Okay.\n\n Yeah.\n\n Yeah, thank you.\n\n When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then decide where to take you after that, okay?\n\n Okay.\n\n And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n Yes, actually. I have, um, an allergy to aspirin.\n\n Right. Okay.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction?\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n Okay. All right.\n\n Yeah.\n\n It's very important that you communicate that to the hospital.\n\n Okay.\n\n Uh, detail you've just told me, because, um, we— we may need to consider aspirin despite.\n\n Oh, okay.\n\n Allergy. Okay? Um, all right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you into one hospital or another based on how bad— what the ECG looks like and what kind of treatment you might need, okay? Um.\n\n Okay.\n\n What I'm going to do is we'll stay on the line for the time being.\n\n Okay.\n\n Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right?\n\n Okay. Okay, sure.\n\n Okay.\n\n Yeah, thank you.\n\n Thank you. Is it now? We'll— we'll end the conversation now for the purposes?\n\n Yeah.\n\n Is that okay?\n\n That's okay. Okay, thank you very much.\n\n Okay, thanks. Bye.\n\n Thank you, bye.", "note": "## Subjective\n- First episode of diffuse central chest pressure, like someone sitting on chest, beginning while kneeling and gardening 2 hours ago. Activity was not strenuous. Symptoms remain present, with pain spreading mainly to left arm and shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Heart feels faster now, attributed to stress about the situation; no earlier increased heartbeat noticed today.\n- High blood pressure. No diabetes. Cholesterol never checked. Describes self as overweight.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly. Generally inactive.\n- Father died of a heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes swelling, described as mild and not life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone and currently alone at home. Front door open. Works as a restaurant owner, owning a sushi shop.\n\n## Objective\n- Video consultation.\n\n## Assessment\n- Possible heart attack; clinician explained this is not confirmed but is the first priority to exclude.\n\n## Plan\n- Ambulance arranged through colleague; patient informed it was on the way.\n- Advised to remain near the front door with it open for ambulance access.\n- Reassured that help was coming. Plan to remain on the line until ambulance arrival and hand over to the team.\n- Explained ambulance team would assess and perform an electrocardiogram; destination hospital would depend on its findings and treatment required.\n- Advised to communicate the aspirin reaction details to hospital staff, as aspirin might still need consideration despite the allergy.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 61, "Hi," ], [ 118, 136, "Doctor Dean Resor" ], [ 142, 153, "" ], [ 174, 203, "That's the same thing. 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OK," ], [ 7504, 7509, "" ] ], "grade": { "facts": [ [ "yes", "\"beginning while kneeling and gardening 2 hours ago\"." ], [ "yes", "\"chest pressure, like someone sitting on chest\"." ], [ "yes", "\"Associated nausea\"." ], [ "yes", "\"No vomiting\"." ], [ "yes", "\"sweating\" listed." ], [ "yes", "\"shortness of breath\" listed." ], [ "yes", "\"Symptoms remain present\"." ], [ "yes", "\"diffuse central chest pressure\"; central conveys not to one side." ], [ "yes", "\"diffuse central chest pressure\"." ], [ "yes", "\"spreading mainly to left arm\"." ], [ "yes", "\"and shoulder\"." ], [ "yes", "\"while kneeling and gardening... Activity was not strenuous\"." ], [ "yes", "\"First episode\"." ], [ "yes", "\"Heart feels faster now, attributed to stress\"." ], [ "yes", "\"Generally inactive\"." ], [ "yes", "\"Smokes 10 cigarettes daily\"." ], [ "yes", "\"for 15 years\"." ], [ "yes", "\"Drinks 7–8 pints of beer weekly\"." ], [ "yes", "\"Describes self as overweight\"." ], [ "yes", "\"High blood pressure\"." ], [ "yes", "\"No diabetes\"." ], [ "yes", "\"Cholesterol never checked\"." ], [ "yes", "\"Father died of a heart attack around age 60\"." ], [ "yes", "\"Mother had heart problems\"." ], [ "yes", "\"Aspirin allergy\"." ], [ "yes", "\"causes swelling, described as mild and not life-threatening\"." ], [ "yes", "\"No other allergies\"." ], [ "yes", "\"Possible heart attack; ... not confirmed but is the first priority to exclude\"." ], [ "yes", "\"Ambulance arranged through colleague\"." ], [ "yes", "\"perform an electrocardiogram\"." ], [ "yes", "\"destination hospital would depend on its findings and treatment required\"." ], [ "yes", "\"communicate the aspirin reaction details to hospital staff, as aspirin might still need consideration\"." ], [ "yes", "\"remain on the line until ambulance arrival and hand over to the team\"." ] ], "claims": [], "significantMarks": [ { "i": 4, "reason": "Patient's first name transcribed as Dean instead of Jim; wrong patient identity in the record." }, { "i": 53, "reason": "Missed \"and I did\" today, which changes whether a faster heartbeat was noticed today (palpitation history)." }, { "i": 83, "reason": "Father's age at heart attack transcribed as \"6\" instead of sixty; wrong number in family history." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Hanah", "case": "day2_consultation07", "run": 5, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Thanks. What about something very different than that?\n\n Uh, hi there. Good morning.\n\n Hi, good morning.\n\n Um, I'm Dr. Dean Merzer from GP at home. Nice to see you.\n\n Nice to see you too.\n\n Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah, sure.\n\n Sure.\n\n Um, my name is Tim Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n Yeah.\n\n So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct?\n\n Yeah, yeah, around that. Yeah, about 60, yeah.\n\n 60. Okay, perfect. All right.\n\n Yeah.\n\n So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n Yes, I am, yeah.\n\n Okay, fantastic. So, um, how can I help you today?\n\n Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n Um, no, they're still present.\n\n Okay. So you've still got the chest discomfort right now?\n\n Yes.\n\n Okay. Um, we're probably going to have to call an ambulance for you.\n\n Okay.\n\n To take you to the hospital. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n Yeah, sure.\n\n It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n Sure.\n\n So just to— just to double-check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n Okay.\n\n I mean, it's quite a diffuse pain.\n\n Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n Yeah, it's— it's, um, mainly in my left arm, uh, it's feeling a little bit— um, uh, painful.\n\n Okay.\n\n And— and in my shoulder as well.\n\n Right, okay. Do you remember what you were doing at the time?\n\n Uh, yeah, so it started, uh, just when I was gardening. So nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything, it wasn't doing any physical exercise.\n\n Sure, okay. And— and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n No, I don't— I— I generally don't do much activity at all.\n\n Okay.\n\n Um, yeah.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, okay. Can—\n\n Yeah.\n\n Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Um, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n Okay.\n\n Um, today.\n\n So I— I know you're stressed. We've got an ambulance coming on the way. Okay?\n\n Yeah.\n\n So, um, we'll take care of everything, so don't— don't worry.\n\n Okay, thank you.\n\n We'll put you in the house with you at the moment.\n\n Uh, no, no one's in the house at the moment.\n\n Okay. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n Okay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you.\n\n Yeah.\n\n All right.\n\n Yeah.\n\n Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n How— how long have you been smoking for?\n\n Uh, for the past 15 years.\n\n 15 years. Okay. Um.\n\n Yeah.\n\n Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n Okay. Have you ever had your cholesterol checked?\n\n No.\n\n Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did—\n\n Yes.\n\n Did either of them have any heart problems or heart attacks or anything like that?\n\n Um, yes, so my, um, father died of a heart attack.\n\n Okay.\n\n Um, and my mother had some heart problems.\n\n Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n Um, he was about my age.\n\n Right, so about just under 6— around 60.\n\n Yes, around 60, yes.\n\n Okay. All right. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n Okay. Is that a— a beer you're talking about?\n\n Oh, beer, yes.\n\n Okay. Um, I— I can't tell from the video. Are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right.\n\n Yeah.\n\n Okay. All right. Um, uh, now, um, you're— do you normally live alone?\n\n Uh, yeah, I live alone, uh, at the moment, yeah.\n\n Okay.\n\n Uh, it's just me in the house.\n\n Sure. Okay. And— and, uh, are you working at the moment?\n\n Yeah, yeah, I— I work, yeah.\n\n Right. What do you work as?\n\n Um, I work as a restaurant owner.\n\n Okay.\n\n So I own a sushi shop.\n\n Right, okay.\n\n Yeah.\n\n All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n Okay.\n\n So I'm not saying you definitely have a heart attack, but we— that— so our number one priority to exclude that, okay?\n\n Okay.\n\n So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n Okay.\n\n All right.\n\n Yeah, thank you.\n\n When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then.\n\n Okay.\n\n They'll decide where to take you after that, okay?\n\n Okay.\n\n And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, okay.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a— an allergic reaction?\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n Okay. All right.\n\n Yeah.\n\n It's very important that you communicate that to the hospital.\n\n Okay.\n\n And how detailed you've just told me, because, um, we— we may need to consider aspirin despite.\n\n Oh, okay.\n\n Allergy, okay? Um.\n\n Okay.\n\n All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what the ECG looks like and what kind of treatment you might need, okay? Um.\n\n Okay.\n\n What I'm going to do is we'll stay on the line for the time being.\n\n Okay.\n\n Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on, all right?\n\n Okay. Okay, sure.\n\n Okay.\n\n Yeah, thank you.\n\n Thank you. Is it now? We'll— we'll end the conversation now for the purposes?\n\n Yeah.\n\n Is that okay?\n\n That's okay. Okay, thank you very much.\n\n Okay, thanks. Bye.\n\n Thank you, bye.", "note": "## Subjective\n- First episode of ongoing diffuse central chest pressure, described as a weight on the chest, starting a couple of hours ago while kneeling and gardening without strenuous exertion. Radiates to left arm and shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Heart feels faster now, attributed to stress about the situation; no earlier increased heartbeat noticed today.\n- History of high blood pressure. No diabetes. Cholesterol never checked. Reports being overweight and generally inactive.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly.\n- Father died of a heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes mild swelling, described as not life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone; no one currently present. Front door open. Owns a sushi restaurant.\n\n## Objective\n- Video consultation. No measured observations or examination findings documented.\n\n## Assessment\n- Possible heart attack; not confirmed. Urgent exclusion is the priority.\n\n## Plan\n- Ambulance arranged for urgent assessment and hospital transfer; clinician advised it was on the way.\n- Advised remaining near the front door and keeping it open for emergency access.\n- Reassured that help was coming. Planned to remain on the line until ambulance arrival and hand over to the crew.\n- Explained that ambulance crew would perform an electrocardiogram; destination hospital and treatment would depend on findings.\n- Advised communicating the aspirin reaction and its details to the hospital. Explained that aspirin might still need consideration despite the reported allergy.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 61, "Hi," ], [ 118, 121, "Doctor" ], [ 127, 133, "Resor" ], [ 139, 150, "" ], [ 171, 200, "That's the same thing. 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OK," ], [ 7568, 7573, "" ] ], "grade": { "facts": [ [ "yes", "\"starting a couple of hours ago\"." ], [ "yes", "\"chest pressure, described as a weight on the chest\" preserves pressure-not-pain, someone-sitting quality." ], [ "yes", "\"Associated nausea\"." ], [ "yes", "\"No vomiting.\"" ], [ "yes", "\"sweating\" listed." ], [ "yes", "\"shortness of breath\" listed." ], [ "yes", "\"ongoing\" chest pressure; ambulance plan reflects current symptoms." ], [ "yes", "\"diffuse central chest pressure\" captures central location." ], [ "yes", "\"diffuse\" stated." ], [ "yes", "\"Radiates to left arm\"." ], [ "yes", "\"and shoulder\"." ], [ "yes", "\"while kneeling and gardening without strenuous exertion\"." ], [ "yes", "\"First episode\"." ], [ "yes", "\"Heart feels faster now, attributed to stress\"." ], [ "yes", "\"generally inactive\"." ], [ "yes", "\"Smokes 10 cigarettes daily\"." ], [ "yes", "\"for 15 years\"." ], [ "yes", "\"Drinks 7-8 pints of beer weekly\"." ], [ "yes", "\"Reports being overweight\"." ], [ "yes", "\"History of high blood pressure\"." ], [ "yes", "\"No diabetes.\"" ], [ "yes", "\"Cholesterol never checked.\"" ], [ "yes", "\"Father died of a heart attack around age 60\"." ], [ "yes", "\"Mother had heart problems.\"" ], [ "yes", "\"Aspirin allergy\"." ], [ "yes", "\"causes mild swelling, described as not life-threatening\"." ], [ "yes", "\"No other allergies.\"" ], [ "yes", "\"Possible heart attack; not confirmed. Urgent exclusion is the priority.\"" ], [ "yes", "\"Ambulance arranged\"." ], [ "yes", "\"ambulance crew would perform an electrocardiogram\"." ], [ "yes", "\"destination hospital and treatment would depend on findings\"." ], [ "yes", "Advised communicating aspirin reaction details to hospital; aspirin may still need consideration." ], [ "yes", "\"remain on the line until ambulance arrival and hand over to the crew\"." ] ], "claims": [], "significantMarks": [ { "i": 6, "reason": "Patient name transcribed as Tim instead of Jim; wrong patient identity in the record." }, { "i": 2, "reason": "Clinician surname Merzer instead of Resor; wrong clinician identity in the record." } ] }, "generation": { "date": "2026-10-24", "model": "gpt-6.1-sol", "effort": "low", "source": "regenerated from captured transcript" } }, { "product": "Heidi", "case": "day1_consultation06", "run": 1, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes, I can hear you. Okay, great. So you're your doctor? I am, yes. Doctor Seed here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, it's become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. The drugs. Sure. Okay. All right. Um, fine, so moving on to your, uh, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh... But then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what had happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or, um. Um. Uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, metoprolol. That metoprolol, was it? Or, uh, metoprolol. Sorry. The connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? So any medications? No. No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nIs your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I've got two cats. You got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. Do you do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and walk to the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you, you said you're feeling more breathless even walking to the stop, uh, to the shop, she said. Um, right. So, um, based on your, based on your history and having listened to all your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know- That's- It's- What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously, having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options- Yeah... to move forward. Um-\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. Do you think that would be better? I think I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan is it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good Oh, yes. Remember that.\n\nSorry? Uh, yeah, I remember now. You remember now? Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like- would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\nOkay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And I wish you all the best. Have a good day. See you soon. Okay. Thank you.", "note": "Subjective\n\n- SOB for ~2 weeks, worsening over last few days\n\n- Breathlessness on minimal exertion - walking to shops and around house\n\n- Dry cough, not troublesome\n\n- Bilateral ankle swelling over last few days\n\n- Feeling slightly run down, otherwise well\n\n- Denies chest pain, palpitations, skipped beats, fevers\n\n- Appetite and urination normal\n\n\n\n\nPast Medical History\n\n- Heart failure - previously diagnosed, managed with medication\n\n- MI (\"small heart attack\") ~5 years ago, presented with chest pain, few days hospitalisation\n\n\n\n\nMedications\n\n- Furosemide (dose not recalled)\n\n- Aspirin\n\n- Metoprolol\n\n- Simvastatin\n\n\n\n\nAllergies\n\n- NKDA\n\n\n\n\nFamily History\n\n- Father: died early 60s from MI\n\n- Mother: alive, osteoporosis\n\n\n\n\nSocial History\n\n- Lives alone with two cats\n\n- Works part-time as lorry driver, day shifts; finds work exhausting; concerned re ability to work if health deteriorates\n\n- Ex-smoker: ~1 pack/day for 25 years, stopped\n\n- Nil alcohol\n\n- Walks to shops once daily\n\n\n\n\nObjective\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment\n\n- Likely flare-up of heart failure\n\n\n\n\nPlan\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC, renal function\n\n- Echocardiogram to assess cardiac function\n\n- Review in 1 week\n\n- Safety netting: advised to call sooner if worsening SOB, chest pain, palpitations or dizziness", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 19, 19, "Uh," ], [ 44, 49, "OK?" ], [ 72, 77, "OK," ], [ 85, 107, "" ], [ 119, 130, "Nice to see you" ], [ 182, 182, "Are you the doctor?" ], [ 254, 259, "OK." ], [ 415, 415, "now" ], [ 603, 607, "really" ], [ 663, 668, "" ], [ 707, 708, "" ], [ 744, 755, "OK. 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See you soon." ] ], "grade": { "facts": [ [ "yes", "'SOB for ~2 weeks'" ], [ "yes", "'SOB for ~2 weeks, worsening' captures gradual worsening over two weeks." ], [ "yes", "'worsening over last few days'." ], [ "partial", "Notes breathlessness walking to shops but not that he was previously fine or must sit to catch breath." ], [ "yes", "'Breathlessness on minimal exertion - walking to shops and around house'." ], [ "no", "Patient's worry that his heart failure is getting worse is not recorded." ], [ "yes", "'Denies chest pain'." ], [ "yes", "'Dry cough, not troublesome'." ], [ "yes", "'Feeling slightly run down, otherwise well'." ], [ "yes", "'Bilateral ankle swelling'." ], [ "yes", "'over last few days'." ], [ "no", "Previous ankle swelling during prior heart failure episode not mentioned." ], [ "yes", "'Denies ... palpitations, skipped beats'." ], [ "yes", "'Denies ... fevers'." ], [ "yes", "'Appetite ... normal'." ], [ "partial", "'urination normal' omits that he urinates a lot since starting the diuretic." ], [ "yes", "'Heart failure - previously diagnosed'." ], [ "partial", "'managed with medication' but omits initial breathlessness that improved on treatment." ], [ "partial", "'MI (\"small heart attack\") ~5 years ago' but omits 'more than angina'/diagnosis not recalled." ], [ "yes", "'presented with chest pain, few days hospitalisation'." ], [ "no", "Being well since the heart attack is not recorded." ], [ "no", "Prior echocardiogram not mentioned." ], [ "no", "No statement that there is no other past medical history." ], [ "yes", "'Furosemide'." ], [ "partial", "'dose not recalled' captured; current one tablet daily only implied by plan." ], [ "yes", "'Aspirin'." ], [ "no", "Note lists 'Metoprolol' instead of bisoprolol." ], [ "yes", "'NKDA'." ], [ "yes", "'Father: died early 60s from MI'." ], [ "yes", "'early 60s'." ], [ "yes", "'Mother: alive, osteoporosis'." ], [ "yes", "'Lives alone with two cats'." ], [ "yes", "'Works part-time as lorry driver'." ], [ "yes", "'finds work exhausting; concerned re ability to work if health deteriorates'." ], [ "yes", "'Ex-smoker'." ], [ "yes", "'~1 pack/day'." ], [ "yes", "'for 25 years'." ], [ "yes", "'Nil alcohol'." ], [ "yes", "'Walks to shops once daily'." ], [ "yes", "'Chest: NAD'." ], [ "yes", "'Saturations: normal'." ], [ "yes", "'BP: normal'." ], [ "yes", "'otherwise well' recorded." ], [ "partial", "'Likely flare-up of heart failure' but omits heart not pumping as well as it should." ], [ "yes", "'Increase furosemide to one tablet twice daily'." ], [ "no", "Increase for the first few days then reassess is not captured." ], [ "partial", "'FBC' listed but purpose (anaemia) not stated." ], [ "yes", "'renal function'." ], [ "yes", "'Echocardiogram to assess cardiac function'." ], [ "no", "Requested today and one-to-two-week wait not mentioned." ], [ "yes", "'Review in 1 week'." ], [ "yes", "'call sooner if worsening SOB'." ], [ "yes", "'chest pain, palpitations or dizziness'." ] ], "claims": [ { "claim": "Medications: Metoprolol", "reason": "Patient confirmed he takes bisoprolol; metoprolol was only the clinician's mishearing, corrected by the patient.", "fact": 26 }, { "claim": "Medications: Simvastatin", "reason": "Simvastatin is never mentioned in the reference transcript; invented medication.", "fact": null } ], "significantMarks": [ { "i": 80, "reason": "Drug name bisoprolol transcribed as metoprolol." }, { "i": 81, "reason": "Patient's correction 'Bisoprolol' transcribed as metoprolol, reversing the medication record." }, { "i": 85, "reason": "Inserts 'simvastatin', a medication never mentioned." }, { "i": 143, "reason": "'Furosemide' transcribed as 'fruit', losing the drug name in the dose-change plan." }, { "i": 161, "reason": "'Furosemide' transcribed as 'fruit' in the treatment plan." } ] } }, { "product": "Heidi", "case": "day1_consultation06", "run": 2, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello? Hello there. Hello. Can you hear me? Okay.\n\nYeah. Okay. Great. Are you a doctor? Oh, I am. Yes. Doctor Seed here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, it's become quite troublesome in the last few days. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh-\n\nA while ago, and I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that, is that both ankle? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. With the drugs. Sure. Okay. All right. Um, fine, so moving on to your, uh, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh... But then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or, um. Um, uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, zoprolol. That metoprolol, was it? Or Loprolol. Sorry. The connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? Take any medications? No. No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of?\n\nUm, my mother had osteoporosis. Okay. Is your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\nUh, I work part-time as a, uh, lorry driver. Okay, and how is that? Is that quite stressful, long hours? Uh, it's okay. Um, I, uh... Yeah, like, when I'm working, it's pretty exhausting. Mm-hmm. Um, I guess I'm a bit worried that if I get sick, I won't-- if I get more sick, then I won't be able to work properly. Yeah, there's certainly a consideration, isn't there? So let's, let's try and get you better soon so it doesn't have any, um- Yeah... impact on your, on your job. And, and do you find yourself doing a lot of antisocial hours? Do you sort of, do, do you do a lot of night driving, weekend driving?\n\nOh, no. I I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. So do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you, but well done for stopping.\n\nUm, and what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? Uh, I try and walk to the shops at least once a day. Okay. Um, okay. But, uh, that's about it. I've... Yeah, I don't, I don't go running like I used to when I was young. Right, okay. And certainly now with your symptoms, y- you, you said you're feeling more breathless even walking to the stop, uh, to the shop, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know-\n\nIt's What's going on? So I seem like your heart's not pumping as well as it should be. And, obviously, having diagnosed with heart failure, there's obviously it's the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of fruit. So maybe rather than a one tablet a day, we can give you two tablets a day for the first few days and see and see how you're getting on. Okay. Do you think that would be better? I I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\nOkay. Is that something you've had? Yeah. So, um, an echo scan. It's a it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good Oh, yes, I remember now. Sorry? Uh, yeah, I remember now. Remember now? Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day.\n\nI really like, would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And then I wish you all the best. Have a good day. See you soon. Okay. Thank you.", "note": "Subjective\n\n- Increasing dyspnoea over last couple of weeks, significantly worse in last few days\n\n- Breathlessness on minimal exertion - walking to shops and around house\n\n- Dry cough, not troublesome\n\n- Bilateral ankle swelling over last few days\n\n- No chest pain\n\n- No palpitations or skipped heartbeats\n\n- No fevers\n\n- Appetite normal\n\n- Urinary output normal\n\n- Feeling slightly run down, otherwise well\n\n\n\n\nObjective\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment\n\n- Possible exacerbation of heart failure\n\n\n\n\nPlan\n\n- Increase Furosemide to one tablet twice daily for a few days\n\n- Bloods: FBC, renal function (check for anaemia and kidney function)\n\n- Echocardiogram to assess cardiac function (previously performed at diagnosis)\n\n- Review in one week\n\n- Advised to contact sooner if symptoms worsen (increased breathlessness, chest pain, palpitations, dizziness)", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 19, 19, "Uh," ], [ 44, 73, "OK? Yes, I can hear" ], [ 78, 91, "OK, great." ], [ 103, 114, "Nice to see you" ], [ 127, 127, "Um," ], [ 162, 162, "Are you the doctor? Um," ], [ 230, 235, "OK." ], [ 391, 391, "now" ], [ 578, 582, "really" ], [ 638, 643, "" ], [ 682, 683, "" ], [ 719, 730, "OK. OK. OK." ], [ 839, 844, "OK." ], [ 883, 883, "Um," ], [ 938, 944, "" ], [ 979, 979, "um," ], [ 1039, 1039, "OK. Right." ], [ 1047, 1052, "OK." ], [ 1070, 1089, "you're feeling, uh," ], [ 1171, 1174, "it's" ], [ 1191, 1191, "Um, uh," ], [ 1281, 1281, "Um," ], [ 1324, 1324, "uh, uh," ], [ 1405, 1410, "OK. And" ], [ 1434, 1434, "coughing," ], [ 1451, 1451, "Um. Uh," ], [ 1513, 1524, "OK. OK." ], [ 1581, 1581, "uh," ], [ 1625, 1634, "run-down," ], [ 1679, 1684, "OK." ], [ 1731, 1736, "OK." ], [ 1786, 1793, "it's" ], [ 1820, 1825, "OK." ], [ 1852, 1871, "Kind of" ], [ 1926, 1931, "Both ankles? OK." ], [ 2067, 2071, "Past" ], [ 2082, 2087, "OK." ], [ 2232, 2243, "OK. OK." ], [ 2254, 2259, "OK." ], [ 2296, 2296, "you're" ], [ 2303, 2303, "in" ], [ 2494, 2510, "reporting" ], [ 2530, 2534, "" ], [ 2557, 2557, "any," ], [ 2567, 2567, "any," ], [ 2669, 2674, "OK." ], [ 2715, 2720, "OK." ], [ 2778, 2783, "OK?" ], [ 2812, 2817, "OK." ], [ 2827, 2839, "waterworks?" ], [ 2862, 2867, "OK?" ], [ 2878, 2883, "but" ], [ 2911, 2921, "ever since" ], [ 2933, 2955, "Yeah. Sure, OK. Alright." ], [ 2969, 2981, "" ], [ 3273, 3275, "into" ], [ 3286, 3291, "OK." ], [ 3342, 3347, "OK. And when," ], [ 3360, 3360, "a" ], [ 3424, 3424, "a," ], [ 3447, 3447, "Um." ], [ 3489, 3489, "something" ], [ 3491, 3491, "uh," ], [ 3535, 3560, "It's more hard to say. OK." ], [ 3615, 3619, "that it, uh," ], [ 3662, 3667, "OK." ], [ 3745, 3750, "and," ], [ 3755, 3760, "OK. OK." ], [ 3781, 3785, "OK" ], [ 3810, 3814, "OK" ], [ 3827, 3843, "OK, alright." ], [ 3993, 4004, "OK. OK." ], [ 4090, 4090, "And" ], [ 4149, 4160, "" ], [ 4173, 4176, "" ], [ 4215, 4218, "" ], [ 4256, 4259, "I" ], [ 4274, 4274, "That's OK." ], [ 4341, 4346, "OK." ], [ 4356, 4370, "Bisoprolol. The" ], [ 4394, 4403, "Uh, Bisoprolol." ], [ 4415, 4428, "connection's" ], [ 4444, 4449, "OK." ], [ 4461, 4465, "yeah." ], [ 4471, 4517, "And a thousand, OK. Alright." ], [ 4540, 4544, "" ], [ 4562, 4565, "Uh," ], [ 4584, 4589, "No. OK." ], [ 4632, 4632, "uh," ], [ 4906, 4910, "sixties." ], [ 4917, 4931, "sixties, OK. Alright." ], [ 5001, 5006, "OK." ], [ 5041, 5045, "yeah," ], [ 5066, 5082, "OK, alright." ], [ 5209, 5209, "Well," ], [ 5247, 5252, "OK," ], [ 5362, 5367, "OK." ], [ 5425, 5436, "day to day," ], [ 5514, 5519, "OK." ], [ 5583, 5588, "OK." ], [ 5608, 5613, "" ], [ 5656, 5663, "Mm." ], [ 5789, 5796, "that's" ], [ 5830, 5836, "it?" ], [ 5909, 5916, "" ], [ 5946, 5950, "No. Uh," ], [ 5991, 6001, "anti-social" ], [ 6016, 6028, "" ], [ 6081, 6084, "Ohh" ], [ 6161, 6166, "OK. OK," ], [ 6215, 6227, "'cause that" ], [ 6293, 6295, "Do you," ], [ 6321, 6329, "any more." ], [ 6403, 6406, "Ooh" ], [ 6455, 6455, "Um," ], [ 6498, 6501, "Ohh" ], [ 6511, 6512, "oof," ], [ 6537, 6556, "OK. And what about the" ], [ 6567, 6569, "That" ], [ 6585, 6589, "" ], [ 6609, 6626, "" ], [ 6651, 6654, "" ], [ 6698, 6703, "OK." ], [ 6801, 6806, "OK." ], [ 6811, 6816, "" ], [ 6917, 6917, "OK." ], [ 6925, 6930, "OK." ], [ 6949, 6953, "" ], [ 6969, 6976, "you, you're," ], [ 7037, 7042, "" ], [ 7060, 7063, "she" ], [ 7081, 7084, "Ohh" ], [ 7113, 7117, "you" ], [ 7161, 7164, "" ], [ 7280, 7312, "uh, Mmm. That. It's" ], [ 7316, 7322, "it seems" ], [ 7377, 7377, "Um," ], [ 7449, 7453, "What's going on. Um, that's" ], [ 7492, 7492, "Um," ], [ 7525, 7527, "" ], [ 7541, 7541, "Um, Mmm." ], [ 7673, 7678, "OK," ], [ 7720, 7729, "Furosemide." ], [ 7748, 7749, "" ], [ 7775, 7783, "do" ], [ 7824, 7824, "Um," ], [ 7864, 7872, "OK. If" ], [ 7883, 7893, "that'll" ], [ 7904, 7904, "Uh," ], [ 7906, 7906, "think," ], [ 8146, 8151, "OK." ], [ 8181, 8181, "before?" ], [ 8199, 8209, "" ], [ 8224, 8229, "general" ], [ 8254, 8257, "might" ], [ 8267, 8269, "this" ], [ 8335, 8338, "What does that? Ohh" ], [ 8392, 8392, "You" ], [ 8402, 8412, "that. OK," ], [ 8465, 8465, "And," ], [ 8470, 8476, "that might" ], [ 8790, 8796, "Furosemide," ], [ 8838, 8838, "But" ], [ 8945, 8949, "" ], [ 9075, 9080, "feel like" ], [ 9199, 9199, "uh," ], [ 9210, 9214, "" ], [ 9307, 9312, "OK." ], [ 9336, 9341, "OK?" ], [ 9375, 9375, "Uh," ], [ 9453, 9453, "well" ], [ 9496, 9499, "OK. Thank" ], [ 9504, 9526, "OK. See you soon." ] ], "grade": { "facts": [ [ "yes", "\"Increasing dyspnoea\" captures shortness of breath." ], [ "yes", "\"Increasing dyspnoea over last couple of weeks\"." ], [ "yes", "\"significantly worse in last few days\"." ], [ "partial", "\"walking to shops\" noted as breathless, but prior baseline and needing to sit down not captured." ], [ "yes", "\"Breathlessness on minimal exertion - walking to shops and around house\"." ], [ "no", "Patient's concern that his heart failure is worsening is not recorded." ], [ "yes", "\"No chest pain\"." ], [ "yes", "\"Dry cough, not troublesome\"." ], [ "yes", "\"Feeling slightly run down, otherwise well\"." ], [ "yes", "\"Bilateral ankle swelling\"." ], [ "yes", "\"Bilateral ankle swelling over last few days\"." ], [ "no", "Previous ankle swelling during prior heart failure episode not mentioned." ], [ "yes", "\"No palpitations or skipped heartbeats\"." ], [ "yes", "\"No fevers\"." ], [ "yes", "\"Appetite normal\"." ], [ "partial", "\"Urinary output normal\" omits that he urinates a lot since starting the diuretic." ], [ "partial", "Known heart failure only implied via \"exacerbation of heart failure\"; no PMH documented." ], [ "no", "Initial breathlessness at diagnosis improving with medication not mentioned." ], [ "no", "Previous small heart attack five years ago not documented." ], [ "no", "Chest pain presentation and hospital admission not documented." ], [ "no", "Wellness since the heart attack not documented." ], [ "yes", "\"Echocardiogram ... (previously performed at diagnosis)\"." ], [ "no", "No statement about absence of other past medical history." ], [ "partial", "Furosemide use only implied by \"Increase Furosemide\"; no medication list." ], [ "no", "Current dose of one tablet daily and unknown mg dose not stated." ], [ "no", "Aspirin not mentioned." ], [ "no", "Bisoprolol not mentioned." ], [ "no", "Allergy status not documented." ], [ "no", "Family history of father's heart attack not documented." ], [ "no", "Father's age at death not documented." ], [ "no", "Mother's osteoporosis not documented." ], [ "no", "Social history (lives alone) not documented." ], [ "no", "Occupation as part-time lorry driver not documented." ], [ "no", "Work exhaustion and worry about working not documented." ], [ "no", "Smoking history not documented." ], [ "no", "Pack-a-day smoking not documented." ], [ "no", "Smoking duration of 25 years not documented." ], [ "no", "Alcohol status not documented." ], [ "no", "Usual daily walk to shops as exercise not documented as baseline." ], [ "yes", "\"Chest: NAD\"." ], [ "yes", "\"Saturations: normal\"." ], [ "yes", "\"BP: normal\"." ], [ "yes", "\"otherwise well\" recorded." ], [ "yes", "\"Possible exacerbation of heart failure\"; pumping detail omitted but diagnosis captured." ], [ "yes", "\"Increase Furosemide to one tablet twice daily\"." ], [ "yes", "\"for a few days\" captures the short-term increase." ], [ "yes", "\"Bloods: FBC ... check for anaemia\"." ], [ "yes", "\"renal function\"." ], [ "yes", "\"Echocardiogram to assess cardiac function\"." ], [ "no", "Requesting echo today and 1-2 week wait not stated." ], [ "yes", "\"Review in one week\"." ], [ "yes", "\"contact sooner if symptoms worsen (increased breathlessness...)\"." ], [ "yes", "\"chest pain, palpitations, dizziness\" listed in safety-net." ] ], "claims": [], "significantMarks": [ { "i": 79, "reason": "Drug name misheard: 'zoprolol' instead of Bisoprolol." }, { "i": 80, "reason": "Drug name misheard: 'Loprolol' instead of Bisoprolol confirmation." }, { "i": 84, "reason": "Invented medication 'simvastatin' not said by patient." }, { "i": 142, "reason": "Furosemide transcribed as 'fruit', losing the drug being increased." }, { "i": 161, "reason": "Furosemide transcribed as 'fruit' in the dose-change plan." } ] } }, { "product": "Heidi", "case": "day1_consultation06", "run": 3, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes. I can do you. Okay. Great. So you're your doctor. I am. Yes. Doctor. Seod here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Can you tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, and it's become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that, is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay, and how about your appetite? Are you eating and drinking okay?\n\nYeah, I'm, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. The, the, the drugs that I've done. Sure. Okay. All right. Um, fine, so moving on to your, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh, but then I just got better.\n\nOkay. Um, when you say small heart attack, did they give you a name for what happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or, um. Um, uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't. But I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, um, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, metoprolol. That metoprolol, was it? Or, uh, metoprolol. Sorry. The connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? So any medications? No. No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nIs your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I've got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. I kinda like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. So do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you that well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and walk to the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay, and certainly now with your symptoms, y- you, you said you're feeling more breathless even walking to the stop- uh, to the shop, she said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know- That's- It's- What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously, having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options- Yeah... to move forward. Um-\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. If you think that would be better. I I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan is it's a jelly scan of your heart. You may have had this done before when you were diagnosed, and it's just to get a good Oh, yes. I remember now.\n\nSorry? Uh, yeah, I remember now. You remember now? Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like- would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\nOkay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. Now I wish you all the best. Have a good day. See you soon. Okay. Thank you.", "note": "Subjective:\n\n- Increasing dyspnoea over past 2 weeks, significantly worse in last few days\n\n- Difficulty walking to shops; now breathless with minimal exertion around house\n\n- Mild dry cough\n\n- Bilateral ankle swelling, noticed over last few days\n\n- No chest pain\n\n- No palpitations or skipped heartbeats\n\n- No temperatures/fevers\n\n- Appetite normal\n\n- Urination normal\n\n- Feeling slightly run down, otherwise well\n\n- Worried about worsening heart failure\n\n\n\n\nPast Medical History:\n\n- Heart failure, previously managed with medication\n\n- Small heart attack ~5 years ago; presented with chest pain, brief hospitalisation, diagnosis more than angina\n\n\n\n\nMedications:\n\n- Furosemide (dose not recalled)\n\n- Aspirin\n\n- Metoprolol\n\n- Simvastatin\n\n\n\n\nAllergies:\n\n- NKDA\n\n\n\n\nFamily History:\n\n- Father died of heart attack in early 60s\n\n- Mother has osteoporosis, still living\n\n\n\n\nSocial History:\n\n- Lives alone with two cats\n\n- Works part-time as lorry driver, day shifts only; finds work exhausting\n\n- Ex-smoker, ~1 pack/day for 25 years\n\n- Non-drinker\n\n- Walks to shops daily; current symptoms limiting this\n\n\n\n\nObjective:\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment:\n\n- Possible flare-up of heart failure\n\n\n\n\nPlan:\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC, renal function\n\n- Organise echocardiogram\n\n- Review in 1 week\n\n- Advised to contact sooner if dyspnoea worsens or new symptoms develop (chest pain, palpitations, dizziness)", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 19, 19, "Uh," ], [ 44, 49, "OK?" ], [ 62, 64, "hear" ], [ 70, 75, "OK," ], [ 83, 105, "" ], [ 117, 129, "Nice to see you" ], [ 142, 142, "Um," ], [ 177, 177, "Are you the doctor? 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OK." ], [ 4121, 4121, "And" ], [ 4180, 4191, "" ], [ 4204, 4207, "" ], [ 4246, 4249, "" ], [ 4287, 4290, "I" ], [ 4305, 4305, "That's OK." ], [ 4372, 4377, "OK." ], [ 4387, 4403, "Bisoprolol. The" ], [ 4432, 4443, "Bisoprolol." ], [ 4455, 4468, "connection's" ], [ 4484, 4489, "OK." ], [ 4501, 4505, "yeah." ], [ 4511, 4557, "And a thousand, OK. Alright." ], [ 4580, 4582, "" ], [ 4600, 4603, "Uh," ], [ 4622, 4627, "No. OK." ], [ 4670, 4670, "uh," ], [ 4944, 4948, "sixties." ], [ 4955, 4969, "sixties, OK. Alright." ], [ 5038, 5043, "OK." ], [ 5079, 5083, "yeah," ], [ 5104, 5120, "OK, alright." ], [ 5248, 5252, "Well, I" ], [ 5288, 5293, "OK," ], [ 5403, 5408, "OK." ], [ 5466, 5477, "day to day," ], [ 5536, 5536, "uh," ], [ 5551, 5556, "OK." ], [ 5610, 5610, "Uh," ], [ 5616, 5621, "OK. Um," ], [ 5624, 5635, "uh, yeah" ], [ 5677, 5677, "Mm. 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That." ], [ 7267, 7283, "" ], [ 7425, 7425, "What's going on." ], [ 7430, 7434, "that's" ], [ 7512, 7522, "" ], [ 7540, 7540, "Mmm." ], [ 7664, 7664, "are" ], [ 7669, 7674, "OK," ], [ 7716, 7725, "Furosemide." ], [ 7769, 7777, "do" ], [ 7819, 7819, "Um," ], [ 7859, 7864, "OK." ], [ 7878, 7888, "that'll" ], [ 7899, 7899, "Uh," ], [ 7901, 7901, "think," ], [ 8140, 8145, "OK." ], [ 8175, 8175, "before?" ], [ 8185, 8200, "um, an it's a," ], [ 8208, 8213, "general" ], [ 8238, 8241, "might" ], [ 8321, 8324, "What does that? Ohh" ], [ 8393, 8403, "that. OK," ], [ 8456, 8456, "And," ], [ 8461, 8467, "that might" ], [ 8781, 8787, "Furosemide," ], [ 8939, 8943, "" ], [ 9069, 9074, "feel like" ], [ 9208, 9217, "" ], [ 9311, 9316, "OK." ], [ 9340, 9345, "OK?" ], [ 9379, 9379, "Uh," ], [ 9449, 9452, "and then well" ], [ 9495, 9498, "OK. Thank" ], [ 9503, 9525, "OK. See you soon." ] ], "grade": { "facts": [ [ "yes", "\"Increasing dyspnoea\"." ], [ "yes", "\"Increasing dyspnoea over past 2 weeks\"." ], [ "yes", "\"significantly worse in last few days\"." ], [ "partial", "\"Difficulty walking to shops\" captured, but not the previous baseline or needing to sit down." ], [ "yes", "\"now breathless with minimal exertion around house\"." ], [ "yes", "\"Worried about worsening heart failure\"." ], [ "yes", "\"No chest pain\"." ], [ "yes", "\"Mild dry cough\"." ], [ "yes", "\"Feeling slightly run down, otherwise well\"." ], [ "yes", "\"Bilateral ankle swelling\"." ], [ "yes", "\"noticed over last few days\"." ], [ "no", "Previous ankle swelling during an earlier heart failure episode is not mentioned." ], [ "yes", "\"No palpitations or skipped heartbeats\"." ], [ "yes", "\"No temperatures/fevers\"." ], [ "yes", "\"Appetite normal\"." ], [ "partial", "\"Urination normal\" leaves out frequent urination since starting the diuretic." ], [ "yes", "\"Heart failure, previously managed with medication\"." ], [ "partial", "Medication is mentioned, but not the breathlessness at diagnosis that improved on it." ], [ "yes", "\"Small heart attack ~5 years ago... diagnosis more than angina\"." ], [ "yes", "\"presented with chest pain, brief hospitalisation\"." ], [ "no", "The note does not say he has been well since." ], [ "no", "No mention of a previous echocardiogram." ], [ "no", "The note does not record that there is no other past medical history." ], [ "yes", "\"Furosemide\"." ], [ "partial", "\"dose not recalled\" captured, but the current one tablet daily is not stated." ], [ "yes", "\"Aspirin\"." ], [ "no", "Note lists Metoprolol instead of bisoprolol." ], [ "yes", "\"NKDA\"." ], [ "yes", "\"Father died of heart attack\"." ], [ "yes", "\"in early 60s\"." ], [ "yes", "\"Mother has osteoporosis\"." ], [ "yes", "\"Lives alone with two cats\"." ], [ "yes", "\"Works part-time as lorry driver\"." ], [ "partial", "\"finds work exhausting\" captured; worry about being unable to work is missing." ], [ "yes", "\"Ex-smoker\"." ], [ "yes", "\"~1 pack/day\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"Non-drinker\"." ], [ "yes", "\"Walks to shops daily\"." ], [ "yes", "\"Chest: NAD\"." ], [ "yes", "\"Saturations: normal\"." ], [ "yes", "\"BP: normal\"." ], [ "yes", "\"otherwise well\" in the subjective section." ], [ "partial", "\"Possible flare-up of heart failure\" captured; the explanation that the heart is not pumping well is missing." ], [ "yes", "\"Increase furosemide to one tablet twice daily\"." ], [ "no", "No mention of increasing it for the first few days and then reviewing." ], [ "partial", "\"FBC\" listed, but not its purpose (checking for anaemia)." ], [ "yes", "\"renal function\"." ], [ "partial", "\"Organise echocardiogram\" given without its purpose of assessing heart pumping." ], [ "partial", "Echo organised, but neither the request today nor the 1-2 week wait is stated." ], [ "yes", "\"Review in 1 week\"." ], [ "yes", "\"contact sooner if dyspnoea worsens\"." ], [ "yes", "\"chest pain, palpitations, dizziness\"." ] ], "claims": [ { "claim": "Medications: Metoprolol", "reason": "The patient takes bisoprolol and corrected the doctor; metoprolol is the wrong drug.", "fact": 26 }, { "claim": "Medications: Simvastatin", "reason": "The reference transcript never mentions simvastatin or any statin.", "fact": null } ], "significantMarks": [ { "i": 86, "reason": "Bisoprolol is transcribed as metoprolol, the wrong drug name." }, { "i": 87, "reason": "The patient's correction to bisoprolol is transcribed as metoprolol, the wrong drug." }, { "i": 91, "reason": "Inserts simvastatin, a medication the patient never mentioned." }, { "i": 117, "reason": "Reverses the meaning: says he likes night work when he said he doesn't." }, { "i": 150, "reason": "The drug name furosemide is lost ('fruit'), so it is unclear which dose is being increased." }, { "i": 166, "reason": "Furosemide is transcribed as 'fruit', so the drug in the plan is lost." } ] } }, { "product": "Heidi", "case": "day1_consultation06", "run": 4, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes. I can hear you. Okay. Great. Are you Doctor? Oh, I am. Yes. Doctor Seoud here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Can you tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, I've become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have gotten a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that, is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles. Um, but reporting no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. The drugs. Sure. Okay. All right. Um, fine, so moving on to your, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh... But then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what had happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um. Um, uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, Loprolol. That metoprolol, was it? Or Loprolol. Sorry, the connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all to any medications? No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s. Okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nIs your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. Okay. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. Do do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and watch the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've yeah, I don't I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you you said you're feeling more breathless even walking to the stop to the shops, you said. Um, right. So, um, based on your based on your history and having listened to all your story, I wonder whether you've had a bit of a flare up of your heart failure, sir. Um, which can sometimes happen. Um, um, and, you know, it's what's going on. So I seem like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now there's a couple of options to move forward. Um.\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. If you think that would be best. I think I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan is it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good Oh, yes.\n\nSorry? Uh, yeah, I remember now. Okay, fine. That's something I can organize for you today, and they may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like- we'd like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that- Okay.-and we can have a chat on the phone as well.\n\nOkay, I'll see how I get on. Okay. Do you have any questions for me? Uh, I think that's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best. Have a good day. See you soon. Okay. Thank you.", "note": "Subjective\n\n\n\n\n- Worsening SOB over last 2 weeks, significantly worse in last few days\n\n- Now breathless on minimal exertion; previously able to walk to shops without issue\n\n- Worried about symptoms\n\n- Dry cough, not troublesome\n\n- Mild lethargy, feeling \"run down\"\n\n- Bilateral ankle swelling over last few days (similar to previous heart failure flare)\n\n- Denies: chest pain, palpitations, skipped heartbeats, fever, reduced appetite, urinary issues\n\n- PMHx: heart failure (previously diagnosed, improved with medication); \"small heart attack\" ~5 years ago with brief hospitalisation (query angina)\n\n- Meds: furosemide (dose unknown), aspirin, metoprolol, simvastatin\n\n- Allergies: NKDA\n\n- FHx: father died of MI in early 60s; mother osteoporosis (alive)\n\n- Social: lives alone with two cats; works part-time as lorry driver (day shifts), concerned re impact of worsening health on work; ex-smoker (~1 pack/day x25 years); non-drinker; walks to shops once daily\n\n\n\n\nObjective\n\n\n\n\n- Chest examination: NAD\n\n- Saturations: within normal limits\n\n- BP: within normal limits\n\n\n\n\nAssessment\n\n\n\n\n- Suspected flare-up of heart failure\n\n\n\n\nPlan\n\n\n\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC (anaemia), renal function\n\n- Organise echocardiogram to assess cardiac function\n\n- Review in 1 week\n\n- Safety netting: advised to contact sooner if increased breathlessness, chest pain, palpitations or dizziness", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 19, 19, "Uh," ], [ 44, 49, "OK?" ], [ 72, 77, "OK," ], [ 85, 104, "" ], [ 116, 128, "Nice to see you" ], [ 141, 141, "Um," ], [ 176, 176, "Are you the doctor? 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See you soon." ] ], "grade": { "facts": [ [ "yes", "'Worsening SOB'" ], [ "yes", "'Worsening SOB over last 2 weeks'" ], [ "yes", "'significantly worse in last few days'" ], [ "yes", "'previously able to walk to shops without issue' plus now breathless on minimal exertion." ], [ "yes", "'Now breathless on minimal exertion'" ], [ "partial", "'Worried about symptoms' but not that his heart failure is getting worse." ], [ "yes", "'Denies: chest pain'" ], [ "yes", "'Dry cough, not troublesome'" ], [ "yes", "'Mild lethargy, feeling \"run down\"'" ], [ "yes", "'Bilateral ankle swelling'" ], [ "yes", "'over last few days'" ], [ "yes", "'similar to previous heart failure flare'" ], [ "yes", "'Denies: ... palpitations, skipped heartbeats'" ], [ "yes", "'Denies: ... fever'" ], [ "yes", "'Denies: ... reduced appetite'" ], [ "partial", "'Denies ... urinary issues' omits that he urinates a lot since starting the diuretic." ], [ "yes", "'PMHx: heart failure (previously diagnosed...)'" ], [ "partial", "'improved with medication' but does not say he was breathless at diagnosis." ], [ "partial", "'small heart attack ~5 years ago' captured, but '(query angina)' misstates; he was told it was more than angina." ], [ "partial", "'brief hospitalisation' captured; chest pain presentation omitted." ], [ "no", "Not mentioned that he has been well since." ], [ "no", "Previous echocardiogram not mentioned." ], [ "no", "No explicit statement of no other past medical history." ], [ "yes", "'Meds: furosemide'" ], [ "partial", "'dose unknown' captured, but current one tablet a day not stated." ], [ "yes", "'aspirin'" ], [ "no", "Note lists 'metoprolol' instead of bisoprolol: wrong medication." ], [ "yes", "'Allergies: NKDA'" ], [ "yes", "'father died of MI'" ], [ "yes", "'in early 60s'" ], [ "yes", "'mother osteoporosis (alive)'" ], [ "yes", "'lives alone with two cats'" ], [ "yes", "'works part-time as lorry driver'" ], [ "partial", "'concerned re impact of worsening health on work' but work being exhausting omitted." ], [ "yes", "'ex-smoker'" ], [ "yes", "'~1 pack/day'" ], [ "yes", "'x25 years'" ], [ "yes", "'non-drinker'" ], [ "yes", "'walks to shops once daily'" ], [ "yes", "'Chest examination: NAD'" ], [ "yes", "'Saturations: within normal limits'" ], [ "yes", "'BP: within normal limits'" ], [ "no", "Not stated that he is otherwise well at the moment." ], [ "partial", "'Suspected flare-up of heart failure' but heart not pumping as well omitted." ], [ "yes", "'Increase furosemide to one tablet twice daily'" ], [ "no", "Increase for the first few days then review response not captured." ], [ "yes", "'Bloods: FBC (anaemia)'" ], [ "yes", "'renal function'" ], [ "yes", "'Organise echocardiogram to assess cardiac function'" ], [ "partial", "Echo organised, but requested today and 1-2 week wait not captured." ], [ "yes", "'Review in 1 week'" ], [ "yes", "'contact sooner if increased breathlessness'" ], [ "yes", "'chest pain, palpitations or dizziness'" ] ], "claims": [ { "claim": "Meds: ... metoprolol", "reason": "Patient confirmed bisoprolol; metoprolol was only the doctor's mishearing query. Wrong medication.", "fact": 26 }, { "claim": "Meds: ... simvastatin", "reason": "Simvastatin is never mentioned in the reference transcript (only 'And a thousand'); invented medication.", "fact": null } ], "significantMarks": [ { "i": 83, "reason": "Drug name bisoprolol rendered as 'Loprolol', confusable with metoprolol." }, { "i": 84, "reason": "Patient's confirmation 'Bisoprolol' rendered as 'Loprolol'; wrong drug name." }, { "i": 88, "reason": "Invents 'simvastatin', a medication not stated in the reference." }, { "i": 130, "reason": "'watch the shops' instead of 'walk to the shops' loses the exercise history." }, { "i": 152, "reason": "Furosemide rendered as 'fruit'; drug name in the dose-change plan lost." }, { "i": 168, "reason": "Furosemide rendered as 'fruit'; drug name in the plan lost." } ] } }, { "product": "Heidi", "case": "day1_consultation06", "run": 5, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes, I can hear you. Okay, great. So you're your doctor, right? I am, yes. Doctor Seod here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? So when did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, and it's become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling\n\nWeak, lethargic? I'm feeling a little run down, but otherwise otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? It's just like they've sort of swollen up a bit. Okay. Is that is that both ankles? Both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this for? I kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I'm I'm that's fine. Okay. And your water works, are you passing urine okay? Uh, yeah, that yeah. I usually pee a lot. Yeah. The drugs. Sure. Okay. All right. Um, fine. So moving on to your your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Uh, well, I was told I had, like, a they called it, like, a small heart attack about five years ago. Um, I, uh, I had I I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh, but then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what happened? A name of a diagnosis? I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or no? They they said they it seemed it was, like, more than angina. Okay. But I didn't but I only had to stay in hospital for a few days. Okay. Okay. And, yeah, I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, zoprolol. That metoprolol, was it? Or metoprolol. Sorry. The connection is not very good. Okay. Thank you. Yep.\n\nUm, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? Take medications? No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nYour mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. Oh, I've got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. So do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. That must have been very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and walk to the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you, you said you're feeling more breathless, even walking to the stop- uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to all your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know- That's- It's- What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options- Yeah... to move forward. Um-\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. Do you think that would be better? I think I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan it's it's a jelly scan of your heart. You may have had this done before when you were diagnosed, and it's just to get a good Oh, yes.\n\nSorry? Uh, yeah, I remember now. I remember now. Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like, would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\nOkay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. No. Well, I wish you all the best. Have a good day. See you soon. Okay. Thank you.", "note": "Subjective\n\n- SOB over last couple of weeks, worse in last few days\n\n- Normally walks to shops without issue, now requires sitting to catch breath; breathless even around the house\n\n- Worried about symptoms\n\n- Bilateral ankle swelling over last few days\n\n- Dry cough, not troublesome\n\n- Feeling a little run down\n\n- Denies chest pain, palpitations, skipped heartbeats, temperatures, fevers\n\n- Appetite and urination normal\n\n\n\n\nPast Medical History\n\n- Heart failure, diagnosed some time ago, previously caused breathlessness, managed with medication\n\n- Small heart attack ~5 years ago, presented with chest pain, brief hospitalisation, described as \"more than angina\"\n\n\n\n\nMedications\n\n- Furosemide (dose not recalled, requires checking)\n\n- Aspirin\n\n- Metoprolol\n\n- Simvastatin\n\n\n\n\nAllergies\n\n- NKDA\n\n\n\n\nFamily History\n\n- Father: died in early 60s from heart attack\n\n- Mother: living, osteoporosis\n\n\n\n\nSocial History\n\n- Lives alone with two cats\n\n- Works part-time as lorry driver, daytime shifts only\n\n- Concerns re impact of worsening health on ability to work\n\n- Ex-smoker: ~1 pack/day for 25 years, stopped\n\n- Non-drinker\n\n- Walks to shops once daily\n\n\n\n\nObjective\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment\n\n- Possible flare-up of heart failure\n\n\n\n\nPlan\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC, U&E, check for anaemia\n\n- Echocardiogram to assess cardiac function\n\n- Review in 1 week\n\n- Safety netting: advised to call sooner if increased breathlessness, chest pain, palpitations or dizziness", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 19, 19, "Uh," ], [ 44, 49, "OK?" ], [ 72, 77, "OK," ], [ 85, 114, "" ], [ 126, 137, "Nice to see you" ], [ 189, 189, "Are you the doctor?" ], [ 261, 266, "OK." ], [ 311, 313, "" ], [ 426, 429, "now" ], [ 617, 621, "really" ], [ 677, 682, "" ], [ 756, 767, "OK. 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OK." ], [ 4030, 4030, "And" ], [ 4089, 4100, "" ], [ 4113, 4116, "" ], [ 4155, 4158, "" ], [ 4212, 4212, "That's OK." ], [ 4279, 4284, "OK." ], [ 4294, 4308, "Bisoprolol. The" ], [ 4332, 4343, "Uh, Bisoprolol." ], [ 4355, 4368, "connection's" ], [ 4384, 4389, "OK." ], [ 4401, 4405, "yeah." ], [ 4416, 4462, "a thousand, OK. Alright." ], [ 4485, 4489, "Any" ], [ 4502, 4502, "Uh," ], [ 4521, 4526, "No. OK." ], [ 4569, 4569, "uh," ], [ 4843, 4847, "sixties." ], [ 4854, 4868, "sixties, OK. Alright." ], [ 4937, 4942, "OK. Is" ], [ 4975, 4979, "yeah," ], [ 5000, 5016, "OK, alright." ], [ 5144, 5152, "Well, I" ], [ 5188, 5193, "OK," ], [ 5303, 5308, "OK." ], [ 5366, 5377, "day to day," ], [ 5436, 5436, "uh," ], [ 5451, 5456, "OK." ], [ 5510, 5510, "Uh," ], [ 5516, 5521, "OK. Um," ], [ 5524, 5535, "uh, yeah" ], [ 5577, 5577, "Mm. 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See you soon." ] ], "grade": { "facts": [ [ "yes", "\"SOB over last couple of weeks\"." ], [ "yes", "\"SOB over last couple of weeks\" captures the gradual onset over weeks." ], [ "yes", "\"worse in last few days\"." ], [ "yes", "\"Normally walks to shops without issue, now requires sitting to catch breath\"." ], [ "yes", "\"breathless even around the house\"." ], [ "partial", "Only \"Worried about symptoms\"; does not state concern that heart failure is worsening." ], [ "yes", "\"Denies chest pain\"." ], [ "yes", "\"Dry cough, not troublesome\"." ], [ "yes", "\"Feeling a little run down\"." ], [ "yes", "\"Bilateral ankle swelling\"." ], [ "yes", "\"Bilateral ankle swelling over last few days\"." ], [ "no", "Previous ankle swelling during earlier heart failure episode not mentioned." ], [ "yes", "\"Denies ... palpitations, skipped heartbeats\"." ], [ "yes", "\"Denies ... temperatures, fevers\"." ], [ "yes", "\"Appetite ... normal\"." ], [ "partial", "\"urination normal\" omits that he urinates a lot since starting the diuretic." ], [ "yes", "\"Heart failure, diagnosed some time ago\"." ], [ "yes", "\"previously caused breathlessness, managed with medication\"." ], [ "yes", "\"Small heart attack ~5 years ago ... described as 'more than angina'\"." ], [ "yes", "\"presented with chest pain, brief hospitalisation\"." ], [ "no", "Being well since the heart attack is not documented." ], [ "no", "Previous echocardiogram not mentioned." ], [ "no", "Absence of other past medical history not stated." ], [ "yes", "\"Furosemide\" listed." ], [ "partial", "Notes dose not recalled, but does not record current regimen of one tablet a day." ], [ "yes", "\"Aspirin\" listed." ], [ "no", "Lists \"Metoprolol\"; patient takes bisoprolol (corrected in the consultation)." ], [ "yes", "\"NKDA\"." ], [ "yes", "\"Father: died in early 60s from heart attack\"." ], [ "yes", "\"died in early 60s\"." ], [ "yes", "\"Mother: living, osteoporosis\"." ], [ "yes", "\"Lives alone with two cats\"." ], [ "yes", "\"Works part-time as lorry driver\"." ], [ "partial", "Records concern about ability to work but not that work is exhausting." ], [ "yes", "\"Ex-smoker\"." ], [ "yes", "\"~1 pack/day\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"Non-drinker\"." ], [ "yes", "\"Walks to shops once daily\"." ], [ "yes", "\"Chest: NAD\"." ], [ "yes", "\"Saturations: normal\"." ], [ "yes", "\"BP: normal\"." ], [ "no", "Otherwise well at the moment is not stated." ], [ "partial", "\"Possible flare-up of heart failure\" but omits heart not pumping as well as it should." ], [ "yes", "\"Increase furosemide to one tablet twice daily\"." ], [ "no", "No mention of the increase being for the first few days then reassess." ], [ "yes", "\"Bloods: FBC ... check for anaemia\"." ], [ "yes", "\"U&E\" covers kidney function." ], [ "yes", "\"Echocardiogram to assess cardiac function\"." ], [ "no", "Requesting today and the one-to-two week wait are not documented." ], [ "yes", "\"Review in 1 week\"." ], [ "yes", "\"advised to call sooner if increased breathlessness\"." ], [ "yes", "\"chest pain, palpitations or dizziness\"." ] ], "claims": [ { "claim": "Medications: Metoprolol", "reason": "Patient twice stated bisoprolol; clinician's 'Metoprolol, was it?' was corrected to bisoprolol.", "fact": 26 }, { "claim": "Medications: Simvastatin", "reason": "Simvastatin is never mentioned in the reference transcript.", "fact": null } ], "significantMarks": [ { "i": 86, "reason": "Patient's 'Bisoprolol' transcribed as 'zoprolol', obscuring the drug name." }, { "i": 87, "reason": "Patient's correction 'Bisoprolol' transcribed as 'metoprolol': wrong drug." }, { "i": 91, "reason": "Inserts 'simvastatin' as a medication not said in the consultation." }, { "i": 149, "reason": "'Furosemide' transcribed as 'fruit', losing the drug being increased." }, { "i": 166, "reason": "'Furosemide' transcribed as 'fruit' in the plan, losing the drug name." } ] } }, { "product": "Heidi", "case": "day2_consultation07", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Hi there. Good morning. Hi. Good morning. I'm Dr. Dean Moser from GP at Henn. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um... So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, that's 60, yeah. Sixty. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't, don't worry. Okay. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years, okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol, diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry, in your parents, did yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. But what do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, uh, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. It's very important that you communicate that to the hospital- Okay.-detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-like, okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay.-the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Is it now? We, we'll, we'll end the consultation now for the purposes? Yeah. Is that okay? Thanks. Okay. Okay, thank you very much. Take care, thanks. Bye. Thank you. Bye.", "note": "Subjective:\n\n- New onset chest discomfort, nausea, sweating and SOB, onset ~2 hours ago while gardening\n\n- Chest discomfort described as pressure, \"like someone sitting on chest\", central over pectoral muscles, diffuse\n\n- Symptoms currently present\n\n- Associated pain in left arm and shoulder\n\n- Onset during non-strenuous activity (gardening, kneeling)\n\n- Generally low physical activity levels\n\n- No previous episodes\n\n- Reports heart beating faster, attributes to stress\n\n- No one else home; front door left open for ambulance access\n\n\n\n\nObjective:\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment:\n\n- Clinical presentation concerning for possible MI, requiring urgent evaluation\n\n\n\n\nPlan:\n\n- Ambulance called for urgent transport to hospital for further assessment and management\n\n- Advised to communicate aspirin allergy (mild allergic reaction with swelling, not life-threatening) to hospital staff\n\n- Clinician to remain on line until ambulance arrival\n\n- Hospital team to assess and determine appropriate facility based on ECG findings and treatment needs", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 0, "Hi," ], [ 41, 41, "Um," ], [ 46, 49, "Doctor" ], [ 55, 60, "Resor" ], [ 66, 77, "" ], [ 95, 118, "That's the same thing. 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OK," ], [ 6842, 6852, "" ] ], "grade": { "facts": [ [ "yes", "\"onset ~2 hours ago while gardening\" matches a couple of hours ago." ], [ "yes", "\"described as pressure, 'like someone sitting on chest'\"." ], [ "yes", "Nausea listed." ], [ "no", "Absence of vomiting not documented." ], [ "yes", "Sweating listed." ], [ "yes", "SOB listed." ], [ "yes", "\"Symptoms currently present\"." ], [ "yes", "\"central over pectoral muscles\" conveys central, not one-sided." ], [ "yes", "\"diffuse\" documented." ], [ "yes", "\"Associated pain in left arm\"." ], [ "yes", "\"and shoulder\" documented." ], [ "yes", "\"Onset during non-strenuous activity (gardening, kneeling)\"." ], [ "yes", "\"No previous episodes\"." ], [ "yes", "\"Reports heart beating faster, attributes to stress\"." ], [ "yes", "\"Generally low physical activity levels\"." ], [ "no", "Smoking not mentioned in the note." ], [ "no", "Smoking duration not mentioned." ], [ "no", "Alcohol intake not mentioned." ], [ "no", "Overweight status not mentioned." ], [ "no", "Hypertension not mentioned." ], [ "no", "Diabetes status not mentioned." ], [ "no", "Cholesterol never checked not mentioned." ], [ "no", "Family history of father's MI not mentioned." ], [ "no", "Mother's heart problems not mentioned." ], [ "yes", "Aspirin allergy documented." ], [ "yes", "\"mild allergic reaction with swelling, not life-threatening\"." ], [ "no", "No other allergies not documented." ], [ "yes", "\"concerning for possible MI, requiring urgent evaluation\" conveys possible, not confirmed." ], [ "yes", "\"Ambulance called\"." ], [ "partial", "ECG only implied via \"based on ECG findings\"; not stated that the ambulance team will do one." ], [ "partial", "Note says the hospital team decides the facility based on ECG/treatment; reference says the ambulance team." ], [ "partial", "Advised to tell hospital of allergy, but omits that aspirin may be considered despite the allergy." ], [ "partial", "\"Clinician to remain on line until ambulance arrival\"; handover to the crew omitted." ] ], "claims": [], "significantMarks": [ { "i": 3, "reason": "Clinician surname transcribed as Moser instead of Resor; wrong name in the record." }, { "i": 6, "reason": "Patient first name transcribed as Kim instead of Jim; wrong patient identity in the record." }, { "i": 83, "reason": "'beer' transcribed as 'fear'; loses the type of alcohol in the drinking history." }, { "i": 115, "reason": "Aspirin reaction 'swell up' transcribed as 'swallow'; loses the nature of the allergic reaction." }, { "i": 120, "reason": "'That team' (ambulance) became 'the hospital team'; changes who assesses and decides the destination hospital." } ] } }, { "product": "Heidi", "case": "day2_consultation07", "run": 2, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Well, that's something very different than that. Hi there. Good morning. Hi, good morning. Um, I'm Dr. Dean Mesler from GP at Han. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um... Yeah. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, that's 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, and the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't don't worry about it. Okay. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry. In your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. It's very important that you communicate that to the hospital- Okay.-uh, detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay... okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay... the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Thank you. Is it now? We, we'll, we'll end the conversation now for the purposes. Yeah. Is that okay? That's okay. Okay, thank you very much. Take care. Thanks. Bye. Thank you. Bye.", "note": "Subjective\n\n- Chest discomfort, described as pressure in the middle of the chest, radiating to the left arm and shoulder\n\n- Associated nausea, diaphoresis and SOB\n\n- Onset a couple of hours ago while gardening (non-strenuous activity); symptoms still present\n\n- Denies vomiting\n\n- Denies palpitations initially; notes heart beating faster currently due to stress\n\n- First-time occurrence\n\n- Lives alone; no one else in the house currently\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Symptoms concerning for possible cardiac event; urgent assessment required to exclude MI\n\n\n\n\nPlan\n\n- Ambulance called for urgent transfer to hospital\n\n- Dr. Jane Doe to remain on the line until paramedics arrive\n\n- Advised to keep front door open for paramedic access\n\n- Explained paramedics will perform ECG and determine appropriate hospital based on findings and treatment needs\n\n- Advised to communicate aspirin allergy to hospital staff, as aspirin may still be considered\n\n\n\n\nPast Medical History\n\n- Hypertension\n\n- Overweight\n\n\n\n\nSocial History\n\n- Smoker: 10 cigarettes daily for 15 years\n\n- Alcohol: 7-8 pints of beer per week\n\n- Lives alone\n\n- Works as a restaurant owner (sushi shop)\n\n- Generally sedentary lifestyle\n\n\n\n\nFamily History\n\n- Father: died of MI around 60 years of age\n\n- Mother: history of heart problems\n\n\n\n\nAllergies\n\n- Aspirin: mild allergic reaction including swelling, not life-threatening", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 48, "Hi," ], [ 99, 102, "Doctor" ], [ 108, 114, "Resor" ], [ 120, 130, "" ], [ 148, 171, "That's the same thing. 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OK," ], [ 6909, 6919, "" ] ], "grade": { "facts": [ [ "yes", "\"Onset a couple of hours ago while gardening\"." ], [ "partial", "\"described as pressure\" captures pressure not pain, but omits the someone-sitting-on-chest description." ], [ "yes", "\"Associated nausea\"." ], [ "yes", "\"Denies vomiting\"." ], [ "yes", "\"diaphoresis\"." ], [ "yes", "\"SOB\"." ], [ "yes", "\"symptoms still present\"." ], [ "yes", "\"pressure in the middle of the chest\" conveys central location." ], [ "no", "Diffuse nature of the pain is not mentioned." ], [ "yes", "\"radiating to the left arm\"." ], [ "yes", "\"and shoulder\"." ], [ "yes", "\"while gardening (non-strenuous activity)\"; kneeling omitted but core meaning kept." ], [ "yes", "\"First-time occurrence\"." ], [ "yes", "\"notes heart beating faster currently due to stress\"." ], [ "yes", "\"Generally sedentary lifestyle\"." ], [ "yes", "\"10 cigarettes daily\"." ], [ "yes", "\"for 15 years\"." ], [ "yes", "\"7-8 pints of beer per week\"." ], [ "yes", "\"Overweight\" listed." ], [ "yes", "\"Hypertension\"." ], [ "no", "Absence of diabetes not documented." ], [ "no", "Cholesterol never checked is not documented." ], [ "yes", "\"Father: died of MI around 60 years of age\"." ], [ "yes", "\"Mother: history of heart problems\"." ], [ "yes", "\"Aspirin\" allergy listed." ], [ "yes", "\"mild allergic reaction including swelling, not life-threatening\"." ], [ "no", "No other allergies is not documented." ], [ "yes", "\"concerning for possible cardiac event; urgent assessment required to exclude MI\"." ], [ "yes", "\"Ambulance called\"." ], [ "yes", "\"paramedics will perform ECG\"." ], [ "yes", "\"determine appropriate hospital based on findings and treatment needs\"." ], [ "yes", "\"communicate aspirin allergy to hospital staff, as aspirin may still be considered\"." ], [ "partial", "Staying on the line is noted (under a wrong clinician name); the handover to paramedics is omitted." ] ], "claims": [ { "claim": "Dr. Jane Doe to remain on the line", "reason": "The clinician introduced himself as Doctor Dean Resor; the name Jane Doe appears nowhere in the transcript or authorContext.", "fact": null } ], "significantMarks": [ { "i": 5, "reason": "Patient name transcribed as Kim instead of Jim; wrong patient identity in the record." }, { "i": 80, "reason": "\"fear\" instead of \"beer\" loses the type of alcohol consumed." }, { "i": 112, "reason": "\"swallow\" instead of \"swell up\" misrecords the nature of the aspirin allergic reaction." } ] } }, { "product": "Heidi", "case": "day2_consultation07", "run": 3, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Mezza from GP at Han. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And, and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't, I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't, don't worry about it. Okay. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol, diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry. In your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, uh, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. It's very important that you communicate that to the hospital- Okay.-detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-IoV. Okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Uh-huh... the team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Is it now? We, we'll, we'll end the consultation now for the purposes? Yeah. Is that okay? That's... Okay. Okay, thank you very much. Take care. Thanks. Bye. Thank you. Bye.", "note": "Subjective:\n\n- Kim Gowers, DOB 08/08/1958, presented with chest discomfort and associated symptoms.\n\n- Onset a couple of hours prior while gardening (kneeling, non-strenuous activity).\n\n- Describes pressure sensation on chest, \"like someone sitting on chest\".\n\n- Associated nausea, diaphoresis, SOB.\n\n- Symptoms currently ongoing.\n\n- Chest discomfort diffuse, central/pectoral, not lateralised.\n\n- Radiation to left arm and shoulder.\n\n- No prior similar episodes.\n\n- Denies palpitations until recently, attributed to stress.\n\n- Lives alone; no one else in house.\n\n\n\n\nObjective:\n\n- Telehealth consultation; no physical examination performed.\n\n- Reports awareness of faster heart rate, attributed to stress.\n\n\n\n\nAssessment:\n\n- Clinical presentation suggestive of possible myocardial infarction.\n\n\n\n\nPlan:\n\n- Ambulance called for urgent assessment and transport to hospital.\n\n- Advised to keep front door open for ambulance access.\n\n- Counselled on importance of informing paramedics and hospital staff re: aspirin allergy (swelling, mild, non-life-threatening).\n\n- Remain on the line until ambulance arrival for handover.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 0, "Hi," ], [ 41, 41, "Um," ], [ 59, 64, "Resor" ], [ 70, 80, "" ], [ 98, 121, "That's the same thing. 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OK," ], [ 6840, 6850, "" ] ], "grade": { "facts": [ [ "yes", "\"Onset a couple of hours prior while gardening\"." ], [ "yes", "\"pressure sensation on chest, 'like someone sitting on chest'\"." ], [ "yes", "\"Associated nausea\"." ], [ "no", "Absence of vomiting not documented." ], [ "yes", "\"diaphoresis\"." ], [ "yes", "\"SOB\"." ], [ "yes", "\"Symptoms currently ongoing\"." ], [ "yes", "\"central/pectoral, not lateralised\"." ], [ "yes", "\"Chest discomfort diffuse\"." ], [ "yes", "\"Radiation to left arm and shoulder\"." ], [ "yes", "\"Radiation to left arm and shoulder\"." ], [ "yes", "\"while gardening (kneeling, non-strenuous activity)\"." ], [ "yes", "\"No prior similar episodes\"." ], [ "yes", "\"Reports awareness of faster heart rate, attributed to stress\"." ], [ "no", "Low baseline activity level not documented." ], [ "no", "Smoking (10/day) not documented." ], [ "no", "Smoking duration not documented." ], [ "no", "Alcohol intake not documented." ], [ "no", "Overweight not documented." ], [ "no", "Hypertension not documented." ], [ "no", "Absence of diabetes not documented." ], [ "no", "Cholesterol never checked not documented." ], [ "no", "Father's MI at ~60 not documented." ], [ "no", "Mother's heart problems not documented." ], [ "yes", "\"aspirin allergy\" documented in plan." ], [ "yes", "\"(swelling, mild, non-life-threatening)\"." ], [ "no", "No other allergies not documented." ], [ "yes", "\"suggestive of possible myocardial infarction\"; uncertainty preserved." ], [ "yes", "\"Ambulance called for urgent assessment\"." ], [ "no", "ECG by ambulance team not mentioned." ], [ "partial", "\"transport to hospital\" noted, but not that hospital choice depends on ECG/treatment needed." ], [ "partial", "Told to inform hospital of allergy, but omits that aspirin may be considered despite the allergy." ], [ "yes", "\"Remain on the line until ambulance arrival for handover\"." ] ], "claims": [], "significantMarks": [ { "i": 5, "reason": "Patient name transcribed as Kim instead of Jim; wrong patient identity carried into the record." }, { "i": 48, "reason": "Missed 'and I did' reverses meaning: patient did notice faster heartbeat today." }, { "i": 113, "reason": "'swallow' instead of 'swell up' loses the nature of the aspirin allergic reaction." }, { "i": 117, "reason": "Garbled span drops 'allergy' from 'consider aspirin despite allergy', losing a key treatment caveat." } ] } }, { "product": "Heidi", "case": "day2_consultation07", "run": 4, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Mesler from GP at Hen. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Garris, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort. So I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now do you have those these symptoms right now, or have they gone off now? No. They're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the the ambulance team when they when they arrive. Okay? Sure. So just to just to double check, where exactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So\n\nUm, yeah, but not not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't don't worry. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry. In your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. What when they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. No. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. Uh, it's very important that you communicate that to the hospital- Okay... detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-liab. Okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay... the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Is it now? We, we'll, we'll end the consultation now for the purposes. Yeah. Is that okay? That's... Okay. Okay, thank you very much. Take care. Thanks. Bye. Thank you. Bye.", "note": "Subjective\n\n- Chest discomfort, onset ~2 hours ago while gardening (kneeling, light activity, not strenuous)\n\n- Described as pressure, \"like someone sitting on chest\", rather than pain\n\n- Diffuse, central chest over pectoral region\n\n- Radiation to left arm and shoulder\n\n- Associated nausea (no vomiting), sweating, SOB\n\n- Symptoms ongoing\n\n- Reports palpitations, heart beating faster, attributed to stress\n\n- No prior similar episodes\n\n- Lives alone, no one else in house\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Symptoms suggestive of possible myocardial infarction\n\n- Priority to exclude cardiac event given symptom nature and family history\n\n\n\n\nPlan\n\n- Ambulance called for urgent transport to hospital\n\n- Advised to keep front door open for ambulance access\n\n- Counselled on importance of communicating aspirin allergy to hospital staff\n\n- Remain on line until ambulance arrives, then handover to paramedics\n\n- Hospital team to assess and determine appropriate transfer/treatment based on ECG and clinical findings\n\n\n\n\nSocial History\n\n- Smoker ~10 cigarettes/day x 15 years\n\n- Alcohol ~7-8 pints beer/week\n\n- Overweight\n\n- Lives alone\n\n- Works as restaurant owner (sushi shop)\n\n\n\n\nPast Medical History\n\n- Hypertension\n\n- No diabetes\n\n- Cholesterol not previously checked\n\n\n\n\nFamily History\n\n- Father died of heart attack ~60 years of age\n\n- Mother had heart problems\n\n\n\n\nAllergies\n\n- Aspirin (allergic reaction - swelling, mild, not life-threatening)", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 0, "Hi," ], [ 41, 41, "Um," ], [ 59, 65, "Resor" ], [ 71, 81, "" ], [ 99, 122, "That's the same thing. 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OK," ], [ 6789, 6799, "" ] ], "grade": { "facts": [ [ "yes", "\"onset ~2 hours ago while gardening\"" ], [ "yes", "\"Described as pressure, 'like someone sitting on chest', rather than pain\"" ], [ "yes", "\"Associated nausea\"" ], [ "yes", "\"(no vomiting)\"" ], [ "yes", "\"sweating\"" ], [ "yes", "\"SOB\"" ], [ "yes", "\"Symptoms ongoing\"" ], [ "yes", "\"central chest over pectoral region\"; central captures not to one side." ], [ "yes", "\"Diffuse\"" ], [ "yes", "\"Radiation to left arm\"" ], [ "yes", "\"and shoulder\"" ], [ "yes", "\"while gardening (kneeling, light activity, not strenuous)\"" ], [ "yes", "\"No prior similar episodes\"" ], [ "yes", "\"heart beating faster, attributed to stress\"" ], [ "no", "Baseline low physical activity level not recorded." ], [ "yes", "\"Smoker ~10 cigarettes/day\"" ], [ "yes", "\"x 15 years\"" ], [ "yes", "\"Alcohol ~7-8 pints beer/week\"" ], [ "yes", "\"Overweight\"" ], [ "yes", "\"Hypertension\"" ], [ "yes", "\"No diabetes\"" ], [ "yes", "\"Cholesterol not previously checked\"" ], [ "yes", "\"Father died of heart attack ~60 years of age\"" ], [ "yes", "\"Mother had heart problems\"" ], [ "yes", "\"Aspirin\" under Allergies" ], [ "yes", "\"allergic reaction - swelling, mild, not life-threatening\"" ], [ "no", "Note does not state no other allergies." ], [ "yes", "\"Symptoms suggestive of possible myocardial infarction\" with priority to exclude." ], [ "yes", "\"Ambulance called\"" ], [ "partial", "ECG mentioned only as basis for decisions; not stated that the ambulance team will do an ECG." ], [ "partial", "Attributes assessment/transfer decision to \"Hospital team\" rather than the ambulance team; ECG basis captured." ], [ "partial", "\"communicating aspirin allergy to hospital staff\" but omits that aspirin may be considered despite the allergy." ], [ "yes", "\"Remain on line until ambulance arrives, then handover to paramedics\"" ] ], "claims": [], "significantMarks": [ { "i": 5, "reason": "Patient name misheard (Kim Garris vs Jim Gowers): wrong patient identity in the record." }, { "i": 52, "reason": "Missed 'and I did' flips meaning to not having noticed a faster heartbeat today (palpitations)." }, { "i": 84, "reason": "'fear' for 'beer' loses the type of alcohol consumed." }, { "i": 115, "reason": "'swallow' for 'swell up' changes the described nature of the aspirin allergic reaction." }, { "i": 121, "reason": "Garbled 'despite- ... -liab' loses 'despite allergy': the plan to consider aspirin despite the allergy is lost." }, { "i": 122, "reason": "'the hospital team' for 'That team' (ambulance) misattributes who assesses and chooses the hospital." } ] } }, { "product": "Heidi", "case": "day2_consultation07", "run": 5, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Well, that's very difficult. Hi there. Good morning. Hi, good morning. Um, I'm Dr. Dean Moser from GP at Hen. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort. So I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. I wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't don't worry about it. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry, in your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. Uh, it's very important that you communicate that to the hospital- Okay.-uh, detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-liverie, okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay... the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Thank you. Now, we, we'll, we'll end the conversation now for the purposes. Yeah. Is that okay? That's okay. Okay, thank you very much. Take care. Thanks. Bye. Thank you. Bye.", "note": "Subjective\n\n\n\n\n- Chest discomfort, onset ~2 hours ago while gardening\n\n- Describes as pressure, \"like someone sitting on my chest\"\n\n- Associated nausea (no vomiting), sweating, SOB\n\n- Symptoms currently present\n\n- Pain mid-sternal, diffuse, not lateralised; radiates to left arm and shoulder\n\n- Onset during gardening, not strenuous, no significant exertion\n\n- Generally low activity level\n\n- First episode\n\n- Palpitations: reports heart beating faster currently, attributed to stress; none earlier today\n\n- PMHx: HTN; no diabetes; cholesterol never checked\n\n- Allergies: aspirin - allergic reaction with swelling, mild, not life-threatening\n\n- Social: smoker 10/day x15 years; ETOH 7-8 pints/week; overweight; lives alone; restaurant owner (sushi shop)\n\n- FHx: father died of MI ~age 60; mother with heart problems\n\n\n\n\nObjective\n\n\n\n\n- Telehealth consultation; no physical examination performed\n\n\n\n\nAssessment\n\n\n\n\n- Symptoms suggestive of cardiac event, possibility of MI\n\n\n\n\nPlan\n\n\n\n\n- Ambulance called for immediate transfer to hospital\n\n- Counselled re potential for heart attack and need for prompt assessment\n\n- Advised to keep front door open for ambulance access\n\n- Remain on line until ambulance arrival, then hand over details\n\n- Emphasised importance of informing hospital staff re aspirin allergy, including nature of reaction\n\n- Hospital team to assess and determine appropriate care facility", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 28, "Hi," ], [ 79, 82, "Doctor" ], [ 88, 93, "Resor" ], [ 99, 109, "" ], [ 127, 150, "That's the same thing. 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OK," ], [ 6876, 6886, "" ] ], "grade": { "facts": [ [ "yes", "\"onset ~2 hours ago while gardening\"." ], [ "yes", "\"Describes as pressure, 'like someone sitting on my chest'\"." ], [ "yes", "\"Associated nausea (no vomiting)\"." ], [ "yes", "\"no vomiting\" stated." ], [ "yes", "\"sweating\" listed." ], [ "yes", "\"SOB\" listed." ], [ "yes", "\"Symptoms currently present\"." ], [ "yes", "\"Pain mid-sternal ... not lateralised\"." ], [ "yes", "\"diffuse\" stated." ], [ "yes", "\"radiates to left arm and shoulder\"." ], [ "yes", "\"radiates to left arm and shoulder\"." ], [ "yes", "\"Onset during gardening, not strenuous, no significant exertion\"; kneeling omitted but meaning preserved." ], [ "yes", "\"First episode\"." ], [ "yes", "\"reports heart beating faster currently, attributed to stress\"." ], [ "yes", "\"Generally low activity level\"." ], [ "yes", "\"smoker 10/day\"." ], [ "yes", "\"x15 years\"." ], [ "yes", "\"ETOH 7-8 pints/week\"; pints implies beer." ], [ "yes", "\"overweight\" in social history." ], [ "yes", "\"PMHx: HTN\"." ], [ "yes", "\"no diabetes\"." ], [ "yes", "\"cholesterol never checked\"." ], [ "yes", "\"father died of MI ~age 60\"." ], [ "yes", "\"mother with heart problems\"." ], [ "yes", "\"Allergies: aspirin\"." ], [ "yes", "\"allergic reaction with swelling, mild, not life-threatening\"." ], [ "no", "Note does not state there are no other allergies." ], [ "yes", "\"Symptoms suggestive of cardiac event, possibility of MI\" conveys possible, unconfirmed MI." ], [ "yes", "\"Ambulance called for immediate transfer to hospital\"." ], [ "no", "ECG by ambulance team not mentioned." ], [ "partial", "\"Hospital team to assess and determine appropriate care facility\": misattributes to hospital team, omits ECG basis." ], [ "partial", "Informing hospital of aspirin allergy captured, but not that aspirin may be considered despite the allergy." ], [ "yes", "\"Remain on line until ambulance arrival, then hand over details\"." ] ], "claims": [], "significantMarks": [ { "i": 5, "reason": "Patient name transcribed as Kim instead of Jim; identity error in the record." }, { "i": 48, "reason": "Missed 'and I did today' about noticing a faster heartbeat today; changes palpitation history." }, { "i": 81, "reason": "'fear' instead of 'beer' loses the type of alcohol consumed." }, { "i": 113, "reason": "'swallow' instead of 'swell up' misrecords the nature of the aspirin allergic reaction." }, { "i": 119, "reason": "'despite allergy' garbled to 'despite- liverie', losing the instruction that aspirin may be considered despite the allergy." }, { "i": 120, "reason": "Inserts 'the hospital' team; the reference refers to the ambulance team deciding destination, changing who makes the triage decision." } ] } }, { "product": "i-scribe", "case": "day2_consultation07", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "transcript": "Hi there, good morning. Hi, good morning. I'm Dr. Dean Meza from GP at Hand. Nice to see you. Nice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August. That's great. Thank you so much for that. You look a lot younger, so... That would make you roughly about 50 years old, 51 years old, is that correct? Yeah, around that, yeah, about 60, yeah. 60, okay, perfect. All right, so nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah. Okay, fantastic. So how can I help you today? Yeah, I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago and I felt not exactly a pain but like a pressure on my chest feels like someone's sitting on my chest and I've noticed a bit of nausea not no vomiting but I'm pretty sweaty short of breath and it kind of feels like someone's sitting on my chest right okay now do you have those these symptoms right now or have they gone off now um no they're still present okay so you've still got the chest discomfort right now yes okay um we're probably going to have to call an ambulance for you today okay okay so what i'm going to do is i'm going to task my cody next to me to sort that out while we do that i'm going to ask you a few more questions okay a bit more information to the ambulance team when they when they arrive okay so just just to double check um wearing exactly in the chest is the pain? It's in the middle of my chest, over my pecs, but not necessarily to one side. It's quite a diffuse pain. Is it spreading anywhere else, like down to your arm, up to the jaw and the neck, anything like that? Yeah, it's mainly in my left arm. It's feeling a little bit painful, and in my shoulder as well. Okay. Do you remember what you were doing at the time? Yeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and yeah, wasn't running or anything. It was during any physical exercise. Okay. And how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything? No, I don't. I generally don't do much activity at all. Yeah. Have you had this before? No. this is the first time actually right okay yeah are you aware of any palpitations like your heart beating faster or more prominently than normal um yeah it's it's beating a bit faster now I think that's because I'm a little bit stressed about the situation but I haven't noticed it beating faster than usual today so I know you're stressed we've got an ambulance coming on the way okay yeah we'll take care of everything so don't okay in the house with you at moment? No, no one's in the house at the moment. Okay, and is your front door open? Yes, it's open. Okay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you. Yeah. All right, so are you a smoker at all? Yeah, I smoke a fair bit, so I smoke about 10 cigarettes a day. Yeah. How long have you been smoking for? For the past 15 years. 15 years, okay. Yeah. Do you have high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood pressure but not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. All right. Now, in your wider family, in your family, sorry, in your parents, did either of them have any heart problems or heart attacks or anything like that? Yes, so my father died of a heart attack and my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack? He was about my age. Right, so just around 60? Yes, around 60, yes. Okay, all right. Do you drink much alcohol? Yeah, I drink per week probably about seven or eight pints week. Okay, is that a beer you're talking about? Oh yeah, yes. Okay, I can't tell from the video, are you overweight? Yes, I'm overweight, yeah. Now, do you normally live alone? Yeah, I live alone at the moment, yeah, it's just me in the house. Sure, okay, and are you working at the moment? Yeah, yeah, I work, yeah. What do you work as? I work as a restaurant owner so I own a sushi shop. So the symptoms that you've described to me, they indicate the possibility of a heart attack. So I'm not saying you definitely have a heart attack but it's our number one priority to exclude that. So the ambulance team will be with you very shortly. I'm going to stay on the line with you until they come okay okay yeah thank you when they come what they'll do is they're going to put some stickers on your chest and do an ecg and then decide where to take you after that okay okay and um what what uh can i just double check do you have um any allergies to any medication yes actually i have um an allergy to aspirin right okay yeah and no other allergies sure what's the nature of that allergy to aspirin do you does it does it cause you heartburn or is it like an allergic reaction? Yeah, it's an allergic reaction so I swell up a bit but nothing life-threatening. I sometimes even have it and it's a mild reaction to it. Okay, all right. It's very important that you communicate that to the hospital, the details you've just told me, because we may need to consider aspirin. Okay, all right. Now in terms of what happens from here the team will assess you and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need okay okay what I'm going to do is we'll stay on the line for the time being okay until they come and then once they come then I'll hand over to them I'll explain what's going on all right okay okay sure okay thank you We'll end the conversation now for the purposes. Yeah. Okay. Okay. Thank you very much. Thanks. Bye. Thank you. Bye.", "note": "Subjective\n\nCC: Acute-onset retrosternal chest pressure (\"someone sitting on chest\") during light activity (gardening).\n\nSymptoms:\n\nNausea (no emesis)\n\nDiaphoresis\n\nSOB\n\nRadiation: L arm and shoulder\n\nStatus: Symptoms currently ongoing\n\nPalpitations: Pt reports heart beating faster (attributed to stress).\n\nPMH:\n\nHTN\n\nNo DM\n\nNo hx of cholesterol checked\n\nAllergies: Aspirin (Reaction: mild swelling/allergic reaction).\n\nFH:\n\nFather: Deceased due to MI @ ~60.\n\nMother: Hx of heart problems.\n\nSH:\n\nSmoking: 10 cigarettes/day (15 years).\n\nAlcohol: ~7–8 pints of beer/week.\n\nOccupation: Restaurant owner (Sushi shop).\n\nBMI: Pt reports being overweight.\n\nObjective\n\nPhysical Exam: No physical examination performed via video consultation.\n\nInvestigations: No completed investigations.\n\nAssessment\n\nProvisional Diagnosis: ACS/MI\n\nConfirmed: HTN\n\nConfirmed: Aspirin Allergy\n\nPlan\n\nDispatch ambulance for urgent assessment and ECG.\n\nParamedics to assess and determine hospital admission based on ECG results and clinical presentation.\n\nPt to keep front door open for emergency access.\n\nAdvised pt to communicate aspirin allergy to hospital staff.", "facts": [ "Chest discomfort started a couple of hours ago", "Discomfort is a pressure rather than a pain, like someone sitting on the chest", "Nausea", "No vomiting", "Sweating", "Short of breath", "Symptoms are still present at the time of the call", "Discomfort is central chest, not to one side", "Discomfort is diffuse", "Radiates to the left arm", "Radiates to the shoulder", "Onset while gardening (kneeling), not during strenuous exertion or exercise", "First episode; never had this before", "Heart beating faster now, which the patient attributes to stress", "Generally does very little physical activity", "Smokes about 10 cigarettes a day", "Has smoked for 15 years", "Drinks about 7-8 pints of beer a week", "Overweight (patient-reported)", "High blood pressure", "No diabetes", "Cholesterol has never been checked", "Father died of a heart attack at around age 60", "Mother had heart problems", "Allergic to aspirin", "Aspirin reaction is swelling, mild and not life-threatening", "No other allergies", "Symptoms indicate a possible heart attack, which is the priority to exclude (not confirmed)", "Ambulance called", "Ambulance team will do an ECG", "Ambulance team will decide which hospital based on ECG and treatment needed", "Patient to tell the hospital about the aspirin allergy details, as aspirin may need to be considered despite the allergy", "Clinician stays on the line until the ambulance arrives and hands over to them" ], "marks": [ [ 0, 0, "Hi," ], [ 41, 41, "Um," ], [ 46, 49, "Doctor" ], [ 55, 59, "Resor" ], [ 65, 76, "" ], [ 94, 120, "That's the same thing. OK" ], [ 235, 235, "Um," ], [ 247, 250, "Jim" ], [ 276, 280, "nineteen fifty eight uh" ], [ 288, 291, "eighth" ], [ 344, 344, "Um," ], [ 374, 374, "um Yeah. Does that," ], [ 409, 411, "fifty" ], [ 423, 425, "fifty one, fifty one" ], [ 436, 436, "Is that" ], [ 453, 453, "or? Yeah," ], [ 485, 488, "sixty," ], [ 495, 504, "Six, OK," ], [ 527, 527, "um," ], [ 535, 535, "see" ], [ 591, 602, "you are OK" ], [ 619, 619, "Yep." ], [ 637, 642, "OK" ], [ 656, 656, "um," ], [ 682, 682, "Um," ], [ 688, 688, "I was," ], [ 701, 701, "um," ], [ 758, 758, "um," ], [ 814, 814, "um" ], [ 819, 819, "a" ], [ 842, 842, "um," ], [ 854, 863, "someone" ], [ 883, 883, "Um," ], [ 900, 900, "um," ], [ 936, 936, "um," ], [ 954, 954, "um," ], [ 1033, 1037, "OK." ], [ 1139, 1143, "OK." ], [ 1199, 1203, "OK," ], [ 1222, 1230, "gonna" ], [ 1265, 1280, "OK." ], [ 1293, 1301, "gonna" ], [ 1312, 1320, "gonna" ], [ 1329, 1333, "colleague" ], [ 1383, 1391, "gonna" ], [ 1421, 1425, "OK? OK. Mmm, sure. We're gonna" ], [ 1448, 1448, "to the," ], [ 1451, 1451, "help" ], [ 1498, 1502, "OK. Sure." ], [ 1510, 1510, "to," ], [ 1535, 1542, "where" ], [ 1576, 1576, "Um," ], [ 1588, 1588, "uh," ], [ 1608, 1608, "um," ], [ 1613, 1613, "uh, yeah, my" ], [ 1622, 1622, "so, um, yeah" ], [ 1626, 1626, "not" ], [ 1655, 1655, "um, and" ], [ 1667, 1668, "" ], [ 1682, 1682, "Is," ], [ 1724, 1726, "into" ], [ 1751, 1758, "in your" ], [ 1790, 1790, "It's," ], [ 1795, 1795, "um," ], [ 1818, 1818, "er," ], [ 1844, 1844, "um, er," ], [ 1853, 1853, "and," ], [ 1882, 1887, "Right, OK." ], [ 1937, 1942, "Uh yes," ], [ 1956, 1956, "uh" ], [ 2018, 2018, "um" ], [ 2047, 2047, "Uh," ], [ 2085, 2088, "wasn't" ], [ 2119, 2124, "Sure, OK. And," ], [ 2209, 2214, "" ], [ 2240, 2240, "I," ], [ 2284, 2289, "um, you know." ], [ 2358, 2367, "OK. Can" ], [ 2464, 2464, "Yeah." ], [ 2523, 2530, "'cause" ], [ 2556, 2556, "Um," ], [ 2601, 2601, "um," ], [ 2627, 2627, "um, and I did" ], [ 2659, 2659, "but, but" ], [ 2701, 2710, "OK? So um," ], [ 2743, 2743, "don't," ], [ 2750, 2754, "worry. Who's" ], [ 2779, 2779, "the" ], [ 2787, 2787, "Yeah. OK, thank you. Uh," ], [ 2829, 2834, "OK. Um," ], [ 2863, 2863, "Uh," ], [ 2880, 2885, "OK" ], [ 2894, 2894, "we'll," ], [ 3012, 3015, "could" ], [ 3027, 3027, "Yeah," ], [ 3034, 3044, "Alright. Um," ], [ 3047, 3047, "um, uh," ], [ 3072, 3072, "Uh," ], [ 3086, 3086, "um," ], [ 3116, 3118, "ten" ], [ 3129, 3129, "uh," ], [ 3136, 3136, "Um," ], [ 3178, 3178, "Uh," ], [ 3192, 3194, "fifteen" ], [ 3202, 3204, "Fifteen" ], [ 3212, 3223, "OK. Um," ], [ 3235, 3235, "um," ], [ 3291, 3301, "anything? Yeah." ], [ 3319, 3319, "blood, uh," ], [ 3338, 3338, "um," ], [ 3353, 3358, "OK." ], [ 3407, 3412, "OK," ], [ 3423, 3423, "Um," ], [ 3428, 3428, "anyone" ], [ 3443, 3450, "in," ], [ 3573, 3573, "Yes. Um," ], [ 3584, 3584, "um," ], [ 3614, 3614, "um," ], [ 3654, 3659, "OK. Uh," ], [ 3742, 3742, "he had," ], [ 3750, 3754, "the" ], [ 3768, 3768, "Um," ], [ 3804, 3804, "under sixty," ], [ 3812, 3815, "sixty." ], [ 3828, 3831, "sixty," ], [ 3837, 3853, "Yeah, OK, alright. Um," ], [ 3880, 3880, "Um," ], [ 3894, 3894, "um, about," ], [ 3939, 3939, "a" ], [ 3946, 3951, "OK," ], [ 3959, 3959, "a," ], [ 3989, 3991, "yeah? Ohh." ], [ 4003, 4008, "Uh, I," ], [ 4057, 4057, "Um," ], [ 4084, 4084, "Right, OK. Alright. Um, uh" ], [ 4089, 4089, "um, you," ], [ 4117, 4117, "Yeah. Uh," ], [ 4136, 4136, "uh," ], [ 4157, 4157, "uh," ], [ 4191, 4196, "OK, and," ], [ 4200, 4200, "uh," ], [ 4243, 4243, "I," ], [ 4257, 4257, "Right," ], [ 4278, 4278, "Um," ], [ 4330, 4330, "Right, OK. Alright. Um," ], [ 4333, 4333, "um, the," ], [ 4375, 4375, "Yeah. Um," ], [ 4408, 4408, "um," ], [ 4424, 4424, "OK?" ], [ 4481, 4481, "we, that," ], [ 4528, 4534, "OK. OK, so" ], [ 4585, 4593, "gonna" ], [ 4636, 4645, "OK," ], [ 4651, 4660, "OK." ], [ 4703, 4711, "gonna" ], [ 4757, 4757, "OK, yeah. Thank you." ], [ 4803, 4812, "OK? OK. OK, no." ], [ 4955, 4959, "OK." ], [ 4992, 4992, "Uh," ], [ 5116, 5116, "Um" ], [ 5122, 5122, "uh," ], [ 5162, 5162, "um," ], [ 5172, 5172, "um," ], [ 5181, 5198, "life threatening. Um, I've," ], [ 5227, 5227, "it's, it's a," ], [ 5256, 5261, "OK," ], [ 5335, 5335, "Yeah. Um," ], [ 5340, 5354, "detail you" ], [ 5376, 5376, "um, we," ], [ 5410, 5426, "despite allergy, OK? OK. Ohh, OK. Um, alright, um," ], [ 5442, 5442, "um," ], [ 5466, 5469, "OK. That" ], [ 5518, 5523, "into" ], [ 5631, 5640, "OK? Uh huh. Um," ], [ 5707, 5711, "OK," ], [ 5736, 5736, "um," ], [ 5779, 5779, "and" ], [ 5809, 5828, "alright? OK. OK. OK, OK," ], [ 5834, 5838, "OK. Yeah," ], [ 5876, 5883, "after" ], [ 5897, 5897, "Is that OK?" ], [ 5904, 5915, "that's, OK. OK," ] ], "grade": { "facts": [ [ "no", "Note says 'Acute-onset' but never states onset a couple of hours ago." ], [ "yes", "'retrosternal chest pressure (\"someone sitting on chest\")'." ], [ "yes", "'Nausea (no emesis)'." ], [ "yes", "'no emesis' captured." ], [ "yes", "'Diaphoresis'." ], [ "yes", "'SOB'." ], [ "yes", "'Status: Symptoms currently ongoing'." ], [ "yes", "'retrosternal' conveys central chest." ], [ "no", "Diffuse quality of the discomfort not recorded." ], [ "yes", "'Radiation: L arm and shoulder'." ], [ "yes", "'Radiation: L arm and shoulder'." ], [ "yes", "'during light activity (gardening)' conveys non-strenuous onset; kneeling detail omitted." ], [ "no", "First episode not documented." ], [ "yes", "'heart beating faster (attributed to stress)'." ], [ "no", "Low baseline physical activity not documented." ], [ "yes", "'10 cigarettes/day'." ], [ "yes", "'(15 years)'." ], [ "yes", "'~7-8 pints of beer/week'." ], [ "yes", "'Pt reports being overweight'." ], [ "yes", "'HTN'." ], [ "yes", "'No DM'." ], [ "yes", "'No hx of cholesterol checked'." ], [ "yes", "'Father: Deceased due to MI @ ~60'." ], [ "yes", "'Mother: Hx of heart problems'." ], [ "yes", "'Allergies: Aspirin'." ], [ "yes", "'mild swelling/allergic reaction' captures swelling and mildness." ], [ "no", "No other allergies not stated." ], [ "yes", "'Provisional Diagnosis: ACS/MI' conveys possible, not confirmed." ], [ "yes", "'Dispatch ambulance'." ], [ "yes", "'urgent assessment and ECG'." ], [ "yes", "'determine hospital admission based on ECG results and clinical presentation'." ], [ "partial", "Advised to tell hospital about allergy, but omits that aspirin may be considered despite it." ], [ "no", "Clinician staying on the line and handing over not documented." ] ], "claims": [], "significantMarks": [ { "i": 7, "reason": "Patient name 'Jim' transcribed as 'Tim' - patient identity error in the record." }, { "i": 72, "reason": "'wasn't during any physical exercise' became 'It was during', inverting the exertional context of chest pain onset." }, { "i": 169, "reason": "Missed 'despite allergy' - loses that aspirin may be given despite the documented allergy, a safety-relevant treatment detail." } ] } }, { "product": "i-scribe", "case": "day1_consultation06", "run": 1, "reference": "Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.", "transcript": "Hello. Hello there. Hello, can you hear me okay? Yes, I can hear you. Okay, great. Are you a doctor? I am, yes. Dr Seed here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? When did it all start? Well it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome in the last few days. Normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath and I'm even starting to get a bit breathless just about the house and it's got me kind of worried. I don't really know what's going on. Is there anything you're particularly worried about? Well, I've got heart failure. Okay. I was told that a while ago, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that helped, but I'm a bit worried it's getting worse. Right, okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse. Yeah. and you're now feeling more breathless or kind of minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. And how's your general health otherwise? Are you feeling weak, lethargic? I'm feeling a little rundown, but otherwise pretty normal. I've noticed my ankles have got a bit bigger. Okay, and what do you mean by that? It's just like they've sort of swollen up a bit. Okay, is that both ankles? Yeah, both ankles. Yeah, it's a bit embarrassing. Okay, I can imagine, yeah. And again, over how long have you noticed this? I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past? I think my ankles did swell up a bit last time the heart failure was a problem. Okay, okay. Fine, okay. So just to really recap, so really the last couple of weeks you've been feeling breathless but worse in the last couple of days. You mentioned you had a bit of a dry cough and some swelling in your ankles. But importantly, no chest pain. And have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? No. Okay. And how about your appetite? Are you eating and drinking okay? Yeah, that's fine. Okay. And your water works? Are you passing urine okay? Yeah. I usually pee a lot. Moving on to your past medical history, you mentioned heart failure, any other medical history I should be aware of? Well I was told I had, they called it like a small heart attack about five years ago. I had chest pain and they took me to hospital and they But then I just got better. Okay. When you say small heart attack, did they give you a name for what happened, a name of a diagnosis? I can't remember. They just called it something like that, a small heart attack. Small heart attack, okay. Was it like angina or...? No, they said it seemed it was like more than angina. Okay. But I only had to stay in hospital for a few days. Okay. And yeah, I've been okay since then. You've been okay since then. Okay, all right. So apart from the heart problems, the heart failure, any other problems I should be aware of? No, I think otherwise I'm okay. Okay. Do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Yeah, I take something called furosemide. Do you know which dose you're taking? I can't remember. I'm sorry, doctor. I have to check. No problems. Any other medications? Yeah, I take aspirin. Okay. And Zoprolol. Is that Metoprolol, was it? Zoprolol. Sorry, the connection is not very good. Okay, thank you. Yep. Simvastatin. Simvastatin, okay. All right. Any allergies at all? Any medications? No, no allergies. Okay. And is there anything in the family that's important for me to know? Any family history of medical problems, heart problems, lung problems? My father died of a heart attack. I'm sorry to hear that. How old was your father when he passed away? He was Early 60s. Early 60s, okay. Anything else I should be aware of? My mother had osteoporosis. Okay. Is your mother still with us? Yes, she's still living. Okay, all right. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? I live on my own. I've got two cats. You've got two cats, okay. great do you have names they're my family uh they're called um they're called holly and tim okay um so this is junior cats and um in terms of day-to-day are you working at the moment uh i work part-time as a uh lorry driver okay and how is that is that quite stressful long hours Uh, it's okay. Um, I, uh, yeah, like when I'm working, it's pretty exhausting. Um, I guess I'm a bit worried that if I get sick, I won't, if I get more sick, then I won't be able to work properly. Yeah. There's certainly a consideration, isn't there? So let's, let's try and get better soon. So it doesn't have any, um, impact on your, on your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving? Oh no, I only take shifts during the day. I don't like working at night. Okay, all right. And what about smoking and alcohol? Because they can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day, back in the day. And how many was that for? Oh that was a good 25 years. Okay well done for stopping, it must have been very difficult for you, but well done for stopping. And what about alcohol? I don't drink alcohol. Do you do much in the way of exercise though? I try and walk to the shops at least once a day, but that's about it. Yeah I don't I don't get running like I used to when I was young. Right, and certainly now with your symptoms, you said you're getting more breathless even walking to the shop, she said. Right, based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen. What's going on? So, it seems like your heart's not pumping as well as it should be. obviously having diagnosed with heart failure, there's obviously, it's the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of Fruzomide. Maybe rather than one tablet a day, we can give you two tablets a day for the first few days and see how you're getting on. Okay, if you think that would be best. is definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah, so an echo scan, it's a jelly scan of your heart. You may have had this done before when you were diagnosed, and it's just to get a good... Oh, yes, I remember now. Sorry? Yeah, I remember now. Okay, fine. That's something I can organise for you today and they may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's get a blood test done. We can check your full blood count, look for signs of anemia. We can have a check of your kidney function. And we can definitely increase your fruzomide to one tablet twice a day. But I really would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, I want you to give me a call sooner than that and we can have a chat on the phone as well. Okay, I'll see how I get on. Okay, do you have any questions for me? I think that's all pretty clear. Thank you very much, Doctor. Great, I wish you all the best. Have a good day. See you soon. Okay, thank you.", "note": "Subjective\n\nCC: Worsening dyspnoea over 2 weeks, acutely worsening over last 2 days.\n\nHPI:\n\nDyspnoea occurs with minimal exertion (walking to shops); previously able to walk without issue.\n\nAssociated symptoms: Dry cough, bilateral ankle oedema (noted last few days).\n\nNegative symptoms: Denies chest pain, palpitations, fever, or dizziness.\n\nAppetite/Urinary output: Normal/stable.\n\nPMH:\n\nHeart failure (diagnosed previously).\n\nHistory of MI (~5 years ago).\n\nMedications:\n\nFurosemide (dose unknown; to be increased to 1 tab BD).\n\nAspirin.\n\nMetoprolol (transcribed as \"Zoprolol\").\n\nSimvastatin.\n\nAllergies: NKDA.\n\nFH:\n\nPaternal: MI (early 60s).\n\nMaternal: Osteoporosis.\n\nSH:\n\nOccupation: Part-time lorry driver (day shifts).\n\nLiving situation: Lives alone with two cats.\n\nSmoking: Ex-smoker (1 pack/day for 25 years).\n\nAlcohol: Nil.\n\nObjective\n\nChest: Normal.\n\nSaturations: Normal.\n\nBlood Pressure: Normal.\n\nPeripheral: Bilateral ankle oedema noted.\n\nAssessment\n\nHeart failure (confirmed) flare-up.\n\nHistory of MI (confirmed).\n\nPlan\n\nMedication: Increase Furosemide to 1 tablet BD for the first few days.\n\nInvestigations:\n\nBloods: FBC (to screen for anaemia) and renal function.\n\nOrganise Echocardiogram (approx. 1-2 week lead time).\n\nFollow-up: Review in 1 week.\n\nSafety Netting: Contact clinic immediately if experiencing chest pain, palpitations, or increased dyspnoea.", "facts": [ "Presents with shortness of breath.", "Breathlessness has been gradually worsening over the last couple of weeks.", "Breathlessness has become much more troublesome in the last few days.", "Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.", "Now breathless just moving about the house (breathless on minimal exertion).", "Concerned that his heart failure is getting worse.", "No chest pain.", "Has a mild dry cough that is not too troublesome.", "Feels a little run-down; otherwise feels generally normal.", "Swelling of both ankles.", "Ankle swelling noticed over the last few days.", "Ankles also swelled previously when his heart failure was a problem.", "No palpitations or racing/skipped heartbeat.", "No fevers or temperatures.", "Eating and drinking normally (appetite fine).", "Passing urine OK, but urinates a lot since starting his medication (diuretic).", "Known heart failure, diagnosed some time ago.", "Was breathless when heart failure was first diagnosed and this improved with medication.", "Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).", "That episode presented with chest pain and he was admitted to hospital.", "Has been well since the heart attack.", "Has had an echocardiogram before (around the time of heart failure diagnosis).", "No other past medical history apart from the heart problems.", "Takes furosemide (diuretic).", "Current furosemide dose is one tablet a day; patient does not know the dose in mg.", "Takes aspirin.", "Takes bisoprolol.", "No known drug allergies.", "Father died of a heart attack.", "Father was in his early sixties when he died.", "Mother has osteoporosis.", "Lives alone.", "Works part-time as a lorry driver.", "Finds work exhausting and is worried that worsening illness will stop him working properly.", "Ex-smoker.", "Smoked about a pack a day.", "Smoked for about 25 years.", "Does not drink alcohol.", "Usual exercise is walking to the shops at least once a day.", "Chest examination OK.", "Oxygen saturations OK.", "Blood pressure OK.", "Otherwise well at the moment.", "Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.", "Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).", "Increased furosemide dose for the first few days, then see how he gets on.", "Blood test: full blood count to look for anaemia.", "Blood test: kidney function.", "Echocardiogram to assess how well the heart is pumping.", "Echocardiogram to be requested today; may take one to two weeks to be arranged.", "Follow-up review in about one week.", "Safety-net: call sooner if more unwell or more breathless.", "Safety-net: call sooner if chest pain, palpitations or dizziness develop." ], "marks": [ [ 19, 19, "Uh," ], [ 43, 48, "OK?" ], [ 70, 75, "OK," ], [ 83, 100, "" ], [ 112, 119, "Nice to see you" ], [ 132, 132, "Um," ], [ 167, 167, "Are you the doctor? Um," ], [ 235, 240, "OK." ], [ 307, 307, "Uh," ], [ 386, 386, "Um, now" ], [ 438, 438, "Uh, I kind of," ], [ 557, 561, "really" ], [ 619, 619, "uh," ], [ 649, 650, "" ], [ 685, 685, "OK. OK. OK." ], [ 738, 738, "Um," ], [ 744, 744, "I've, I've uh," ], [ 753, 753, "um," ], [ 769, 774, "OK. Uh," ], [ 790, 790, "uh," ], [ 803, 803, "Um," ], [ 859, 865, "" ], [ 890, 890, "that, that um," ], [ 930, 930, "just" ], [ 945, 945, "OK. Right." ], [ 953, 958, "OK." ], [ 976, 995, "you're feeling, uh," ], [ 1099, 1104, "Um, uh," ], [ 1144, 1146, "on" ], [ 1154, 1154, "minimal," ], [ 1186, 1186, "Um," ], [ 1229, 1229, "uh, uh," ], [ 1309, 1314, "OK. And" ], [ 1338, 1338, "coughing," ], [ 1355, 1355, "Um. Uh," ], [ 1417, 1422, "OK. OK." ], [ 1479, 1479, "uh," ], [ 1496, 1496, "Um," ], [ 1518, 1526, "run-down, um," ], [ 1530, 1530, "otherwise," ], [ 1555, 1555, "OK." ], [ 1602, 1607, "OK." ], [ 1637, 1637, "Uh," ], [ 1653, 1660, "it's" ], [ 1687, 1692, "OK. Um, is that," ], [ 1706, 1713, "Kind of Um," ], [ 1764, 1769, "Both ankles? OK. Uh," ], [ 1790, 1790, "Um," ], [ 1815, 1815, "has this," ], [ 1838, 1838, "for? Um," ], [ 1879, 1883, "Past" ], [ 1894, 1899, "OK." ], [ 1957, 1957, "Uh," ], [ 2038, 2049, "OK. OK. Um," ], [ 2056, 2061, "OK." ], [ 2064, 2064, "um," ], [ 2086, 2086, "uh," ], [ 2089, 2089, "you're" ], [ 2096, 2096, "in" ], [ 2121, 2121, "uh," ], [ 2152, 2152, "uh," ], [ 2233, 2233, "Um," ], [ 2268, 2284, "Um, reporting" ], [ 2299, 2299, "Um, and," ], [ 2303, 2303, "have you had any, have you any," ], [ 2405, 2410, "OK." ], [ 2442, 2442, "Uh," ], [ 2447, 2452, "OK." ], [ 2510, 2515, "OK?" ], [ 2521, 2521, "I, I'm," ], [ 2535, 2540, "OK." ], [ 2550, 2562, "waterworks?" ], [ 2585, 2590, "OK? Uh, yeah, but" ], [ 2618, 2630, "ever since the drugs Yeah. Sure, OK. Alright. Um, fine. So, your uh," ], [ 2686, 2686, "Any," ], [ 2734, 2734, "Uh," ], [ 2757, 2757, "like a," ], [ 2820, 2820, "Um, I uh, I had, I," ], [ 2826, 2826, "like some" ], [ 2855, 2857, "into" ], [ 2866, 2866, "OK." ], [ 2870, 2870, "um," ], [ 2875, 2875, "uh," ], [ 2904, 2909, "OK. And when," ], [ 2922, 2922, "a" ], [ 2986, 2986, "a," ], [ 3009, 3009, "Um. Uh," ], [ 3047, 3047, "something a uh," ], [ 3091, 3116, "It's more hard to say. OK." ], [ 3142, 3142, "um, Um. Uh," ], [ 3146, 3146, "they," ], [ 3156, 3156, "that it, uh," ], [ 3197, 3202, "OK. Um, uh, but um, I didn't," ], [ 3254, 3259, "and, uh. OK. OK." ], [ 3280, 3284, "OK" ], [ 3309, 3313, "OK" ], [ 3326, 3342, "OK, alright." ], [ 3356, 3356, "the uh, the heart," ], [ 3436, 3436, "Uh," ], [ 3448, 3448, "I'm" ], [ 3463, 3474, "OK. OK. Um," ], [ 3556, 3556, "And" ], [ 3580, 3580, "Uh," ], [ 3714, 3714, "That's OK." ], [ 3727, 3727, "Um," ], [ 3750, 3750, "Uh," ], [ 3773, 3778, "OK." ], [ 3783, 3800, "uh, Bisoprolol. The" ], [ 3821, 3830, "Or? Uh, Bisoprolol." ], [ 3842, 3855, "connection's" ], [ 3871, 3876, "OK." ], [ 3888, 3935, "yeah. Um, And a thousand, OK. Alright." ], [ 3974, 3974, "Uh," ], [ 3993, 3998, "No. OK." ], [ 4034, 4034, "that's, uh, that, that's uh," ], [ 4138, 4138, "Uh my," ], [ 4153, 4153, "of a, uh," ], [ 4196, 4196, "And, um," ], [ 4241, 4241, "Uh," ], [ 4248, 4248, "um," ], [ 4255, 4259, "sixties." ], [ 4266, 4276, "sixties, OK. Alright." ], [ 4312, 4312, "Um," ], [ 4341, 4346, "OK." ], [ 4377, 4381, "Uh, yeah," ], [ 4402, 4418, "OK, alright. Um," ], [ 4519, 4519, "Uh," ], [ 4538, 4542, "Well, I" ], [ 4578, 4583, "OK," ], [ 4593, 4596, "they" ], [ 4628, 4628, "they're," ], [ 4662, 4667, "Polly" ], [ 4676, 4680, "OK." ], [ 4687, 4701, "it's just you and your" ], [ 4726, 4736, "day to day," ], [ 4808, 4812, "OK." ], [ 4873, 4878, "OK." ], [ 4896, 4900, "" ], [ 4942, 4942, "Mm." ], [ 5067, 5074, "that's" ], [ 5108, 5114, "it?" ], [ 5142, 5142, "you" ], [ 5212, 5212, "No. Uh," ], [ 5253, 5263, "anti-social" ], [ 5270, 5270, "Do you" ], [ 5322, 5324, "Ohh" ], [ 5328, 5328, "I I I," ], [ 5395, 5411, "OK. OK, alright." ], [ 5448, 5460, "So, 'cause that" ], [ 5525, 5525, "Do you," ], [ 5551, 5559, "any more." ], [ 5587, 5587, "And" ], [ 5629, 5632, "Ooh" ], [ 5639, 5639, "about," ], [ 5676, 5676, "Um," ], [ 5680, 5680, "how many," ], [ 5689, 5689, "years" ], [ 5704, 5706, "Ohh" ], [ 5716, 5717, "oof," ], [ 5723, 5725, "twenty five" ], [ 5733, 5751, "OK. And what about the" ], [ 5762, 5764, "That" ], [ 5780, 5784, "" ], [ 5804, 5835, "stopping. Um, and what," ], [ 5878, 5878, "OK." ], [ 5917, 5924, "sir? Uh," ], [ 5973, 5973, "OK. Um," ], [ 5977, 5977, "uh," ], [ 5994, 5994, "I've." ], [ 6016, 6019, "go" ], [ 6060, 6060, "OK." ], [ 6067, 6067, "OK." ], [ 6086, 6090, "" ], [ 6105, 6105, "you, you're," ], [ 6122, 6129, "feeling" ], [ 6158, 6158, "to the uh," ], [ 6181, 6181, "Um," ], [ 6188, 6188, "Ohh um," ], [ 6202, 6202, "based on you" ], [ 6245, 6245, "I," ], [ 6312, 6312, "Um," ], [ 6341, 6357, "Um, um, and uh, Mmm. That. It's" ], [ 6425, 6425, "Um, and" ], [ 6492, 6496, "What's going on. Um, that's" ], [ 6535, 6535, "Um," ], [ 6568, 6570, "" ], [ 6584, 6584, "Um, Mmm." ], [ 6716, 6721, "OK," ], [ 6763, 6773, "Furosemide." ], [ 6817, 6825, "do" ], [ 6866, 6866, "Um, and see," ], [ 6898, 6903, "OK." ], [ 6910, 6910, "think that'll be better. Uh, I" ], [ 6917, 6939, "I think, it's, it's, it's" ], [ 7155, 7160, "OK." ], [ 7190, 7190, "before?" ], [ 7199, 7199, "um," ], [ 7203, 7213, "it's a," ], [ 7221, 7226, "general" ], [ 7251, 7254, "might" ], [ 7337, 7340, "What does that? Ohh" ], [ 7368, 7368, "Uh," ], [ 7391, 7396, "You remember that. OK," ], [ 7426, 7434, "organize" ], [ 7448, 7448, "And," ], [ 7453, 7461, "that might" ], [ 7551, 7551, "let's, um, Let's," ], [ 7593, 7593, "your um, you know" ], [ 7687, 7687, "Um," ], [ 7718, 7718, "your um," ], [ 7724, 7733, "Furosemide, uh," ], [ 7736, 7736, "you know," ], [ 7773, 7773, "like," ], [ 7836, 7838, "" ], [ 7866, 7870, "" ], [ 7931, 7931, "And of" ], [ 7989, 7994, "feel like" ], [ 8113, 8113, "uh," ], [ 8215, 8220, "OK." ], [ 8244, 8249, "OK?" ], [ 8283, 8283, "Uh," ], [ 8352, 8352, "and then well" ], [ 8395, 8398, "OK. Thank" ], [ 8403, 8425, "OK. See you soon." ] ], "grade": { "facts": [ [ "yes", "CC: \"Worsening dyspnoea\"." ], [ "yes", "\"Worsening dyspnoea over 2 weeks\"." ], [ "yes", "\"acutely worsening over last 2 days\"." ], [ "yes", "\"previously able to walk without issue\"; minimal exertion walking to shops." ], [ "partial", "\"Dyspnoea occurs with minimal exertion\" but breathlessness around the house not stated." ], [ "no", "Patient's worry that his heart failure is worsening is not recorded." ], [ "yes", "\"Denies chest pain\"." ], [ "partial", "\"Dry cough\" recorded but not that it is mild/not troublesome." ], [ "no", "Feeling run-down not mentioned." ], [ "yes", "\"bilateral ankle oedema\"." ], [ "yes", "\"(noted last few days)\"." ], [ "no", "Previous ankle swelling with earlier heart failure episode not mentioned." ], [ "yes", "\"Denies ... palpitations\"." ], [ "yes", "\"Denies ... fever\"." ], [ "yes", "\"Appetite ... Normal\"." ], [ "partial", "\"Urinary output: Normal/stable\" misses that he urinates a lot since starting the diuretic." ], [ "yes", "\"Heart failure (diagnosed previously)\"." ], [ "no", "Breathlessness at diagnosis improving with medication not recorded." ], [ "partial", "\"History of MI (~5 years ago)\"; omits 'small heart attack', more than angina, diagnosis not recalled." ], [ "no", "Chest pain presentation and hospital admission not recorded." ], [ "no", "Being well since the heart attack not recorded." ], [ "no", "Previous echocardiogram not mentioned." ], [ "no", "Absence of other past medical history not stated." ], [ "yes", "\"Furosemide\" listed." ], [ "partial", "\"dose unknown\" captured but current one tablet a day not stated." ], [ "yes", "\"Aspirin\" listed." ], [ "no", "Note lists \"Metoprolol\" instead of bisoprolol." ], [ "yes", "\"Allergies: NKDA\"." ], [ "yes", "\"Paternal: MI\"." ], [ "yes", "\"(early 60s)\"." ], [ "yes", "\"Maternal: Osteoporosis\"." ], [ "yes", "\"Lives alone with two cats\"." ], [ "yes", "\"Part-time lorry driver\"." ], [ "no", "Work exhaustion and worry about being unable to work not recorded." ], [ "yes", "\"Ex-smoker\"." ], [ "yes", "\"1 pack/day\"." ], [ "yes", "\"for 25 years\"." ], [ "yes", "\"Alcohol: Nil\"." ], [ "no", "Daily walk to shops as usual exercise not recorded." ], [ "yes", "\"Chest: Normal\"." ], [ "yes", "\"Saturations: Normal\"." ], [ "yes", "\"Blood Pressure: Normal\"." ], [ "no", "'Otherwise well at the moment' not recorded." ], [ "partial", "\"Heart failure (confirmed) flare-up\" stated as definite and omits reduced pumping." ], [ "yes", "\"Increase Furosemide to 1 tablet BD\"." ], [ "yes", "\"for the first few days\"." ], [ "yes", "\"FBC (to screen for anaemia)\"." ], [ "yes", "\"renal function\"." ], [ "partial", "\"Organise Echocardiogram\" but purpose (pumping function) not stated." ], [ "partial", "\"approx. 1-2 week lead time\" captured; requesting it today not stated." ], [ "yes", "\"Review in 1 week\"." ], [ "partial", "\"increased dyspnoea\" covered; getting more unwell generally omitted." ], [ "partial", "Chest pain and palpitations listed; dizziness omitted." ] ], "claims": [ { "claim": "Metoprolol (transcribed as \"Zoprolol\")", "reason": "Patient takes bisoprolol, which he confirmed when the doctor queried metoprolol.", "fact": 26 }, { "claim": "Simvastatin", "reason": "Simvastatin is never mentioned in the reference transcript.", "fact": null }, { "claim": "Denies ... dizziness", "reason": "Dizziness was never asked about; it appears only in safety-net advice.", "fact": null }, { "claim": "Heart failure (confirmed) flare-up", "reason": "Clinician only wondered whether it was a flare-up; stated as confirmed.", "fact": 43 } ], "significantMarks": [ { "i": 73, "reason": "Missed 'ever since the drugs', which links frequent urination to the diuretic." }, { "i": 107, "reason": "Drug name bisoprolol transcribed as 'Zoprolol'." }, { "i": 108, "reason": "Patient's confirmation 'Bisoprolol' transcribed as 'Zoprolol'; wrong drug name." }, { "i": 111, "reason": "Invented medication 'Simvastatin' not in the reference." } ] } } ], "addedInterpretation": [ { "case": "hpi-pain-management", "product": "patientnotes", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n\nChief Complaint::\n\nLeft lower extremity pain and numbness.\n\nHistory of Presenting Complaint::\n\n55-year-old white female with low back pain.\n\nPrior right sacroiliac joint injection gave 80% improvement of right-sided low back pain.\n\nMRI shows L4-L5 foraminal stenosis.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: low back pain with left leg numbness secondary to lumbar disc herniation and L4-L5 foraminal stenosis.\n\nPlan\n\nPerform lumbar epidural steroid injection.\n\nIf patient does well, no further intervention will be required.", "addedInterpretation": [ { "text": "low back pain with left leg numbness secondary to lumbar disc herniation and L4-L5 foraminal stenosis", "reason": "The clinician only lists the diagnoses side by side: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. The clinician never says the pain or numbness is caused by the herniation or stenosis. The causal word \"secondary to\" is the scribe's own link." } ] }, { "case": "day2_consultation07", "product": "iscribe", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n\nCC: Acute-onset retrosternal chest pressure (\"someone sitting on chest\") during light activity (gardening).\n\nSymptoms:\n\nNausea (no emesis)\n\nDiaphoresis\n\nSOB\n\nRadiation: L arm and shoulder\n\nStatus: Symptoms currently ongoing\n\nPalpitations: Pt reports heart beating faster (attributed to stress).\n\nPMH:\n\nHTN\n\nNo DM\n\nNo hx of cholesterol checked\n\nAllergies: Aspirin (Reaction: mild swelling/allergic reaction).\n\nFH:\n\nFather: Deceased due to MI @ ~60.\n\nMother: Hx of heart problems.\n\nSH:\n\nSmoking: 10 cigarettes/day (15 years).\n\nAlcohol: ~7–8 pints of beer/week.\n\nOccupation: Restaurant owner (Sushi shop).\n\nBMI: Pt reports being overweight.\n\nObjective\n\nPhysical Exam: No physical examination performed via video consultation.\n\nInvestigations: No completed investigations.\n\nAssessment\n\nProvisional Diagnosis: ACS/MI\n\nConfirmed: HTN\n\nConfirmed: Aspirin Allergy\n\nPlan\n\nDispatch ambulance for urgent assessment and ECG.\n\nParamedics to assess and determine hospital admission based on ECG results and clinical presentation.\n\nPt to keep front door open for emergency access.\n\nAdvised pt to communicate aspirin allergy to hospital staff.", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "hanah-old", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n- Abdominal pain x at least 4 days, onset Sunday evening. Gradual dull ache in upper abdomen → sharp RLQ pain, 8/10, without radiation. Worse with movement; nothing relieves it.\n- Fever last night; home temperature 38°C. Vomited x 3, especially after eating; no appetite.\n- Normal bowel movements; no diarrhea or constipation. No dysuria or ↑ urinary frequency.\n- Concerned about seriousness and need for surgery; asked whether to contact family.\nObjective\n- RLQ tenderness, “gathering” and rebound tenderness.\n- Left-sided abdominal pressure elicited right-sided pain; clinician described positive “rough things sign.”\nAssessment\n- Suspected acute appendicitis. Migratory pain and RLQ tenderness with rebound strongly suggestive; confirmation required.\n- Explained possible appendix inflammation and rupture if untreated.\nPlan\n- Proposed CBC, CRP and likely abdominal US or CT to confirm.\n- Planned IV fluids, analgesia and antibiotics.\n- Discussed possible laparoscopic surgery after confirmation.\n- Discussed oral intake in relation to possible surgery; wording of instruction unclear in transcript.\n- Planned admission and surgical team review within hours; surgical team to determine need for surgery and timing.\n- Encouraged contacting family. Reassured patient that the team would provide care and treatment.", "addedInterpretation": [ { "text": "Migratory pain and RLQ tenderness with rebound strongly suggestive", "reason": "The clinician tied only the exam findings (RLQ tenderness, rebound tenderness and the positive Rovsing's sign) to the appendicitis assessment: \"They are very suggestive of acute appendices.\" Earlier he repeated back that the pain moved from the upper abdomen to the lower right, but he never named that migration as evidence for appendicitis. Listing migratory pain as support for the diagnosis is the scribe's own reasoning." } ] }, { "case": "day4_consultation08", "product": "arlo", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "SOAP Notes\n\nSubjective\n- Main c/o: fatigue, low energy, difficulty waking, ↓ appetite x ~2/12\n- Sx onset w/ new job (started 2/12 ago)\n- ↓ sleep, difficulty initiating/maintaining sleep\n- ↓ concentration, easily distracted\n- Mood: ↓, not suicidal, no anhedonia\n- ↓ libido x few months, less interest in sex\n- No recent change in morning erections\n- SOB w/ sports, ↑ fatigue w/ exertion\n- PMHx: hypothyroidism\n- FHx: father suicide (15y ago), no other psych hx\n- Meds: thyroxine (current)\n- No drug allergies\n\nObjective\n- N/A\n\nWDx\n- Fatigue, ↓ mood, ↓ appetite, ↓ libido, ↓ concentration, sleep disturbance x ~2/12\n- PMHx hypothyroidism on thyroxine\n- FHx suicide (father)\n- SOB w/ exertion\n\nPlan\n- Hx via telehealth\n- Screened mood, sleep, energy, libido, appetite, suicidality\n- Advise in-person review & bloods w/ GP", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "patientnotes", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n\nChief Complaint::\n\nChest discomfort with pressure, nausea, sweating, shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset while gardening ~2 hours ago; pressure central chest radiating to left arm/shoulder; symptoms ongoing; no prior similar episodes; low baseline activity.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible acute myocardial infarction (ACS) – priority to exclude.\n\nPlan\n\nAmbulance dispatched for emergency ECG and management; clinician to remain on line and convey aspirin allergy to emergency team.", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "cliniscripts", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "S (Subjective):\n- Patient, Dean Gowers, born August 8, 1958 (age 60), presented with chest discomfort that started a couple of hours prior while gardening.\n- Symptoms include pressure on the chest, feeling \"someone's sitting on my chest,\" nausea (no vomiting), sweating, and shortness of breath, which are still present.\n- The discomfort is located in the middle of the chest, diffuse, and radiates to the left arm and shoulder.\n- This is the first time the patient has experienced these symptoms.\n- The [scribe] palpitations, with their heart beating faster, which they attribute to stress about the situation.\n\nO (Objective):\n- Patient confirmed full name and date of birth.\n- Patient resides alone and has an open front door for ambulance access.\n- Patient is a smoker (10 cigarettes/day for 15 years) and reports a history of high blood pressure but no diabetes. Cholesterol levels are unknown.\n- Patient drinks approximately 7-8 pints of beer per week and is overweight.\n- Family history includes father's death from a heart attack around age 60 and mother's heart problems.\n\nA (Assessment):\n- The patient's described symptoms are indicative of a possible myocardial infarction (heart attack).\n- The primary concern is to exclude acute cardiac event given the chest discomfort, associated symptoms, and significant risk factors.\n- Differential diagnoses include other causes of chest pain, which require further investigation.\n\nP (Plan):\n- An ambulance has been called to transport the patient to the hospital for further assessment and management.\n- The doctor will remain on the line with the patient until the ambulance team arrives.\n- The patient has an allergy to aspirin, which causes mild swelling, and this information needs to be communicated to the hospital team, as aspirin may still be considered despite the allergy.\n- The ambulance team will perform an ECG on arrival to guide further treatment and hospital destination.\n- The doctor will hand over patient details to the ambulance crew upon their arrival.", "addedInterpretation": [ { "text": "The primary concern is to exclude acute cardiac event given the chest discomfort, associated symptoms, and significant risk factors.", "reason": "The clinician tied the possible heart attack only to the symptoms the patient described ('the symptoms that you've described to me... indicate the possibility of a heart attack'). They asked about smoking, blood pressure, family history, alcohol and weight but never said these risk factors raise the concern or support the assessment. Citing 'significant risk factors' as a reason is the scribe's own reasoning." } ] }, { "case": "day2_consultation07", "product": "hanah-old", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n- First episode of diffuse central chest pressure x ~2 hours, ongoing during consultation; sensation of weight on chest. Started while kneeling gardening, without strenuous exertion. Radiation mainly to left arm, with shoulder pain.\n- Associated nausea, sweating and SOB. No vomiting.\n- Heart feels faster now, attributed to stress about the situation; no earlier increase in heartbeat noticed today.\n- HTN; no DM. Cholesterol never checked.\n- Smokes 10 cigarettes/day x 15 years. Drinks 7–8 pints beer/week. Generally inactive; self-reported overweight.\n- Father died of MI at ~60; mother had heart problems.\n- Lives alone; no one currently in house. Front door open. Works as restaurant owner, owning a sushi shop.\n- Aspirin allergy: swelling, described as mild and not life-threatening; occasionally still takes aspirin. No other allergies.\nObjective\n- Video consultation.\nAssessment\n- Possible MI; urgent exclusion required given persistent central chest pressure with left arm radiation, nausea, sweating and SOB, plus HTN, smoking and FH of heart disease. Diagnosis not confirmed.\nPlan\n- Ambulance arranged for urgent assessment and hospital transfer; clinician advised patient it was on its way.\n- Explained possible MI, not a confirmed diagnosis, and priority of excluding it. Reassured patient that help was coming.\n- Advised remaining near hallway/front door and keeping door open for emergency access.\n- Explained ambulance team would assess and perform ECG; destination hospital would depend on ECG findings and treatment required.\n- Planned to remain on line until ambulance arrival, then hand over symptoms and history to team.\n- Advised communicating aspirin reaction to hospital in detail; explained aspirin may need consideration despite reported allergy.", "addedInterpretation": [ { "text": "Possible MI; urgent exclusion required given ... plus HTN, smoking and FH of heart disease.", "reason": "The clinician linked only the symptoms to a possible heart attack (\"the symptoms that you've described to me... indicate the possibility of a heart attack\"). They asked about hypertension, smoking and family history but never said these raised concern or supported the MI assessment. Using those risk factors as grounds for the assessment is the scribe's own reasoning." } ] }, { "case": "day4_consultation08", "product": "cliniscripts", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "S (Subjective):\n- Patient presents with a 2-month history of difficulty waking up, low energy, and reduced appetite.\n- They report finding normal activities difficult and experiencing difficulty sleeping.\n- Patient describes lower mood, decreased sex drive, difficulty focusing, and being easily distracted.\n- They report not noticing morning erections, which is a change for them.\n- [scribe] new onset shortness of breath during sports over the last few months.\n\nO (Objective):\n- The patient is cooperative during the consultation.\n- The patient's speech is clear and responsive.\n- The patient's affect appears congruent with reported low mood.\n- No other objective findings were explicitly mentioned or observed via equipment.\n- No vital signs, laboratory results, or imaging studies were discussed.\n\nA (Assessment):\n- Patient presents with symptoms consistent with a depressive episode, including low mood, anhedonia (difficulty enjoying activities), sleep disturbance, reduced energy, and decreased libido.\n- Differential diagnosis includes underlying medical conditions, particularly given the history of hypothyroidism and new-onset shortness of breath.\n- The chronicity of symptoms (2 months) suggests a persistent issue.\n- The patient's concern is to return to their previous state of well-being.\n\nP (Plan):\n- Book an in-person appointment for the patient for a physical examination.\n- Conduct blood tests to investigate the reported symptoms further.\n- Further investigations are planned to understand the underlying cause of the symptoms.\n- No specific medication or dietary changes were discussed or prescribed.\n- Referral to other specialties was not explicitly mentioned at this stage.", "addedInterpretation": [ { "text": "Patient presents with symptoms consistent with a depressive episode, including low mood, anhedonia (difficulty enjoying activities), sleep disturbance, reduced energy, and decreased libido.", "reason": "The clinician never names depression or a depressive episode, and never groups these symptoms into a diagnosis. They screen mood and suicide risk, then defer: 'we'll do an examination and... investigations really, to see what's going on'. The working diagnosis and the grouping of symptoms under it are the scribe's own." }, { "text": "Differential diagnosis includes underlying medical conditions, particularly given the history of hypothyroidism and new-onset shortness of breath.", "reason": "The clinician takes the hypothyroidism history and the shortness of breath on exertion but never links either one to the presenting symptoms as a reason for a medical differential. They only plan an exam and blood tests 'to see what's going on'. Tying the differential to these two findings is the scribe's reasoning." }, { "text": "The chronicity of symptoms (2 months) suggests a persistent issue.", "reason": "The clinician only pins down the duration (about two months, starting around the new job) and draws no conclusion from it. 'Suggests a persistent issue' is an inference the scribe added." } ] }, { "case": "hpi-pain-management", "product": "arlo", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "SOAP Notes\n\nSubjective\n- 55 y/o F\n- c/o LBP w/ L lurch, numbness\n- s/p R joint injection w/ 80% improvement R LBP\n- Now w/ L LE P, numbness\n\nObjective\n- MRI: L4/5 foraminal stenosis\n\nWDx\n- LBP w/ L lurch, numbness\n- Lumbar disc herniation\n- Lumbar foraminal stenosis\n\nPlan\n- Lumbar ESI performed\n- If pt doing well, no further intervention", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "cliniscripts", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "S (Subjective):\n- The patient, Tim Gowers, born August 8, 1958 (60 years old), reports new onset chest discomfort for the past couple of hours.\n- Symptoms began while gardening and include a pressure sensation on the chest (\"someone's sitting on my chest\"), nausea (no vomiting), sweating, and shortness of breath.\n- The discomfort is located in the middle of the chest, described as diffuse, and radiates to the left arm and shoulder. Symptoms are currently ongoing.\n- They report their heart beating faster, which they attribute to stress; this is the first time experiencing these symptoms.\n- Relevant social history includes smoking 10 cigarettes daily for 15 years, consuming 7-8 pints of beer weekly, being overweight, and generally having low physical activity.\n- Medical history includes high blood pressure; no history of diabetes, and cholesterol has never been checked. Family history is significant for a father who died of a heart attack around age 60 and a mother with heart problems.\n- The patient reports an allergy to aspirin, causing mild, non-life-threatening swelling.\n\nO (Objective):\n- The patient appears stressed during the interaction, reporting their heart beating faster.\n- The patient confirms they are in a private place and has opened their front door for emergency access.\n- No other objective findings were documented from a physical examination or vital signs.\n\nA (Assessment):\n- The patient's reported symptoms are indicative of a possible heart attack.\n- The primary diagnostic priority is to exclude an acute coronary syndrome.\n\nP (Plan):\n- An ambulance has been dispatched to transport the patient to the hospital for further evaluation and management.\n- The doctor will remain on the line with the patient until the emergency medical services arrive.\n- The ambulance team will perform an ECG and assess the patient to determine the appropriate hospital destination and treatment.\n- The patient has been instructed to communicate their aspirin allergy to the hospital staff upon arrival, given the potential need for aspirin despite the allergy.\n- Further investigations and treatment will be decided by the ambulance team and hospital based on clinical assessment and ECG findings.", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "hanah-old", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n- 55-year-old white female presents to pain clinic with LLE pain and numbness. Prior right SI joint injection → 80% improvement in right-sided low back pain.\nObjective\n- Lumbar MRI: foraminal stenosis at L4–5.\nAssessment\n- Low back pain with LLE numbness; lumbar disc herniation and lumbar foraminal stenosis. L4–5 foraminal stenosis supports proceeding with lumbar epidural steroid injection for current LLE symptoms.\nPlan\n- Decision to proceed with lumbar epidural steroid injection.\n- No further intervention if doing well.", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "heidi", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective:\n- New onset chest discomfort, nausea, sweating and SOB, onset ~2 hours ago while gardening\n- Chest discomfort described as pressure, \"like someone sitting on chest\", central over pectoral muscles, diffuse\n- Symptoms currently present\n- Associated pain in left arm and shoulder\n- Onset during non-strenuous activity (gardening, kneeling)\n- Generally low physical activity levels\n- No previous episodes\n- Reports heart beating faster, attributes to stress\n- No one else home; front door left open for ambulance access\n\n\n\n\nObjective:\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment:\n- Clinical presentation concerning for possible MI, requiring urgent evaluation\n\n\n\n\nPlan:\n- Ambulance called for urgent transport to hospital for further assessment and management\n- Advised to communicate aspirin allergy (mild allergic reaction with swelling, not life-threatening) to hospital staff\n- Clinician to remain on line until ambulance arrival\n- Hospital team to assess and determine appropriate facility based on ECG findings and treatment needs", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "hanah-old", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n- 55-year-old white female presents to pain clinic with left lower extremity pain and numbness.\n- 80% improvement in right-sided low back pain following right sacroiliac joint injection.\nObjective\n- MRI: foraminal stenosis at L4-5.\nAssessment\n- Low back pain with left lower extremity numbness.\n- Lumbar disc herniation.\n- Lumbar foraminal stenosis; L4-5 MRI finding supports proceeding with lumbar epidural steroid injection for left lower extremity symptoms.\nPlan\n- Decision to proceed with lumbar epidural steroid injection.\n- No further intervention if doing well.", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "freed", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\nCliniTech Benchmark 1b0084e8 presents with abdominal pain that began on Sunday evening, approximately 4 days ago. The pain initially started in the upper abdomen and gradually migrated to the right lower quadrant. It began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10 in severity. The patient reports that nothing alleviates the pain, and movement tends to aggravate it. She denies radiation of the pain to the back or shoulders.\n\nShe reports an associated fever, measured at 38 degrees Celsius the previous night. She has vomited three times, particularly after eating, and reports complete loss of appetite. She denies diarrhea or constipation, stating that bowel movements have been normal. She denies dysuria or urinary frequency.\n\nReview of Systems \n- General: Positive for fever and decreased appetite \n- Gastrointestinal: Positive for vomiting, denies diarrhea, constipation \n- Genitourinary: Denies dysuria, urinary frequency\n\nObjective\nPhysical Examination \n- Abdomen: Tenderness in the right lower abdomen. Rebound tenderness present. Positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in the upper abdomen and migrated to the right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute appendicitis \nAssessment: Patient presents with classic signs and symptoms of acute appendicitis. Pain began 4 days ago in the epigastrium and has migrated to the right lower quadrant, which is characteristic of appendiceal inflammation. Pain has progressed from a dull ache to sharp 8/10 intensity. Associated symptoms include fever of 38°C, nausea, vomiting particularly after eating, and anorexia. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen with a positive Rovsing's sign. These clinical findings are highly suggestive of acute appendicitis requiring prompt surgical evaluation. \nPlan: \n- Obtain CBC and CRP blood work \n- Order abdominal ultrasound or CT scan to confirm diagnosis \n- Start IV fluids \n- Administer pain relief medication \n- Initiate antibiotic therapy \n- Keep patient NPO in preparation for possible surgery \n- Admit to hospital \n- Consult surgical team for evaluation within hours \n- Surgical team will determine timing of appendectomy if indicated \n- Patient advised to contact family members regarding admission", "addedInterpretation": [ { "text": "has migrated to the right lower quadrant, which is characteristic of appendiceal inflammation", "reason": "The clinician's stated link to appendicitis rested only on the exam findings (tenderness, guarding, rebound, Rovsing sign: 'very suggestive of acute appendices'). The clinician noted that the pain moved from the upper abdomen to the right lower side but never called that migration characteristic of appendicitis or used it as evidence. The note added that link, and its framing of 'classic signs and symptoms' extends the clinician's exam-based reasoning to the history." } ] }, { "case": "day2_consultation07", "product": "lyrebird", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 22/09/2026\n\nTime: 6:18 am\n\n\n\n\nSubjective:\n\n68-year-old male presenting with central chest pain radiating to left arm and shoulder\n\nOnset during gardening, no strenuous activity at time of onset\n\nFirst episode of this nature\n\nPain described as diffuse, central chest location over pectoral region, not lateralised\n\nRadiation to left arm and left shoulder\n\nTachycardia present, patient attributes to stress regarding current situation\n\nNo palpitations noted prior to presentation\n\nSedentary lifestyle with minimal regular physical activity\n\nCurrently experiencing ongoing chest discomfort at time of consultation\n\n\n\n\nObjective:\n\nPatient appeared stressed during consultation\n\nTachycardia noted on examination\n\nPatient overweight on visual assessment\n\nLives alone, currently no one else in house\n\nFront door accessible for emergency services\n\n\n\n\nAssessment:\n\nPossible acute coronary syndrome\n\nSignificant cardiac risk factors present:\n\n15 pack-year smoking history (10 cigarettes per day for 15 years)\n\nHypertension\n\nOverweight\n\nSedentary lifestyle\n\nStrong family history: father died of myocardial infarction aged approximately 60 years, mother with cardiac disease\n\nAlcohol consumption 7-8 pints beer per week\n\nCholesterol status unknown\n\nAspirin allergy: mild allergic reaction with swelling, non-life-threatening, patient reports occasional use despite reaction\n\n\n\n\nPlan:\n\nEmergency ambulance called during consultation\n\nPatient advised to remain near front door with door open for emergency services access\n\nECG to be performed by ambulance crew on arrival\n\nHospital transfer for urgent assessment and further investigation\n\nAspirin allergy documented and to be communicated to hospital team for consideration of use despite allergy given clinical indication\n\nClinician remained on video consultation until ambulance arrival\n\nHandover to ambulance crew arranged\n\n\n\n\nTreating Clinician\n\nGP at Hand", "addedInterpretation": [ { "text": "Significant cardiac risk factors present: 15 pack-year smoking history ... Hypertension ... Overweight ... Sedentary lifestyle ... Strong family history", "reason": "The clinician asked about smoking, blood pressure, cholesterol, family history, alcohol, weight and activity, and said only that the symptoms (the chest pressure and what came with it) pointed to a possible heart attack. They never called these history items cardiac risk factors, never called them significant, never called the family history strong, and never tied them to the assessment. Grouping them under the Assessment as significant risk factors that back up possible ACS is the scribe's reasoning." } ] }, { "case": "afriswitch-french", "product": "patientnotes", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n\nChief Complaint::\n\nPatient presents with abdominal pain lasting at least four days.\n\nHistory of Presenting Complaint::\n\nPain began Sunday evening in the upper abdomen, gradually became a dull ache then sharp, now localised to the right lower abdomen, severity 8/10.\n\nDuration four days, worsened by movement, no relieving measures.\n\nVomited three times after eating, loss of appetite, no diarrhoea, constipation, or urinary symptoms; bowel movements normal.\n\nObjective\n\nTenderness noted in the right lower abdomen.\n\nRebound tenderness present in the right lower abdomen.\n\nPositive Rovsing's sign observed.\n\nNot discussed\n\nAssessment\n\nClinical impression: acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for pain relief discussed.\n\nAntibiotics discussed.\n\nObtain blood work including CBC and CRP.\n\nArrange abdominal ultrasound or CT to confirm diagnosis.\n\nAdmit patient and have surgical team evaluate for possible laparoscopic appendectomy.\n\nAdvise nil by mouth until further assessment.", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "patientnotes", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n\nChief Complaint::\n\nLLE pain and numbness\n\nHistory of Presenting Complaint::\n\n55‑year‑old white female with prior low back pain and lumbar disc herniation\n\nPreviously received right sacroiliac joint injection with 80% relief of right‑sided low back pain\n\nCurrent MRI shows L4‑5 foraminal stenosis\n\nObjective\n\nMRI demonstrates foraminal stenosis at L4‑5\n\nAge: 55 years\n\nRight sacroiliac joint injection resulted in 80% improvement in right‑sided low back pain\n\nAssessment\n\nLow back pain with left lower extremity numbness secondary to lumbar disc herniation and L4‑5 foraminal stenosis\n\nPlan\n\nPerform lumbar epidural steroid injection\n\nIf patient improves, no further intervention required", "addedInterpretation": [ { "text": "Low back pain with left lower extremity numbness secondary to lumbar disc herniation and L4-5 foraminal stenosis", "reason": "The clinician lists three diagnoses side by side: low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis. The clinician never says the pain and numbness are caused by the herniation or the stenosis. 'Secondary to' is a causal link the scribe added. The only link the clinician draws is from the MRI stenosis finding to the decision to do the epidural injection." } ] }, { "case": "day4_consultation08", "product": "iscribe", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n\nCC: Fatigue and lethargy x ~2 months.\n\nHPI:\n\nPt reports difficulty waking in AM, decr energy, and decr appetite.\n\nSymptoms coincided w/ new employment (~2 months ago).\n\nReports new onset of exertional dyspnoea during sports/physical activity.\n\nNeuropsychiatric:\n\nLow mood and decreased libido (disinterest).\n\nDifficulty focusing/distractibility.\n\nDenies SI/HI.\n\nSleep: Reports insomnia/difficulty sleeping.\n\nPMH:\n\nHypothyroidism (currently on Thyroxine).\n\nNKDA.\n\nFH:\n\nPaternal: Suicide ~15 years ago.\n\nSH:\n\nEmployment: New job started ~2 months ago.\n\nMarital Status: Married.\n\nObjective\n\nPhysical examination not performed during current consultation.\n\nAssessment\n\nFatigue/Lethargy (Provisional).\n\nDyspnoea on exertion (Provisional).\n\nLow mood (Provisional).\n\nPlan\n\nIn-person consultation with GP for physical examination (PE).\n\nBlood investigations to determine aetiology of fatigue and dyspnoea.", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "hanah-new", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n- 55-year-old white female presents to pain clinic with left lower extremity pain and numbness.\n- 80% improvement in right-sided low back pain following right sacroiliac joint injection.\nObjective\n- Magnetic resonance imaging shows foraminal stenosis at L4-5.\nAssessment\n- Low back pain with left lower extremity numbness.\n- Lumbar disc herniation.\n- Lumbar foraminal stenosis.\nPlan\n- Proceed with lumbar epidural steroid injection for foraminal stenosis at L4-5.\n- No further intervention if doing well.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "patientnotes", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n\nChief Complaint::\n\nLow energy, difficulty waking, fatigue, low mood, decreased sex drive.\n\nHistory of Presenting Complaint::\n\nOnset ~2 months, coinciding with new job start.\n\nDuration ongoing, possibly longer than 2 months.\n\nAggravating factors: new job stress; no specific relieving factors reported.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nNot discussed\n\nPlan\n\nMedications::\n\nPatient reports taking thyroxine for hypothyroidism.\n\nArrange in‑person GP appointment for physical examination and blood tests.\n\nFollow‑up to discuss investigation results.", "addedInterpretation": [ { "text": "Aggravating factors: new job stress", "reason": "The clinician never links the symptoms to the new job and never mentions stress. Only the patient raised it, and only as a hedged timing link: the symptoms 'might be related to' or 'coincided with' starting the job two months ago. Nobody said the job worsens the symptoms or that it causes stress. Calling 'new job stress' an aggravating factor turns that coincidence into a causal claim the reference never makes." } ] }, { "case": "day2_consultation07", "product": "arlo", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "SOAP Notes\n\nSubjective\n- Pt: Tim Gowers, DOB 08/08/1958, M\n- c/o central chest pressure x few hrs, onset during light gardening\n- Describes sensation: 'someone sitting on chest', diffuse, midline\n- Assoc Sx: nausea (no vomiting), diaphoresis, SOB\n- L arm & shoulder P\n- Sx ongoing at time of consult\n- Denies prior similar episodes\n- Palpitations: mild, attrib to stress\n- No exertional trigger\n- Smoker: 10 cig/day x15 yrs\n- ETOH: 7-8 pints beer/wk\n- PMHx: HTN\n- No DM\n- No known hypercholesterolemia (never checked)\n- FHx: father MI ~60yo, mother heart problems\n- Lives alone\n- Occup: restaurant owner (sushi shop)\n- Reports overweight\n- Allergic to aspirin (mild allergic reaction: swelling, not life-threatening)\n\nObjective\n- N/A (telehealth, no PE performed)\n\nWDx\n- Central chest pressure w/ L arm & shoulder P, diaphoresis, SOB, nausea\n- Ongoing Sx, high suspicion ACS/AMI\n- Multiple CV risk factors: HTN, smoker, overweight, FHx premature CAD, M, >60yo\n\nPlan\n- Advised ambulance activation\n- Handover to EMS arranged\n- Advised pt to keep front door open for access\n- Allergy to aspirin communicated", "addedInterpretation": [ { "text": "Multiple CV risk factors: HTN, smoker, overweight, FHx premature CAD, M, >60yo", "reason": "The clinician asked about smoking, blood pressure, weight and family history but never called them cardiovascular risk factors or linked them to the suspected heart attack. The note groups them under the working diagnosis as support for ACS, and labels the father's MI 'premature CAD'. That framing is the scribe's own reasoning. The clinician based the heart-attack concern only on 'the symptoms that you've described'." } ] }, { "case": "day4_consultation08", "product": "patientnotes", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n\nChief Complaint::\n\nDifficulty waking up in mornings, low energy, reduced appetite, low mood, decreased sex drive, shortness of breath on exertion.\n\nHistory of Presenting Complaint::\n\nOnset ~2 months, coinciding with new job; symptoms persistent; no specific aggravating or relieving factors identified.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nNot discussed\n\nPlan\n\nMedications::\n\nCurrently taking thyroxine.\n\nArrange GP appointment for in‑person examination and blood tests within the next few days.\n\nFollow‑up after investigations to address fatigue, mood, and respiratory symptoms.", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "patientnotes", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n\nChief Complaint::\n\nAbdominal pain ≥4 days.\n\nHistory of Presenting Complaint::\n\nOnset Sunday evening in upper abdomen, migrated to right lower quadrant.\n\nGradual dull ache progressing to sharp pain, 8/10 intensity.\n\nMovement worsens pain; three episodes of vomiting after meals; loss of appetite.\n\nNo diarrhoea or constipation.\n\nObjective\n\nTenderness and rebound tenderness in right abdomen.\n\nPositive rough things sign suggestive of acute appendicitis.\n\nNot discussed\n\nAssessment\n\nClinical picture highly suggestive of acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for analgesia initiated.\n\nEmpiric antibiotics started.\n\nOrder CBC and CRP.\n\nArrange abdominal ultrasound or CT to confirm diagnosis.\n\nAdmit patient, keep NPO, surgical team to assess for laparoscopic appendectomy.\n\nAdvise patient to inform family of situation.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "lyrebird", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "SOAP Notes\n\n\n\n\nPatient: Brian\n\nDate of Birth: 08/08/1982\n\nConsultation Date: 22/09/2026\n\n\n\n\nSubjective:\n\nFatigue and low mood for approximately 2 months, coinciding with commencement of new employment\n\nDifficulty waking in the morning\n\nReduced energy throughout the day\n\nReduced appetite\n\nDifficulty sleeping\n\nDifficulty concentrating, easily distracted\n\nLow mood\n\nDecreased libido\n\nDenies morning erections (no change from baseline)\n\nReduced enjoyment of usual activities\n\nExertional dyspnoea for 2 months, worse than previous baseline\n\nDenies suicidal ideation\n\nDenies visual changes\n\n\n\n\nObjective:\n\nTelehealth consultation conducted\n\nPatient in confidential location\n\nNo physical examination performed\n\n\n\n\nAssessment:\n\nFatigue and low mood, 2 months duration\n\nPossible contributing factors: new job stress, underlying hypothyroidism\n\nExertional dyspnoea requiring investigation\n\nFamily history of suicide (father, 15 years ago)\n\n\n\n\nPast Medical History:\n\nHypothyroidism\n\n\n\n\nMedications:\n\nThyroxine (dose not specified)\n\n\n\n\nAllergies:\n\nNKDA\n\n\n\n\nFamily History:\n\nFather: suicide 15 years ago\n\nNo family history of depression\n\nMother: well\n\nOnly child\n\n\n\n\nSocial History:\n\nMarried\n\nStarted new job 2 months ago\n\n\n\n\nPlan:\n\nIn-person review for physical examination\n\nBlood tests to be arranged\n\nFollow-up appointment to be scheduled within next few days\n\nFurther investigations pending examination and blood test results", "addedInterpretation": [ { "text": "Possible contributing factors: new job stress, underlying hypothyroidism", "reason": "The clinician never links the fatigue or low mood to the patient's hypothyroidism. Hypothyroidism and thyroxine come up only as past history and medication, and no cause is suggested. The plan is just an exam and unspecified blood tests 'to see what's going on'. The patient, not the clinician, said the symptoms might be related to starting a new job, and nobody mentions stress. So this list of contributing factors is the scribe's own reasoning, mainly the hypothyroidism link." } ] }, { "case": "day2_consultation07", "product": "lyrebird", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 21/09/2026\n\nTime: 2:39 am\n\n\n\n\nSubjective:\n\n66-year-old male presenting with acute central chest pressure x 2 hours\n\nOnset during gardening (minimal exertion)\n\nDescribes sensation as \"someone sitting on chest\"\n\nPain radiating to left arm and shoulder\n\nAssociated symptoms: nausea (no vomiting), diaphoresis, dyspnoea\n\nSymptoms ongoing at time of consultation\n\nDenies palpitations prior to episode, though tachycardic during consult (attributed to stress)\n\nFirst episode of this nature\n\nSedentary lifestyle, no regular physical activity\n\nCardiovascular risk factors: current smoker (10 cigarettes/day x 15 years), alcohol consumption 7-8 pints beer/week, overweight, hypertension (on treatment)\n\nFamily history: father died of myocardial infarction at approximately age 60, mother with cardiac disease\n\nCholesterol never checked\n\nLives alone, works as restaurant owner (sushi shop)\n\nAspirin allergy: mild swelling, non-life-threatening (patient reports occasional use despite reaction)\n\n\n\n\nObjective:\n\nPatient alone at home during consultation\n\nAppeared distressed\n\nVital signs not formally documented during telehealth consultation\n\n\n\n\nAssessment:\n\nSuspected acute coronary syndrome\n\nHigh-risk presentation: central chest pressure with radiation, associated autonomic symptoms, multiple cardiovascular risk factors, strong family history\n\n\n\n\nPlan:\n\nEmergency ambulance dispatched immediately\n\nPatient advised to remain near open front door for ambulance access\n\nECG to be performed by ambulance crew on arrival\n\nHospital transfer for urgent assessment and management\n\nAspirin allergy communicated as critical information for hospital team (mild reaction, may require consideration despite allergy)\n\nClinician remained on line with patient until ambulance arrival\n\nFurther management as per hospital protocol including consideration of acute coronary syndrome pathway\n\n\n\n\nTreating Clinician", "addedInterpretation": [ { "text": "High-risk presentation: central chest pressure with radiation, associated autonomic symptoms, multiple cardiovascular risk factors, strong family history", "reason": "The clinician only said the described symptoms 'indicate the possibility of a heart attack'. They never called the presentation high-risk, and never tied the risk factors (smoking, hypertension, weight) or the family history to that assessment. Grouping these findings as reasons for a 'high-risk' grading is the scribe's own reasoning." } ] }, { "case": "afriswitch-french", "product": "cliniscripts", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "S (Subjective):\n- Patient presents with abdominal pain for 4 days, starting Sunday evening.\n- Pain initially localized to the upper abdomen, now predominantly in the right lower side.\n- Onset was gradual, described as a dull ache, progressing to a sharp pain rated 8/10.\n- Pain does not radiate; it remains in the lower right abdomen.\n- Nothing alleviates the pain; moving around slightly worsens it.\n- Patient reports fever of 38 degrees Celsius last night.\n- Patient experienced 3 episodes of vomiting, especially after eating, and has no appetite.\n- Bowel movements are normal; no diarrhea or constipation.\n- No dysuria or increased urinary frequency reported.\n\nO (Objective):\n- Abdominal palpation revealed tenderness in the right lower abdomen.\n- Rebound tenderness was noted in the right lower abdomen.\n- Positive Rovsing's sign observed (pain on the right side when pressure applied to the left).\n\nA (Assessment):\n- Findings are highly suggestive of acute appendicitis.\n- Potential complication of appendix inflammation and rupture if untreated.\n\nP (Plan):\n- Initiate IV fluids.\n- Administer pain relief medication.\n- Administer antibiotics.\n- NPO status (nothing by mouth) for the patient.\n- Order blood work: CBC, CRP.\n- Order imaging studies: abdominal ultrasound or CT scan to confirm diagnosis.\n- Consult with the surgical team for evaluation within the hour to schedule potential laparoscopic surgery.\n- Patient advised to contact family.", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "hanah-new", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n- 55-year-old white female presents to pain clinic with left lower extremity pain and numbness.\n- Prior right sacroiliac joint injection provided 80% improvement in right-sided low back pain.\nObjective\n- Magnetic resonance imaging shows foraminal stenosis at L4-5.\nAssessment\n- Low back pain with left lower extremity numbness.\n- Lumbar disc herniation.\n- Lumbar foraminal stenosis.\nPlan\n- Proceed with lumbar epidural steroid injection for foraminal stenosis at L4-5.\n- No further intervention if doing well.", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "freed", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\nCliniTech Benchmark 6af0f381 presents with a 4-day history of abdominal pain that began on Sunday evening. The pain initially started in the upper abdomen and gradually migrated to the right lower quadrant. It began as a dull ache but has progressively worsened to a sharp character, rated 8 out of 10 in severity. The patient reports that movement aggravates the pain and that nothing provides relief. She denies radiation of the pain to the back or shoulders.\n\nShe reports an associated fever, measured at 38 degrees Celsius the previous night. She has vomited three times, particularly after eating, and reports complete loss of appetite. She denies diarrhea or constipation, stating that bowel movements have been normal. She denies dysuria or urinary frequency.\n\nReview of Systems \n- General: Positive for fever and decreased appetite \n- Gastrointestinal: Positive for vomiting, negative for diarrhea, constipation \n- Genitourinary: Negative for dysuria, urinary frequency\n\nObjective\nPhysical Examination \n- Abdomen: Right lower abdominal tenderness, rebound tenderness, and positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in upper abdomen and migrated to right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute Appendicitis \nAssessment: Patient presents with classic signs of acute appendicitis including 4-day history of abdominal pain that began in the upper abdomen and migrated to the right lower quadrant. Pain has progressed from dull ache to sharp 8/10 intensity, worsened by movement. Associated symptoms include fever of 38°C, nausea, vomiting three times after eating, and anorexia. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen with positive Rovsing's sign. These clinical findings are highly suggestive of acute appendicitis requiring urgent surgical evaluation. \nPlan: \n- Obtain blood work including CBC and CRP \n- Order abdominal ultrasound or CT scan to confirm diagnosis \n- Start IV fluids, pain relief, and antibiotics \n- Keep patient NPO in preparation for possible surgery \n- Admit patient to hospital \n- Consult surgical team for evaluation within hours \n- Patient advised to contact family members", "addedInterpretation": [ { "text": "Patient presents with classic signs of acute appendicitis including 4-day history of abdominal pain that began in the upper abdomen and migrated to the right lower quadrant... fever of 38°C, nausea, vomiting three times after eating, and anorexia", "reason": "The clinician based 'very suggestive of acute appendicitis' only on the exam findings: RLQ tenderness, guarding, rebound and a positive Rovsing sign. The clinician never called the migrating pain, fever, vomiting or anorexia classic signs, or tied them to the diagnosis. Using the history as supporting evidence is the scribe's own reasoning." } ] }, { "case": "afriswitch-french", "product": "arlo", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "SOAP Notes\n\nSubjective\n- C/o abdo P x4d\n- Onset Sun pm\n- Initial P epigastric, now RIF\n- Gradual onset, dull ache → sharp\n- P 8/10\n- Worse w/ movement\n- No relief\n- 3x vomiting post-prandial\n- Anorexia\n- No diarrhea\n- Bowel motions normal\n- No dysuria, no frequency\n\nObjective\n- TTP RIF\n- Rebound TTP RIF\n- +Rovsing's sign\n- No other abdo findings noted\n\nWDx\n- ?Acute appendicitis\n\nPlan\n- IV fluids commenced\n- Analgesia given\n- IV abx started\n- NBM\n- CBC, CRP, abdo US/CT planned\n- Surgical review requested\n- Pt admitted", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "hanah-new", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n- Abdominal pain for at least 4 days, beginning Sunday evening in upper abdomen and migrating to right lower abdomen. Gradual onset, initially dull, now sharp, 8/10. No radiation. Worse with movement; nothing helps.\n- Fever last night; home temperature 38°C.\n- Vomited 3 times, especially after eating. No appetite.\n- Normal bowel movements; no diarrhea or constipation. No dysuria or increased urinary frequency.\n- Concerned about seriousness and need for surgery. Asked whether to call family.\nObjective\n- Right lower abdominal tenderness, “gathering,” and rebound tenderness.\n- Left-sided pressure elicited right-sided pain; clinician described positive “rough things sign.”\nAssessment\n- Findings very suggestive of acute appendicitis; confirmation pending.\nPlan\n- Blood work: CBC, CRP. Likely abdominal ultrasound or CT for confirmation.\n- Plan to start IV fluids, pain relief, and antibiotics.\n- Discussed possible laparoscopic surgery after confirmation.\n- Eating/drinking advice given in anticipation of possible surgery; wording unclear in transcript.\n- Plan admission and surgical team assessment within hours; surgical team to determine whether and when to operate.\n- Explained possible appendix inflammation and rupture if untreated. Encouraged calling family and reassured patient that care would be provided.", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "lyrebird", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "SOAP Notes\n\n\n\n\nSubjective:\n\n55-year-old female presenting to pain clinic with left lower extremity pain and numbness\n\nPrevious right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nObjective:\n\nMRI findings: foraminal stenosis L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "lyrebird", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "SOAP NOTES\n\n\n\n\nSubjective:\n\n55-year-old female presenting with left lower extremity pain and numbness\n\nPrevious right-sided low back pain improved 80% following right sacroiliac joint injection\n\nCurrently experiencing left lower extremity symptoms\n\n\n\n\nObjective:\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis L4-5\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required\n\nReview post-procedure", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "arlo", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "SOAP Notes\n\nSubjective\n- C/o abdo P x4d\n- Onset Sunday evening\n- Initial P epigastric, migrated to RIF\n- Gradual onset, dull ache → sharp P\n- P severity 8/10\n- Worse with movement\n- Vomited x3, esp post-prandial\n- Anorexia\n- No diarrhea\n- Bowel motions normal\n- No dysuria, no urinary frequency\n\nObjective\n- TTP RIF\n- Rebound TTP RIF\n- Guarding RIF\n- Positive Rovsing's sign\n\nWDx\n- ?Acute appendicitis\n\nPlan\n- IV fluids commenced\n- Analgesia given\n- IV antibiotics started\n- NBM\n- Bloods ordered: CBC, CRP\n- Abdo US/CT planned\n- Surgical referral/admission", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "freed", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\nBrian, a 44-year-old male with a history of hypothyroidism, presents with approximately 2 months of progressive fatigue, difficulty waking in the morning, decreased appetite, low mood, decreased sex drive, and exertional shortness of breath. He reports that over the past approximately 2 months, he has experienced significant difficulty getting up in the morning and has had very low energy throughout the day. He reports that activities he would normally find easy have become quite difficult. He also notes decreased appetite and is not eating very much. He reports difficulty sleeping, which he believes may be contributing to his fatigue. He describes difficulty focusing and being easily distracted. He reports his mood has been somewhat lower recently and notes a decrease in sex drive over the past few months, describing decreased interest in sexual activity with his wife. He denies any change in morning erections. He also reports increased shortness of breath with physical activity compared to a couple of months ago.\n\nThe [scribe] that his symptoms may have coincided with starting a new job approximately 2 months ago. He states that prior to this period, he had no problems with eating or performing his usual daily activities. He expresses a desire to return to his previous baseline functioning. He denies any thoughts of self-harm or harming others. He denies any changes in vision.\n\nMedical History \n- Hypothyroidism\n\nMedications and Supplements \n- Thyroxine PO daily\n\nAllergies \n- No known medication allergies\n\nFamily History \n- Father: Deceased by suicide approximately 15 years ago \n- Mother: No known medical conditions, living\n\nSocial History \n- Occupation: Started a new job approximately 2 months ago \n- Marital Status: Married for many years\n\nReview of Systems \n- General: Difficulty sleeping \n- Respiratory: Exertional shortness of breath \n- Gastrointestinal: Decreased appetite \n- Genitourinary: Denies change in morning erections \n- Psychiatric: Difficulty focusing and distractibility\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and decreased sex drive.\n\nFatigue and low mood \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking, decreased appetite, low mood, decreased sex drive, and shortness of breath with exertion. Symptoms began around the time he started a new job. History of hypothyroidism currently treated with thyroxine. Family history significant for father's suicide 15 years ago. The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism. The shortness of breath with exertion could suggest anemia or other systemic illness. No current suicidal ideation reported. \nPlan: \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation \n- Obtain blood tests to investigate underlying causes \n- Continue current thyroxine medication", "addedInterpretation": [ { "text": "He reports difficulty sleeping, which he believes may be contributing to his fatigue.", "reason": "The patient says he has trouble sleeping but never links it to his fatigue, and neither does the clinician. The note credits the patient with a causal link nobody made." }, { "text": "The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for depression", "reason": "The clinician asks about mood and suicidal thoughts but never names depression or calls these symptoms a sign of it. This is a working diagnosis the scribe added." }, { "text": "medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism", "reason": "The clinician notes the hypothyroidism and the thyroxine and orders blood tests 'to see what's going on'. He never links the symptoms or the tests to thyroid dysfunction." }, { "text": "The shortness of breath with exertion could suggest anemia or other systemic illness.", "reason": "The clinician only notes the breathlessness. He never mentions anemia or a systemic cause, so this differential is the scribe's own reasoning." } ] }, { "case": "day4_consultation08", "product": "freed", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\nBrian, a 44-year-old male with a history of hypothyroidism, presents with approximately 2 months of fatigue, difficulty waking up in the morning, decreased appetite, difficulty focusing, low mood, decreased sex drive, and exertional shortness of breath. He reports that over the past approximately 2 months, he has experienced significant difficulty getting up in the morning and has had very low energy throughout the day. He states that doing most things he would normally find easy has become quite difficult. He also reports not eating very much and having trouble sleeping. He notes difficulty focusing and feeling easily distracted. He endorses a lower mood than usual and decreased interest in sex. He is married and reports being less interested in sexual activity with his spouse. He denies any thoughts of self-harm or harming others. He also reports increased shortness of breath with sports and physical activity compared to a couple of months ago.\n\nHe notes that his symptoms may have coincided with starting a new job approximately 2 months ago. He states he is not able to get his usual enjoyment out of daily activities. He denies any changes in vision.\n\nMedical History \n- Hypothyroidism\n\nMedications and Supplements \n- Thyroxine\n\nAllergies \n- No known medication allergies\n\nFamily History \n- Father: Deceased by suicide approximately 15 years ago \n- Mother: Well\n\nSocial History \n- Occupation: Started a new job approximately 2 months ago \n- Marital Status: Married for many years \n- Exercise: Engages in sports; reports increased difficulty with exertion\n\nReview of Systems \n- General: Difficulty sleeping \n- Respiratory: Shortness of breath with exertion \n- Genitourinary: Decreased sex drive \n- Psychiatric: Difficulty focusing and feeling distracted, denies thoughts of self-harm\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and shortness of breath.\n\nFatigue and low mood \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking in the mornings, decreased appetite, poor concentration, low mood, and decreased libido. Symptoms began around the time he started a new job 2 months ago. He reports difficulty sleeping and shortness of breath with exertion compared to his baseline. Family history is significant for father's suicide 15 years ago. No current suicidal ideation reported. The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for possible depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism. \nPlan: \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation \n- Obtain blood tests to evaluate for underlying medical causes", "addedInterpretation": [ { "text": "The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for possible depression", "reason": "The clinician asked about mood and suicidal thoughts but never named depression or tied the symptom cluster to a depression diagnosis. The only plan stated was an in-person exam and blood tests 'to see what's going on'. This working diagnosis is the scribe's own." }, { "text": "medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism", "reason": "The clinician confirmed the hypothyroidism history and the thyroxine use, but never linked them to the current symptoms and never said the blood tests were meant to check thyroid function. The reason given for the tests is the scribe's inference." } ] }, { "case": "day2_consultation07", "product": "heidi", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n- Chest discomfort, described as pressure in the middle of the chest, radiating to the left arm and shoulder\n- Associated nausea, diaphoresis and SOB\n- Onset a couple of hours ago while gardening (non-strenuous activity); symptoms still present\n- Denies vomiting\n- Denies palpitations initially; notes heart beating faster currently due to stress\n- First-time occurrence\n- Lives alone; no one else in the house currently\n\n\n\n\nObjective\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n- Symptoms concerning for possible cardiac event; urgent assessment required to exclude MI\n\n\n\n\nPlan\n- Ambulance called for urgent transfer to hospital\n- Dr. Jane Doe to remain on the line until paramedics arrive\n- Advised to keep front door open for paramedic access\n- Explained paramedics will perform ECG and determine appropriate hospital based on findings and treatment needs\n- Advised to communicate aspirin allergy to hospital staff, as aspirin may still be considered\n\n\n\n\nPast Medical History\n- Hypertension\n- Overweight\n\n\n\n\nSocial History\n- Smoker: 10 cigarettes daily for 15 years\n- Alcohol: 7-8 pints of beer per week\n- Lives alone\n- Works as a restaurant owner (sushi shop)\n- Generally sedentary lifestyle\n\n\n\n\nFamily History\n- Father: died of MI around 60 years of age\n- Mother: history of heart problems\n\n\n\n\nAllergies\n- Aspirin: mild allergic reaction including swelling, not life-threatening", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "hanah-new", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n- Abdominal pain for at least 4 days, beginning Sunday evening in upper abdomen and migrating to right lower abdomen. Gradual onset, initially dull, now sharp, 8/10. No radiation. Worse with movement; nothing relieves it.\n- Fever last night; self-measured temperature 38°C.\n- Vomited 3 times, especially after eating. No appetite.\n- Normal bowel movements; no diarrhea or constipation. No urinary burning or increased frequency.\n- Concerned about seriousness and need for surgery; asked whether to call family.\nObjective\n- Right lower abdominal tenderness, “gathering,” and rebound tenderness.\n- Left-sided pressure elicited right-sided pain; documented verbally as positive “rough things sign.”\nAssessment\n- Findings very suggestive of acute appendicitis; confirmation pending.\nPlan\n- Blood work: complete blood count and C-reactive protein. Likely abdominal ultrasound or computed tomography to confirm.\n- Start intravenous fluids, pain relief, and antibiotics.\n- Admit for surgical team assessment within hours. Possible laparoscopic surgery discussed; surgical team to determine need and timing.\n- Explained that an inflamed appendix may rupture and untreated disease can be serious.\n- Oral intake instruction in anticipation of possible surgery recorded as: “You should eat or drink anything now.” Wording unclear.\n- Encouraged calling family. Reassured patient that the team would care for her and address the problem.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "lyrebird", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "SOAP Notes\n\n\n\n\nSubjective:\n\n44-year-old married male presenting with 2-month history of fatigue and low mood\n\nSymptoms coincided with starting new job 2 months ago\n\nDifficulty waking in the morning, low energy throughout the day\n\nReduced appetite\n\nInsomnia\n\nDifficulty concentrating, easily distracted\n\nLow mood with decreased libido for 2 months\n\nReduced enjoyment of usual activities\n\nExertional dyspnoea for 2 months, worse than baseline during sports\n\nDenies suicidal ideation, thoughts of self-harm or harm to others\n\nDenies visual changes\n\nReports no change in morning erections from baseline\n\n\n\n\nObjective:\n\nConsultation conducted via telehealth\n\nPatient in confidential setting, consented to consultation\n\nNo physical examination performed during telehealth consultation\n\n\n\n\nAssessment:\n\nFatigue and low mood, 2-month duration\n\nPossible hypothyroidism (history of hypothyroidism on thyroxine)\n\nDifferential diagnoses to consider: thyroid dysfunction, depression, anaemia, other metabolic causes\n\n\n\n\nPlan:\n\nIn-person appointment arranged for physical examination\n\nBlood tests to be ordered\n\nReview thyroid function\n\nFurther investigations as clinically indicated\n\nFollow-up after results available", "addedInterpretation": [ { "text": "Possible hypothyroidism (history of hypothyroidism on thyroxine)", "reason": "The clinician only confirmed the history of hypothyroidism and that the patient takes thyroxine. They never linked his fatigue, low mood or other symptoms to his thyroid, and never named hypothyroidism as a possible cause. The plan was a general one: examination and blood tests 'to see what's going on'. This working diagnosis is the scribe's own." }, { "text": "Differential diagnoses to consider: thyroid dysfunction, depression, anaemia, other metabolic causes", "reason": "The clinician named no differentials. They asked about mood, suicidal thoughts and family history, then ordered an exam and bloods without saying what they suspected. Anaemia, depression and metabolic causes are never mentioned as possible explanations, so this list of diagnoses linked to the symptoms is the scribe's reasoning." } ] }, { "case": "afriswitch-french", "product": "iscribe", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Specialty: General Surgery\n\nSubjective\n\nc/o abdominal pain x 4 days.\n\nOnset: Sunday evening; gradual onset of dull ache in upper abdomen, migrated to RLQ.\n\nCharacter: Currently sharp, 8/10.\n\nAssociated symptoms: Fever (38°C last night), vomiting x3 (post-prandial), anorexia.\n\nNegative findings: No radiation to back/shoulders, no diarrhoea, no constipation, no dysuria.\n\nAggravating factors: Movement.\n\nObjective\n\nAbdomen: Tenderness in RLQ.\n\nRebound tenderness: Positive (RLQ).\n\nRovsing's sign: Positive.\n\nCBC: Pending.\n\nCRP: Pending.\n\nImaging: Abdominal US or CT indicated for confirmation.\n\nAssessment\n\nAcute Appendicitis (Provisional).\n\nClinical presentation highly suggestive of acute appendicitis.\n\nRisk of rupture if untreated.\n\nPlan\n\nAdmit to hospital for surgical review.\n\nNBM (nil by mouth) status for potential laparoscopic appendicectomy.\n\nStart IV fluids, analgesia, and antibiotics.\n\nBloods: CBC, CRP.\n\nImaging: Abdominal US or CT.\n\nSurgical team to review within hours; scheduling of potential operative procedure to follow.", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "heidi", "run": 0, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n- Gradual onset abdominal pain x4 days, beginning in upper abdomen and migrating to RLQ\n- Now sharp, 8/10\n- Movement exacerbates pain; no relieving factors\n- No radiation to back or shoulders\n- Fever last night, temp 38°C\n- Vomiting x3, particularly after eating; complete loss of appetite\n- Bowel movements normal; no diarrhoea or constipation\n- No dysuria or increased urinary frequency\n\n\n\n\nObjective\n- Abdominal exam: tenderness, guarding and rebound tenderness in RLQ\n- Positive Rovsing's sign\n\n\n\n\nAssessment\n- Findings highly suggestive of acute appendicitis\n- Appendix may be inflamed and at risk of rupture if untreated\n\n\n\n\nPlan\n- Bloods: FBC, CRP\n- Abdominal ultrasound or CT to confirm diagnosis\n- Presumed laparoscopic surgery; to confirm after investigations\n- Commence IV fluids, analgesia and antibiotics\n- NBM in preparation for potential surgery\n- Admission to hospital\n- Surgical team review within hours to schedule surgery and provide timeframe\n- Encouraged to contact family", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "cliniscripts", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "S (Subjective):\n- The patient is a 55-year-old female presenting to the pain clinic with left lower extremity pain and numbness.\n- They previously experienced right-sided low back pain, which improved by 80% following a right sacroiliac joint injection.\n\nO (Objective):\n- MRI findings indicate foraminal stenosis at L4-5.\n- The patient previously underwent a right sacroiliac joint injection.\n\nA (Assessment):\n- Diagnosis includes low back pain with left lower extremity numbness.\n- Diagnoses also include lumbar disc herniation and lumbar foraminal stenosis.\n- The patient experienced 80% improvement in right-sided low back pain after a right sacroiliac joint injection.\n\nP (Plan):\n- Proceed with lumbar epidural steroid injection.\n- If the patient shows good progress, no further intervention is planned.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "heidi", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n- Difficulty getting up in the morning and low energy throughout the day for ~2 months\n- Tasks previously easy now challenging\n- Reduced appetite, not eating much\n- Onset coincided with new job 2 months ago\n- Wishes to return to previous state of well-being\n- Sleep: difficulty sleeping\n- Mood: distracted, difficulty focusing; slightly lower recently, not unhappy or happy, unfocused\n- Libido: decreased over past few months, disinterested\n- Morning erections: no change noted\n- SI: denies thoughts of self-harm or harm to others\n- Activities: sometimes able to enjoy daily activities\n- Dyspnoea: SOB during sports, change compared to a couple of months ago\n- Vision: no change\n\n\n\n\nObjective\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n- 2-month history of fatigue, low mood, reduced appetite, sleep disturbance, decreased libido and exertional dyspnoea\n\n\n\n\nPlan\n- In-person consultation and examination\n- Blood tests\n- Advised to book GP appointment within next few days for further investigation and management", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "iscribe", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n\n55F presents w/ LLE pain and numbness\n\nH/o R SIJ injection (80% improvement in R low back pain)\n\nObjective\n\nMRI: L4-L5 foraminal stenosis\n\nAssessment\n\nLumbar foraminal stenosis (L4-L5)\n\nLumbar disc herniation\n\nLLE pain and numbness\n\nPlan\n\nPerform lumbar epidural steroid injection (ESI)\n\nIf post-procedure recovery successful, no further intervention indicated", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "arlo", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "SOAP Notes\n\nSubjective\n- Main c/o: fatigue, low energy, difficulty waking, ↓ appetite x ~2/12\n- Onset w/ new job 2/12 ago; difficulty initiating/maintaining sleep; ↓ motivation; difficulty w/ ADLs; mood ↓; distractibility; ↓ focus; ↓ libido x few months; no change in morning erections; SOB w/ sports; ↑ fatigue w/ exertion; no visual changes\n- PMHx: hypothyroidism; FHx: father suicide (15y ago), no other psych hx\n- Meds: thyroxine; no drug allergies\n\nObjective\n- N/A\n\nWDx\n- Fatigue, ↓ mood, ↓ appetite, sleep disturbance, ↓ libido, SOB on exertion\n- Hx hypothyroidism on thyroxine; psychosocial stressor: new job; FHx significant for suicide (father)\n\nPlan\n- Plan for in-person WDx and bloods discussed\n- Book GP appt for exam and investigations\n- N/A", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "hanah-old", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n- Fatigue, low energy and difficulty getting up x ~2 months, possibly coinciding with starting a new job. Previously easy daily tasks now difficult. Difficulty sleeping rather than early waking.\n- ↓ oral intake, poor focus/distractibility, mildly low mood and ↓ libido over recent months. Married for many years; less interest in sex. Has not noticed morning erections recently but clarified no change from baseline.\n- Enjoyment retained in most activities at times. ↑ SOB during sports compared with ~2 months ago.\n- No visual change. Denies thoughts of self-harm or harming others; confirmed not feeling suicidal.\n- Concerned symptoms are unlike usual baseline. Wants advice and return to previous eating, energy and daily functioning.\n- PMH: hypothyroidism, clarified after initial terminology confusion. No specific previous mental health diagnosis; suspects father's suicide ~15 years ago may have affected him.\n- Medications: currently taking thyroxine. No medication allergies.\n- FH: father died by suicide ~15 years ago. No other significant medical/psychiatric FH, including depression. Mother well; only child.\n- Confirmed privacy and consent to continue remote consultation.\nObjective\n- Remote consultation; no examination, vitals or investigation results obtained.\nAssessment\n- Fatigue with sleep disturbance, ↓ intake, concentration difficulty, low mood and ↓ libido; cause not established. Possible temporal association with new job.\n- Hypothyroidism on thyroxine relevant to assessment of fatigue. Exertional SOB also warrants further assessment.\n- No current suicidal or harm-to-others thoughts disclosed; paternal suicide history noted.\nPlan\n- Proposed face-to-face GP appointment within next few days for examination; patient agreed.\n- Blood tests and further investigations proposed to clarify cause of tiredness and other symptoms; no specific tests ordered during consultation.", "addedInterpretation": [ { "text": "Hypothyroidism on thyroxine relevant to assessment of fatigue.", "reason": "The clinician recorded the hypothyroidism history and that the patient takes thyroxine, but never linked the thyroid condition to the fatigue or to the assessment. The plan was only a general examination and blood tests 'to see what's going on'. Tying the thyroid history to the fatigue workup is the scribe's own reasoning." } ] }, { "case": "day4_consultation08", "product": "hanah-new", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n- Fatigue and low energy for approximately 2 months, possibly coinciding with starting a new job. Difficulty getting up in the morning and performing usual tasks. Difficulty sleeping rather than early waking. Reduced food intake.\n- Slightly lower mood, distractibility and difficulty concentrating. Reduced sex drive and sexual interest over the past few months. Married for many years. Has not noticed morning erections recently but clarified there has been no change.\n- Retains enjoyment of most usual activities at times. Increased shortness of breath during sports compared with a couple of months ago.\n- No visual changes. Denies thoughts of harming self or others.\n- History of hypothyroidism; taking thyroxine. No medication allergies.\n- Father died by suicide approximately 15 years ago; possible personal impact, without a specific related diagnosis. No other significant family medical or psychiatric history. Mother well; only child.\n- Wants advice and help returning to previous energy, eating and daily functioning.\n- Confirmed privacy and consent to consultation.\nObjective\n- Remote consultation; connection briefly froze.\nAssessment\n- Fatigue with sleep difficulty, reduced intake, mildly low mood, impaired concentration and reduced sex drive.\n- Exertional shortness of breath.\n- Further examination and investigations proposed to clarify symptoms.\nPlan\n- Agreed to arrange an in-person appointment with a general practitioner within the next few days for examination.\n- Blood tests and further investigations proposed; none specified.", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "heidi", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n- Gradual onset abdominal pain since Sunday evening.\n- Initially dull ache in upper abdomen, now sharp, 8/10, localised to RLQ.\n- Exacerbated by movement.\n- No radiation.\n- Fever 38°C last night.\n- Vomiting x3, particularly post-prandial.\n- Loss of appetite.\n- Normal bowel movements.\n- No dysuria or increased urinary frequency.\n\n\n\n\nObjective\n- Abdominal exam:\n- Tenderness RLQ.\n- Guarding RLQ.\n- Rebound tenderness RLQ.\n- Positive Rovsing's sign.\n\n\n\n\nAssessment\n- Clinical presentation highly suggestive of acute appendicitis.\n\n\n\n\nPlan\n- Admit for further management.\n- IV fluids.\n- Analgesia.\n- Antibiotics.\n- NBM in preparation for potential surgery.\n- Investigations: FBC, CRP; abdominal ultrasound or CT to confirm diagnosis.\n- Surgical team review within hours for assessment and surgical planning (laparoscopic appendectomy +/-).\n- Advised to contact family.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "hanah-new", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n- Fatigue, low energy and difficulty getting up for approximately 2 months, possibly coinciding with starting a new job. Usual daily tasks now difficult.\n- Reduced food intake. Difficulty sleeping rather than early waking. Poor concentration, distractibility and mildly lower mood.\n- Decreased sex drive and sexual interest over recent months. Married for many years. Clarified no change in morning erections.\n- Enjoyment retained in some activities. Increased shortness of breath during sports over recent months compared with baseline.\n- No visual changes. Denies thoughts of harming self or others; confirms not feeling suicidal.\n- Hypothyroidism, taking thyroxine. No medication allergies.\n- Father died by suicide approximately 15 years ago; suspects this may have affected him, but no specific related diagnosis. No other significant family medical or psychiatric history. Mother well; only child.\n- Wants advice to regain previous energy, eating and daily functioning; symptoms are unusual for him.\n- Confirmed privacy and consent to consultation.\nObjective\nAssessment\n- Fatigue with sleep difficulty, reduced intake, poor concentration, lower mood and decreased sex drive.\n- Exertional shortness of breath.\n- Cause not established during this consultation.\nPlan\n- Agreed to arrange an in-person appointment with general practitioner within the next few days for examination.\n- Blood tests and further investigations proposed to assess tiredness and other symptoms.", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "freed", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\nTim Gowers, a 60-year-old male with a history of hypertension, presents with acute onset chest discomfort with associated nausea, diaphoresis, and shortness of breath.\n\nThe patient reports that while gardening a couple of hours ago, he began experiencing a pressure-like sensation in the middle of his chest, described as \"feels like someone sitting on my chest,\" not localized to one side and quite diffuse. He notes the symptoms are still present. He reports the chest discomfort radiates down his left arm and into his left shoulder. He was engaged in light activity, kneeling down while gardening, and was not performing any strenuous exercise at the time of onset. He also reports associated nausea without vomiting, diaphoresis, and shortness of breath. He notes his heart has been beating faster than usual, which he attributes to stress about the situation. He denies having experienced these symptoms before; this is the first episode. He reports generally not doing much physical activity.\n\nMedical History \n- Hypertension\n\nAllergies \n- Aspirin (swelling)\n\nFamily History \n- Father: MI at age 60, deceased \n- Mother: Heart problems\n\nSocial History \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years \n- Alcohol: 7-8 pints of beer per week \n- Exercise: Generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n60-year-old male with hypertension and family history of cardiac disease, presenting with acute onset chest pressure, dyspnea, diaphoresis, and nausea while gardening.\n\nAcute chest pain \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the center of chest over the pectoral area, associated with dyspnea, diaphoresis, nausea, and left arm and shoulder pain. Symptoms began while gardening with minimal exertion and are currently ongoing. Patient has significant cardiac risk factors including hypertension, 15-year smoking history with 10 cigarettes daily, family history of cardiac disease with father dying of heart attack at similar age and mother having heart problems, and being overweight. Clinical presentation is highly concerning for acute coronary syndrome requiring immediate evaluation and management. \nPlan: \n- Emergency ambulance transport arranged for immediate evaluation \n- Pre-hospital ECG to be performed by emergency team \n- Patient advised to keep front door open for emergency access \n- Continue monitoring symptoms until emergency team arrival \n- Aspirin allergy, which is a mild allergic reaction, to be communicated to emergency team for consideration in treatment decisions \n- Hospital destination to be determined based on ECG findings and required treatment needs", "addedInterpretation": [ { "text": "Patient has significant cardiac risk factors including hypertension, 15-year smoking history with 10 cigarettes daily, family history of cardiac disease ... and being overweight.", "reason": "The clinician asked about smoking, blood pressure, family history and weight but never called them cardiac risk factors or tied them to the assessment. When he raised a possible heart attack he based it only on 'the symptoms that you've described'. The note's framing of this history as 'significant cardiac risk factors' backing the ACS concern is the scribe's own reasoning." } ] }, { "case": "day2_consultation07", "product": "freed", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\nTim Gowers, a approximately 60-year-old male with a history of hypertension, presents with acute onset chest discomfort while gardening. He reports that while kneeling and gardening a couple of hours ago, he began experiencing a pressure sensation in the middle of his chest, described as \"feeling like someone sitting on my chest.\" The pain is diffuse, located over the pectoral area, and radiates down the left arm and into the left shoulder. He reports being sweaty and short of breath. He notes his heart has been beating faster than usual, which he attributes to stress about the situation. He states the symptoms are still present. He denies vomiting. He denies having had these symptoms before.\n\nThe patient reports generally not doing much physical activity. He was not engaged in any strenuous activity at the time of onset.\n\nMedical History \n- Hypertension\n\nAllergies \n- Aspirin (swelling, mild allergic reaction)\n\nFamily History \n- Father: Heart attack at age 60, deceased \n- Mother: Heart problems\n\nSocial History \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years \n- Alcohol: 7-8 pints of beer per week \n- Exercise: Generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n60-year-old male with hypertension and family history of cardiac disease, presenting with acute onset chest pressure and shortness of breath.\n\nAcute chest pain \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the center of chest, associated with nausea, diaphoresis, and shortness of breath. Symptoms began while gardening and are ongoing. Pain radiates to left arm and shoulder. Patient has multiple cardiac risk factors including hypertension, smoking history of 10 cigarettes daily for 15 years, family history of cardiac disease with father dying of heart attack at similar age and mother having heart problems, male gender, and being overweight. Clinical presentation is concerning for acute coronary syndrome and requires immediate evaluation to rule out myocardial infarction. \nPlan: \n- Emergency ambulance transport arranged for immediate evaluation \n- Pre-hospital ECG to be performed by paramedic team \n- Patient advised to keep front door open for emergency access \n- Aspirin allergy to be communicated to emergency team for consideration in treatment decisions \n- Hospital assessment and management based on ECG findings", "addedInterpretation": [ { "text": "Patient has multiple cardiac risk factors including hypertension, smoking history..., family history of cardiac disease..., male gender, and being overweight.", "reason": "The clinician asked about smoking, blood pressure, family history and weight but never called them cardiac risk factors or tied them to the assessment. He based the possible heart attack on the symptoms alone ('the symptoms that you've described to me... indicate the possibility of a heart attack'). Listing these as risk factors behind the ACS concern, and adding male gender, which nobody discussed, is the scribe's own reasoning." } ] }, { "case": "hpi-pain-management", "product": "freed", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\nA 55-year-old female with a history of low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain. She now reports left lower extremity pain and numbness.\n\nMedical History \n- Low back pain with left lower extremity numbness \n- Lumbar disc herniation \n- Lumbar foraminal stenosis\n\nSurgical History \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results \n- MRI lumbar spine: Foraminosis at L4-5\n\nAssessment & Plan\n55-year-old female with low back pain and lumbar disc herniation, presenting with left lower extremity pain and numbness.\n\nLow Back Pain \nAssessment: Patient has low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminal stenosis. MRI demonstrates foraminal stenosis at L4-5 level. Patient previously underwent right sacroiliac joint injection with 80% improvement in right-sided low back pain, but now presents with contralateral left-sided symptoms. \nPlan: \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness \n- If patient responds well to injection, no further intervention will be performed", "addedInterpretation": [ { "text": "low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminal stenosis", "reason": "The clinician only lists the diagnoses side by side (\"low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis\"). They never say the pain and numbness are caused by the herniation or the stenosis. The causal word \"secondary to\" is the scribe's own link." } ] }, { "case": "hpi-pain-management", "product": "heidi", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective:\n- 55yo female\n- Presents to pain clinic with left lower extremity pain and numbness\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n\n\n\nObjective:\n- MRI: foraminal stenosis L4-L5\n\n\n\n\nAssessment:\n- Low back pain with left lower extremity numbness\n- Lumbar disc herniation\n- Lumbar foraminosis\n\n\n\n\nPlan:\n- Proceed with lumbar epidural steroid injection\n- If symptoms resolve, no further intervention planned", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "hanah-old", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "Subjective\n- Abdominal pain x ≥4 days, onset Sunday evening. Gradual dull ache in upper abdomen → sharp RLQ pain, 8/10. No radiation. Worse with movement; nothing helps.\n- Fever last night; home temperature 38°C.\n- Vomited 3 times, especially after eating; no appetite.\n- Normal bowel movements; no diarrhoea or constipation. No dysuria or ↑ urinary frequency.\n- Concerned about seriousness and need for surgery; asked whether to contact family.\nObjective\n- RLQ tenderness, “gathering” and rebound tenderness.\n- Left-sided pressure elicited right-sided pain; positive “rough things sign,” as documented.\nAssessment\n- Suspected acute appendicitis, supported by pain migration to RLQ, fever, vomiting and focal tenderness with rebound.\n- Explained possible appendix inflammation and rupture risk if untreated.\nPlan\n- Proposed CBC, CRP and likely abdominal US or CT to confirm diagnosis.\n- Planned IV fluids, analgesia and antibiotics.\n- Possible laparoscopic surgery discussed, pending confirmation.\n- Oral intake advice given in anticipation of possible surgery; transcript wording ambiguous.\n- Planned admission and surgical team review within hours; surgical team to determine need for surgery and timing.\n- Encouraged contacting family. Reassured that care would be provided and recovery anticipated.", "addedInterpretation": [ { "text": "Suspected acute appendicitis, supported by pain migration to RLQ, fever, vomiting and focal tenderness with rebound.", "reason": "The clinician tied only the exam findings to the diagnosis: RLQ tenderness, rebound tenderness and a positive Rovsing's-type sign, which he called \"very suggestive of acute appendicitis\". He never said the pain moving to the RLQ, the fever or the vomiting supported it. Citing those history items as evidence for the diagnosis is the scribe's own reasoning." } ] }, { "case": "day2_consultation07", "product": "patientnotes", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n\nChief Complaint::\n\nChest discomfort with pressure, nausea, sweating and shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset ~2 hours ago while gardening; diffuse mid‑chest pressure, radiates to left arm and shoulder.\n\nNo prior similar episodes.\n\nSmokes ~10 cigarettes/day for 15 years; hypertension; family history of myocardial infarction (father ~60 y); overweight; consumes ~7‑8 beers/week.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible acute coronary syndrome (ACS) – priority to exclude myocardial infarction.\n\nPlan\n\nEMS dispatched for on‑scene assessment (ECG, treatment as indicated).\n\nCommunicate aspirin allergy to receiving hospital team.\n\nClinician to remain on line until EMS arrival and hand over details.", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "hanah-new", "run": 0, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n- First episode of ongoing diffuse central chest pressure beginning a couple of hours ago while kneeling and gardening without strenuous exertion. Describes a heavy pressure rather than definite pain, with pain in the left arm and shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Feels heart beating faster now, attributed to stress; had not noticed this earlier today.\n- History of high blood pressure. No diabetes. Cholesterol never checked. Reports being overweight.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly. Generally inactive.\n- Father died of a heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes mild swelling, described as non-life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone and currently alone at home. Front door open. Owns a sushi restaurant.\nObjective\n- Video consultation. No measured vital signs or examination findings documented.\nAssessment\n- Possible heart attack; urgent exclusion prioritised. Diagnosis not confirmed.\nPlan\n- Ambulance arranged and reported en route for urgent assessment and hospital transfer.\n- Reassured that help was coming. Planned to remain on the line until ambulance arrival and hand over to the crew.\n- Advised remaining near the hallway/front door and keeping the door open for access.\n- Explained that ambulance staff would perform an electrocardiogram; destination hospital would depend on findings and treatment required.\n- Advised communicating the aspirin reaction to hospital staff in detail. Explained that aspirin might still need consideration despite the reported allergy.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "heidi", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n- Presenting Complaint: Fatigue and low energy for the past two months.\n- History of Presenting Complaint:\n- Difficulty waking in mornings.\n- Difficulty completing routine tasks.\n- Reduced appetite.\n- Sleep disturbance - trouble sleeping.\n- Mood: distracted, difficulty focusing, lower mood, decreased libido.\n- Denies morning erections.\n- SOB with sports, worse over last few months.\n- No suicidal ideation or thoughts of harming others.\n- Enjoys daily activities sometimes.\n- Past Medical History: Hypothyroidism, managed with thyroxine.\n- Medications: Thyroxine.\n- Allergies: NKDA.\n- Family History: Father died by suicide 15 years ago. Mother well. Only child. No family history of depression or other psychiatric conditions.\n- Social History: Married. Started new job two months ago, coinciding with symptom onset.\n- Review of Systems:\n- Vision: no changes.\n\n\n\n\nObjective\n- Not examined (telehealth consultation).\n\n\n\n\nAssessment\n- Fatigue and low energy over two months, with associated sleep disturbance, reduced appetite, lower mood, decreased libido and exertional SOB. Background hypothyroidism on thyroxine.\n\n\n\n\nPlan\n- Blood tests.\n- Book appointment with GP for in-person review and physical examination.\n- Discuss further investigations.", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "hanah-old", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n- Central, diffuse chest pressure x ~2 hours, onset while kneeling gardening without strenuous exertion; ongoing. Heavy sensation over chest, not localized to 1 side. Radiation to left arm and shoulder.\n- Associated nausea, sweating and SOB; no vomiting. First episode.\n- Heart feels faster now, attributed to stress about symptoms; no earlier increased heartbeat noticed today.\n- PMH: HTN; no DM. Cholesterol never checked.\n- Smokes ~10 cigarettes/day x 15 years. Minimal usual physical activity. Self-reported overweight. Alcohol: ~7–8 pints beer/week.\n- FH: father died of MI aged ~60; mother had heart problems.\n- Lives alone; no one currently in house. Front door open. Works as restaurant owner, owns sushi shop.\n- Aspirin allergy: swelling, described as mild and not life-threatening; sometimes still takes aspirin. No other allergies.\nObjective\n- Video consultation.\nAssessment\n- Possible MI: ongoing central chest pressure with left arm/shoulder radiation, nausea, sweating and SOB, with HTN, smoking and FH of heart disease. MI requires urgent exclusion; not confirmed.\nPlan\n- Ambulance arranged and reported en route for urgent assessment and hospital transfer.\n- Explained possible MI and priority to exclude it. Reassured that ambulance was coming and care would be coordinated.\n- Advised speaking near front door and keeping it open to allow emergency access.\n- Explained ambulance team would assess and perform ECG; hospital destination would depend on ECG findings and treatment required.\n- Planned to remain on line until ambulance arrival and hand over symptoms/history to crew.\n- Advised communicating aspirin allergy and reaction details to hospital; explained aspirin might need consideration despite reported allergy.", "addedInterpretation": [ { "text": "Possible MI: ongoing central chest pressure with left arm/shoulder radiation, nausea, sweating and SOB, with HTN, smoking and FH of heart disease.", "reason": "The clinician tied only the described symptoms to a possible heart attack (\"the symptoms that you've described to me... indicate the possibility of a heart attack\"). He asked about hypertension, smoking and family history but never said they support or raise concern for MI. Putting those risk factors forward as support for the MI assessment is the scribe's own reasoning." } ] }, { "case": "hpi-pain-management", "product": "cliniscripts", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "S (Subjective):\n- The patient is a 55-year-old white female.\n- The patient previously underwent a sacroiliac joint injection on the right side with 80% improvement in right-sided low back pain.\n- The patient now presents with left lower extremity pain and numbness.\n\nO (Objective):\n- The patient's MRI shows foraminal stenosis at L4-5.\n\nA (Assessment):\n- Diagnosis: low back pain with left lower extremity numbness.\n- Diagnosis: lumbar disc herniation.\n- Diagnosis: lumbar foraminal stenosis.\n\nP (Plan):\n- Proceed with lumbar epidural steroid injection.\n- If the patient is doing well, no further intervention will be done.", "addedInterpretation": [] }, { "case": "day4_consultation08", "product": "hanah-old", "run": 0, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "Subjective\n- Fatigue, low energy and difficulty getting up x ~2 months, possibly coinciding with starting a new job. Usual tasks now difficult; ↓ food intake.\n- Difficulty sleeping rather than early waking. Poor concentration/distractibility, mildly ↓ mood and ↓ libido over recent months. Married for many years; less sexual interest. Has not noticed morning erections recently but clarified no change from baseline.\n- Enjoyment retained in most activities, sometimes reduced. ↑ SOB during sports compared with a few months ago.\n- No visual change. Denies thoughts of harming self or others; confirms not suicidal.\n- Wants advice and return to previous functioning; symptoms unusual for him.\n- PMH: hypothyroidism, taking thyroxine. No specific prior mental health diagnosis; suspects father's suicide ~15 years ago may have affected him.\n- No medication allergies. No other significant medical/psychiatric FH, including depression. Mother well; only child.\n- Remote consultation; privacy confirmed and consent to proceed given.\nObjective\n- No examination or measurements obtained during remote consultation.\nAssessment\n- Fatigue with sleep disturbance, ↓ intake, poor concentration, low mood and ↓ libido; cause unclear. Known hypothyroidism on thyroxine is relevant to further assessment.\n- Exertional SOB over recent months requires in-person assessment.\n- Low mood without reported suicidal ideation or thoughts of harm to others; FH of paternal suicide noted.\nPlan\n- Proposed GP appointment within the next few days for in-person examination and likely blood tests/further investigations to clarify symptoms; patient agreed.\n- Explained further assessment is needed to identify the cause of tiredness and associated symptoms. Patient found having a plan helpful.", "addedInterpretation": [ { "text": "Known hypothyroidism on thyroxine is relevant to further assessment.", "reason": "The clinician took hypothyroidism and thyroxine only as past history and medication. He never connected them to the fatigue, low mood or other symptoms, and never said they bore on the workup. He planned an examination and blood tests 'to see what's going on' without naming the thyroid. Linking the thyroid history to the assessment is the scribe's own reasoning." } ] }, { "case": "day2_consultation07", "product": "arlo", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "SOAP Notes\n\nSubjective\n- Pt: Tim Gowers, DOB 08/08/1958, M\n- C/o central chest pressure x2h, onset during light gardening\n- Pressure sensation ('someone sitting on chest'), radiates to L arm, L shoulder\n- Assoc Sx: nausea (no vomiting), diaphoresis, SOB, palpitations (likely stress-related)\n- No prev similar episodes\n- Smoker: 10 cig/day x15y\n- Alcohol: 7-8 pints beer/wk\n- PMHx: HTN\n- No DM\n- No known hypercholesterolemia (never checked)\n- FHx: father MI ~60y, mother heart problems\n- Lives alone\n- Occupation: restaurant owner (sushi shop)\n- Overweight (admits)\n- Allergy: aspirin (mild allergic reaction, swelling, non-life-threatening)\n\nObjective\n- N/A (no physical exam performed)\n- No lab or imaging results available\n\nWDx\n- Central chest P/pressure w/ L arm/shoulder radiation, diaphoresis, SOB, nausea\n- High suspicion ACS/AMI given Sx, risk factors (HTN, smoking, FHx, overweight)\n\nPlan\n- GP initiated emergency ambulance transfer\n- Handover to ambulance team arranged\n- Advised pt to communicate aspirin allergy", "addedInterpretation": [ { "text": "High suspicion ACS/AMI given Sx, risk factors (HTN, smoking, FHx, overweight)", "reason": "The clinician tied only the symptoms to the possibility of a heart attack: \"the symptoms that you've described to me... indicate the possibility of a heart attack\". He asked about smoking, blood pressure, family history and weight but never linked them to the suspected diagnosis or used them to justify it. Citing these risk factors as grounds for the working diagnosis, and calling it \"high suspicion\" when he only said \"possibility\", is the scribe's own reasoning." } ] }, { "case": "hpi-pain-management", "product": "freed", "run": 0, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\nA 55-year-old female with a history of low back pain, lumbar disc herniation, and lumbar foraminosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain. She now reports left lower extremity pain and numbness.\n\nMedical History \n- Low back pain \n- Lumbar disc herniation \n- Lumbar foraminosis\n\nSurgical History \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results \n- MRI lumbar spine: Foraminal stenosis at L4-5\n\nAssessment & Plan\n55-year-old female with history of low back pain and recent sacroiliac joint injection, presenting with left lower extremity pain and numbness.\n\nLow Back Pain \nAssessment: Patient has low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminosis. MRI demonstrates foraminosis at L4-5 level. Patient previously underwent right sacroiliac joint injection with 80% improvement in right-sided low back pain, but now presents with left-sided symptoms involving the lower extremity with pain and numbness. \nPlan: \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness \n- If patient responds well to injection, no further intervention will be performed", "addedInterpretation": [ { "text": "low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminosis", "reason": "The reference only lists the diagnoses side by side ('low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis'). The clinician never says the back pain and numbness are caused by the herniation or stenosis. 'Secondary to' is a causal link the scribe added." } ] }, { "case": "hpi-pain-management", "product": "heidi", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "Subjective\n- 55yo female, presents to pain clinic with left lower extremity pain and numbness\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n\n\n\nObjective\n- MRI: foraminal stenosis L4/5\n\n\n\n\nAssessment\n- Low back pain with left lower extremity numbness\n- Lumbar discopathy\n- Lumbar foraminosis\n\n\n\n\nPlan\n- Proceed with lumbar epidural steroid injection\n- If doing well post-procedure, no further intervention planned", "addedInterpretation": [] }, { "case": "day2_consultation07", "product": "hanah-new", "run": 1, "reference": "Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.", "note": "Subjective\n- First episode of ongoing diffuse central chest pressure, beginning while kneeling and gardening a couple of hours ago without strenuous exertion. Feels like someone sitting on chest, with pain spreading mainly to left arm and shoulder.\n- Associated nausea, sweating and shortness of breath. No vomiting.\n- Heart feels faster now, attributed to stress about the situation; no faster heartbeat noticed earlier today.\n- History of high blood pressure. No diabetes. Cholesterol never checked.\n- Smokes 10 cigarettes daily for 15 years. Drinks 7–8 pints of beer weekly. Generally inactive; describes self as overweight.\n- Father died of heart attack around age 60. Mother had heart problems.\n- Aspirin allergy causes mild swelling, described as non-life-threatening; sometimes still takes aspirin. No other allergies.\n- Lives alone; nobody currently in house. Front door open. Owns a sushi restaurant.\nObjective\n- Video consultation. No measured observations or examination findings documented.\nAssessment\n- Possible heart attack; urgent exclusion is the priority. Diagnosis not confirmed.\nPlan\n- Ambulance requested through colleague; subsequently confirmed en route for urgent assessment and hospital transfer.\n- Explained possible heart attack and reassured patient that help was coming.\n- Advised remaining near the front door with door open for emergency access.\n- Plan to remain on the line until ambulance arrival and hand over directly to ambulance team.\n- Explained ambulance team will perform an electrocardiogram; hospital destination will depend on findings and treatment required.\n- Advised communicating aspirin allergy and reaction details to hospital. Explained aspirin may still need consideration despite reported allergy.", "addedInterpretation": [] }, { "case": "hpi-pain-management", "product": "arlo", "run": 1, "reference": "Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.", "note": "SOAP Notes\n\nSubjective\n- 55 y/o white F\n- Hx LBP w/ L lurch\n- c/o L LE P, numbness\n- s/p R joint injection (80% improvement R LBP)\n- Dx: lumbar disc herniation, foraminal stenosis (L4/5)\n\nObjective\n- MRI: foraminal stenosis L4/5\n\nWDx\n- LBP w/ L lurch\n- L LE P/numbness\n- Lumbar disc herniation\n- Foraminal stenosis L4/5\n\nPlan\n- Lumbar epidural steroid injection performed\n- If improving, no further intervention", "addedInterpretation": [] }, { "case": "afriswitch-french", "product": "cliniscripts", "run": 1, "reference": ": Bonjour, madam, je suis le docteur qui va vous prendre en charge aujourd’hui. Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord docteur.", "note": "S (Subjective):\n- The patient reports abdominal pain for the past 4 days, which began on Sunday evening.\n- The pain initially started in the upper abdomen and subsequently localized to the right lower side, now described as sharp with a severity of 8/10.\n- They state that moving around exacerbates the pain, and no specific factors provide relief.\n- Associated symptoms include a fever of 38 degrees Celsius last night, 3 episodes of vomiting, especially after eating, and a complete loss of appetite.\n- The patient denies experiencing diarrhea, constipation, dysuria, or increased urinary frequency, noting normal bowel movements.\n\nO (Objective):\n- Physical examination revealed significant tenderness upon gentle palpation of the right lower abdomen.\n- Rebound tenderness was elicited in the right lower abdomen, reported as worse upon release of pressure.\n- A positive Rovsing's sign was observed, with the patient experiencing pain on the right side when pressure was applied to the left lower abdomen.\n\nA (Assessment):\n- The clinical presentation, including the migratory abdominal pain, fever, vomiting, and specific physical exam findings, is highly suggestive of acute appendicitis.\n- There is a concern for potential inflammation and rupture of the appendix if not promptly treated.\n\nP (Plan):\n- Initiate intravenous fluids, pain relief medication, and antibiotics.\n- Order blood work including a Complete Blood Count (CBC) and C-reactive Protein (CRP).\n- Schedule an abdominal ultrasound or CT scan to confirm the diagnosis.\n- The patient is to remain NPO (nil per os) in preparation for potential surgery.\n- The surgical team will be consulted to evaluate the patient within hours for possible laparoscopic surgery, and the patient will be admitted.\n- Advise the patient to contact their family.", "addedInterpretation": [ { "text": "The clinical presentation, including the migratory abdominal pain, fever, vomiting, and specific physical exam findings, is highly suggestive of acute appendicitis.", "reason": "The clinician called only the exam findings (RLQ tenderness, rebound tenderness, positive Rovsing's sign) 'very suggestive of acute appendicitis'. He never named the migratory pain, fever or vomiting as supporting the diagnosis. The note adds those history items as evidence for the assessment, which is a link the scribe drew itself." } ] }, { "case": "day4_consultation08", "product": "cliniscripts", "run": 1, "reference": "Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. Thanks.", "note": "S (Subjective):\n- Patient reports a 2-month history of difficulty waking, low energy, and general difficulty with daily tasks, which coincided with starting a new job.\n- They experience difficulty sleeping, difficulty focusing, and easy distractibility, along with a decreased appetite.\n- [scribe] a lower mood and decreased sex drive over the past few months, expressing disinterest within their marriage.\n- They report an increase in shortness of breath during sports activities compared to a few months ago.\n- Patient denies any thoughts of self-harm or harming others.\n\nO (Objective):\n- The patient is cooperative and communicative, providing direct answers to the doctor's questions.\n- No physical examination findings, vital signs, or laboratory results are documented in the transcript.\n- No unusual patterns in speech, affect, or thought process were explicitly noted by the doctor during the interaction.\n\nA (Assessment):\n- The doctor has not yet made a definitive diagnosis but is considering various possibilities for the patient's reported fatigue, low mood, and other systemic symptoms.\n- Patient's past medical history of hypothyroidism, currently managed with Thyroxine, is noted as a relevant factor.\n- The constellation of symptoms necessitates further investigation to differentiate between potential medical and psychological etiologies.\n\nP (Plan):\n- Schedule an in-person appointment for the patient with their General Practitioner within the next few days.\n- Conduct a comprehensive physical examination during the scheduled follow-up.\n- Order specific blood tests to aid in the investigation of the patient's reported symptoms.\n- The goal is to identify the underlying cause of the patient's persistent tiredness and associated health concerns.", "addedInterpretation": [ { "text": "Patient's past medical history of hypothyroidism, currently managed with Thyroxine, is noted as a relevant factor.", "reason": "The clinician only took the hypothyroidism and thyroxine history and corrected hypo vs hyper. They never linked it to the fatigue, low mood or other symptoms, or called it relevant to the assessment. The note draws that link itself." }, { "text": "The constellation of symptoms necessitates further investigation to differentiate between potential medical and psychological etiologies.", "reason": "The clinician said only that they would examine and do blood tests 'to see what's going on'. They never framed the work-up as telling medical causes apart from psychological ones. That reasoning behind the plan is the scribe's." } ] } ] }