{"reference":"Hello?\n\n Hello. Can you hear me well?\n\n Uh uh yes. I think. It's a bit better. It's a bit, it's a bit, it's not very clear. But let's continue anyway.\n\n OK.\n\n Uh, OK. Let's start again. So how can I help you sir?\n\n Yes. So, it's been a few days now. I have like a sore, and a red skin. It's kind of, it's really itchy, and it's like super annoying. So I'd like to find something quick to solve it.\n\n OK.\n\n No, no problem. I'm happy to help. Um whereabouts in your skin is it affected?\n\n Uh, mostly like my chest, my, my hands, my arms. Like, like really, it's it's super annoying. Like it's itching a lot, like all the time. And\n\n I can't even sleep at night. I really need something quickly to, to solve it. Because even at work I, I can, when I'm in a meeting and I have to, like uh think about my work, I can't focus, I can't actually focus on my work. It's really annoying because I can't actually think about, uh, what I have to say. I'm always like, uh, disturbed by this disease.\n\n Yeah.\n\n No no, OK. I'm certain this is obviously affecting you. And uh we'll try our very best to get get this sorted out for you. Um, have you had anything like this before in the past?\n\n Um so yes. Uh earlier I was like prescribed for my eczema.\n\n OK.\n\n And they gave me like some cream, and something to, uh when I like shower, when I was in the shower, had to put something. But um\n\n OK.\n\n Did it help?\n\n Um I mean, at that time yes. That's, those symptoms, like these symptoms appear like, when the symptoms appeared again, I tried those and it didn't work.\n\n I've tried a few things. Like I bought a, a steroid cream at the pharmacy last night. But it apparently didn't help, because it's still itching a lot today. Uh, yeah.\n\n OK.\n\n OK.\n\n Do you remember the name of the cream you bought?\n\n A steroid cream.\n\n OK, steroid, OK. um would you say these symptoms are very similar to your eczema symptoms, or different?\n\n Um\n\n it's much more like itchy. And my eczema was more like only in the arm. But now it's also on the chest. And in the on the, on the hands as well.\n\n OK.\n\n Like pretty, yeah when, like I like, for instance hiking, during the weekend. And\n\n I am, I can't really do it anymore, because it's like very like I wanted to do that last weekend. And because super painful, and I I have to take like showers every day to be able to, cannot uh ease this itching part, which is very very annoying.\n\n Yes.\n\n No. Well OK. That's so you mentioned the itchiness. Um you also mentioned it's been quite sore.\n\n Yeah.\n\n Um have you, have you noticed any uh bleeding or discharge from your skins?\n\n . OK.\n\n No. Um so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. But uh, yeah.\n\n OK.\n\n You've not, haven't uh seen any other uh pus or blood, coming out of your skin.\n\n No.\n\n No. And you mentioned it all started three days ago.\n\n Are you, four days ago. Are you aware of any triggers, or anything that you may have done, that may have caused your symptoms to start?\n\n Four days ago.\n\n So for example, have you changed your uh shower gel, any clothing?\n\n Have you been around anyone else?\n\n No I . It's actually like, it's really annoying, because I'm thinking about, maybe I should change something. Because I I haven't, and I don't understand I cannot, um afraid of asking people around me because it's cannot you know um, I don't feel really comfortable asking about these questions. It's kind of intimate that. So I your help now.\n\n Mm.\n\n Mm. No no, OK. That's OK. Um\n\n Fine, so just to resummarize. For the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well?\n\n Yeah.\n\n Uh, no. Just the chest, hands and like, like inside the elbows. Yeah.\n\n OK. anything on your face at all?\n\n Am I what?\n\n On your face?\n\n On my face? No.\n\n No, OK. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n No. just very itchy. Nothing else.\n\n Itchy. OK. So your, your bowels are working OK?\n\n Your chest is OK? No cough, no breathing difficulties?\n\n No.\n\n You're passing urine OK.\n\n I I think so.\n\n OK, alright. Um\n\n It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n Any what?\n\n Any ideas, as to what could be causing your symptoms?\n\n Um so I had eczema before. So maybe it's disease, but it seems like more uh, like uh my eczema was only on the arms. So, I'm I'm not sure. I I really have no idea.\n\n OK. That's OK. So um, normally at this stage I like to examine you. Um\n\n To see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's, you've got some dry skin and some, uh cracked skin as well.\n\n Uh and has been very itchy. And so would your um\n\n Yeah.\n\n Uh your your background of eczema. Um\n\n So\n\n Sorry to say, there's a couple of questions I wanted to ask you, which I completely forgot, my apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n Uh, no. I just had asthma in the past. But not anymore.\n\n OK. Not anymore, OK. And do you take any regular medications at the moment?\n\n Uh no.\n\n No, OK. Do you have any allergies to anything?\n\n I like some , sorry? Yeah?\n\n sorry I said do you have any allergies to anything?\n\n Hello?\n\n Hello? Yes.\n\n can you hear me? That's alright I think it . Uh do you have any allergies at all?\n\n Ohh, allergies. Uh, no.\n\n No, OK. Um and tell me about your um uh your situation at home. Who do you live with?\n\n Uh so, I live with a few flatmates. I'm a, so you know I'm thirty one. Uh I, yeah I'm I have a full time job. And so I'm living with a few people to save money.\n\n OK. And what do you do for work?\n\n Uh I work uh at a pharmaceutical company.\n\n So it's been a, it's been a few years now. Uh it's uh, it's kind of interesting. We're working I'm a, like a kind of project manager. Uh I mean, do you want to, to know more about it?\n\n OK. Uh no no no that's , that's absolutely fine. Um just a couple of questions I want to ask you, which can sometimes affect your symptoms, is, do you smoke at all?\n\n No.\n\n No. And do you drink much in the way of alcohol?\n\n Uh you know, once in a while I can, I like hanging out with people once in a while. So yeah I'd say a few, a few beers per week. Something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger. But it's been, it's been a while.\n\n OK. OK. OK I've got to say, at this stage I've got to say this sound quality is not uh great. But I will continue because we've come this far. Um\n\n So um, based on everything you mentioned Sarah , I do wonder whether this is a flare-up of your eczema. Um\n\n The reason being that you said it was quite itchy. Um it's mainly affecting your chest and your back.\n\n Um and uh, having looked at your skin, uh the the the rash does appear quite familiar. Um you mentioned using steroid creams, yesterday.\n\n Um from the pharmacy. I wonder whether giving you a stronger prescription of a of a steroid may be beneficial.\n\n Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something, some emollients, which helps to moisturize the skin.\n\n OK.\n\n OK.\n\n Um which use in the bath and shower. And it's definitely worth um using that for the first seven to ten days.\n\n OK.\n\n Uh before we make the decision on whether it's working or not.\n\n OK.\n\n Um it's also worth um using antihistamines, which you can sometimes buy over counter.\n\n Things like Loratadine or Piriton, which can help the itchiness of your skin.\n\n OK.\n\n And uh, um it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use, in terms of shower gels or soap.\n\n Because if that's causing your symptoms, then we need to have a discussion about an eczema CU.\n\n OK. Yes, I have tried antihistamines, uh lately, but it didn't really help.\n\n Ohh, could you say that again, sorry?\n\n I have tried uh antihistamines, but uh but it didn't really help.\n\n OK.\n\n OK. So it's something for you to think about. you can get different types of antihistamines. I can give you something a little bit stronger today as well.\n\n Um, something like Fexofenadine, which I can give to you today. It's definitely worth trying, and it's not going to do you any harm.\n\n OK.\n\n Um but I think using the steroids and the emollients, um on a regular basis\n\n Uh over the next week to ten days, should hopefully control your symptoms. But do come back and see me next week, if things don't get better.\n\n That sounds good.\n\n OK? Um do you have any questions for me?\n\n Uh, no that's it. Thank you very much. Bye. Thank you as well. Bye.\n\n OK. Well I wish you all the best.\n\n Thank you. Have a good day.","products":{"hanah":[{"label":"Run 1","wer":14.302812687013763,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So, how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms. Like, like, really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying, because I can't actually think about what I have to say. I'm always, like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get— get us sorted out for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to— when I, like, was shower— when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did that help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms are— like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. That's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— my eczema was more, like, only in the arms, and now it's also on the chest and in the— in the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of ease this itching part, which is very, very annoying.\n\n  No. Well, okay. That's okay. So you mentioned the itchiness.\n\n  Yeah.\n\n  Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. So, my skin is a bit cracked in some parts. Like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  I'm noticing any other, uh, pus or blood coming out of your skin?\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start?\n\n  No.\n\n  So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No. I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something, because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly?\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. Any— anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay?\n\n  Yeah.\n\n  Your chest is okay? No cough, no breathing difficulties?\n\n  No.\n\n  Your passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\n\n  Yeah.\n\n  Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I— like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So, it's been a— it's been a few years now. Uh, it's a— it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I want to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so, um, based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Um.\n\n  Okay.\n\n  Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritan, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just, I— I\n\n  have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully cure— control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[[767,775,"I can",false],[840,843,"I can't",false],[851,855,"I can't",false],[1032,1051,"OK. I'm certain",false],[1125,1127,"this",false],[1473,1480,"That's those",false],[1512,1515,"appear",false],[1528,1533,"the",false],[1869,1887,"OK.",false],[1892,1898,"",false],[2063,2072,"arm. But",false],[2160,2166,"pretty",false],[2226,2234,"weekend.",false],[2240,2240,"am",false],[2311,2318,"wanted",false],[2321,2321,"do",false],[2345,2351,"because",false],[2372,2377,"",false],[2432,2439,"cannot uh",false],[2687,2691,"skins . OK.",false],[2821,2833,"OK. 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OK I've got",false],[6838,6847,"I've got",false],[6990,6996,"Sarah",false],[7088,7092,"it was",false],[7263,7269,"",false],[7380,7382,"",false],[7583,7595,"",false],[7841,7857,"over counter.",false],[7885,7892,"Piriton",false],[8204,8246,"an eczema CU. OK. Yes",false],[8258,8266,"tried",false],[8325,8327,"Ohh",false],[8444,8460,"OK. OK.",false],[8766,8775,"",false],[8897,8901,"",false],[9088,9093,"Thank you very much. Bye. Thank you as well. Bye. OK.",false],[9138,9162,"",false],[9183,9211,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day hx\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"sore, erythematous, intensely pruritic skin affecting chest, hands and antecubital fossae\", dry/cracked; no legs asserted."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding, pus or other discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupting sleep, work concentration and weekend hiking\"."],["The note captures: Known eczema and past asthma.","yes","\"PMH: eczema; past asthma, no longer active\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior treatment \"previously effective, but not with current sx\"; \"OTC steroid cream used last night without benefit\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Antihistamines tried recently without relief\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified trigger; no change in shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Discussed stronger Rx topical steroid for current flare\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"regular emollient use, including as bath/shower substitute, for 7–10 days\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"stronger option of fexofenadine discussed\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of possible triggers, including clothing, soaps and shower gels\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Advised review next week if not improving after 7–10 days of treatment\"."]],"claims":[],"note":"Subjective\n4-day hx sore, erythematous, intensely pruritic skin affecting chest, hands and antecubital fossae; no facial involvement.\nSkin dry/cracked in places; no bleeding, pus or other discharge.\nPruritus constant, disrupting sleep, work concentration and weekend hiking; showering daily to ease itch/pain.\nPrevious eczema, previously limited to arms; current episode more pruritic and more widespread than prior flares.\nPrior eczema cream/shower treatment previously effective, but not with current sx. OTC steroid cream used last night without benefit. Antihistamines tried recently without relief.\nNo identified trigger; no change in shower gel or clothing. Worried about cause and uncomfortable discussing possible exposures with others.\nDenies fever, cough or dyspnoea. Bowels normal; thinks urination normal.\nPMH: eczema; past asthma, no longer active. No regular meds. No known allergies.\nNon-smoker. Alcohol: few beers/week. Lives with flatmates; works full-time.\nObjective\nSkin visually reviewed during consultation; clinician described rash appearance as familiar.\nAssessment\nSuspected eczema flare: intensely pruritic, dry/cracked erythematous rash with prior eczema history.\nPt notes atypical flare pattern, with greater itch and involvement of chest/hands in addition to previous arm involvement.\nNo reported bleeding, purulent discharge, fever or respiratory sx.\nPlan\nDiscussed stronger Rx topical steroid for current flare.\nDiscussed regular emollient use, including as bath/shower substitute, for 7–10 days.\nDiscussed antihistamines for itch: OTC loratadine or Piritan; stronger option of fexofenadine discussed given inadequate response to previous antihistamine.\nKeep diary of possible triggers, including clothing, soaps and shower gels.\nAdvised review next week if not improving after 7–10 days of treatment.\nPt agreed with plan; no further questions.","review":84.0,"saved":232.5,"clean":true,"effort":0.0,"sig":[]},{"label":"Run 2","wer":14.542190305206462,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms, like— like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Uh, earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did that help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and my eczema was more, like, only in the arms, and now it's also on the chest and in the— in the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I wanted to do that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying.\n\n  No. Well, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm not seeing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly.\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. Any— anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay.\n\n  And.\n\n  Your chest is okay. No cough, no breathing difficulties?\n\n  No.\n\n  Your passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well. Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma, in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I use, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while I can— I like hanging out with people once in a while, so yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I was going to say, at this stage, I was going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something— some emollients, which helps moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\n\n  Okay.\n\n  Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just, uh, I\n\n  have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[[765,773,"I can",false],[838,841,"I can't",false],[849,853,"I can't",false],[1029,1048,"OK. I'm certain",false],[1122,1138,"this sorted out",false],[1485,1492,"That's those",false],[1523,1523,"appear",false],[1536,1541,"the",false],[1877,1899,"OK.",false],[1904,1910,"",false],[2074,2083,"arm. But",false],[2171,2177,"pretty",false],[2237,2245,"weekend.",false],[2251,2251,"am",false],[2357,2363,"because",false],[2384,2389,"",false],[2444,2451,"cannot",false],[2698,2702,"skins . OK.",false],[2832,2839,"OK. 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OK.",false],[9136,9160,"",false],[9181,9209,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","4-day history recorded."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked skin on chest, hands and inner elbows; legs not listed."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies bleeding/discharge."],["The note captures: Itching disturbs sleep.","yes","Sleep disturbance recorded."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration and hiking impact recorded."],["The note captures: Known eczema and past asthma.","yes","Eczema and past asthma recorded."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior eczema treatments and OTC steroid last night not relieving current flare."],["The note captures: Antihistamines already tried have not helped.","yes","Antihistamines tried without benefit."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identified trigger; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Suspected eczema flare."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","Stronger topical steroid prescribed."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollient including bath/shower use."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Fexofenadine for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Trigger diary covering clothing, soaps, shower products."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Review next week if not improving; 7–10 day trial."]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx pruritic, erythematous, sore skin rash.\nDistribution: chest, hands and antecubital areas. Denies facial involvement.\nReports marked itch, sleep disturbance, impaired concentration at work and unable to hike due to pain/itch.\nSkin reportedly dry and cracked in places. Denies bleeding, discharge or pus.\nDenies fever, cough, SOB. Reports bowel function normal; thinks urination normal.\nSimilar to prior eczema but itchier and more extensive; previous eczema mainly affected arms.\nNo identified trigger; denies changes to shower gel or clothing.\nPrior eczema treated with cream and a shower product, previously effective but not during current flare.\nUsed OTC steroid cream last night without benefit. Has tried antihistamines without benefit.\nPMH: eczema; past asthma, no longer active per pt.\nRegular meds: none. Allergies: none known.\nSocial: lives with flatmates; works as project manager in pharmaceutical company. Non-smoker. Drinks a few beers/week.\nObjective\nClinician reports visual review of rash; appearance described as familiar/consistent with eczema.\nNo detailed rash morphology or examination findings documented.\nAssessment\nSuspected eczema flare.\nSupported by pruritic, dry/cracked, erythematous and sore skin with prior eczema history; current distribution includes chest, hands and antecubital fossae.\nNo reported fever, purulent discharge or bleeding.\nPlan\nPrescribe stronger topical steroid; strength, regimen and duration not documented.\nProvide emollient/moisturiser for skin and use in bath/shower.\nUse topical steroid and emollient regularly for 7–10 days before assessing response.\nPrescribe fexofenadine for pruritus; pt reports previous antihistamine trial was ineffective.\nKeep diary of possible triggers, including clothing, shower gels and soaps.\nReview next week if symptoms do not improve.","review":84.0,"saved":232.5,"clean":true,"effort":0.0,"sig":[],"mb":11.857361,"latency":23.487,"signable":107.487},{"label":"Run 3","wer":14.362657091561939,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get— get us sorted out for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Earlier I was, like, prescribed for my eczema. And they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did it help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. That's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— My eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I wanted to do that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying.\n\n  No. Well, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm noticing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No, I— I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly?\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. And anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay?\n\n  Yeah.\n\n  Your chest is okay? No cough, no breathing difficulties?\n\n  No.\n\n  You're passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\n\n  Yeah.\n\n  Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma, in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I use, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you some— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Um.\n\n  Okay.\n\n  Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just, uh, I\n\n — I have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[[765,773,"I can",false],[838,841,"I can't",false],[849,853,"I can't",false],[1029,1048,"OK. I'm certain",false],[1122,1124,"this",false],[1476,1483,"That's those",false],[1514,1514,"appear",false],[1527,1532,"the",false],[1868,1886,"OK.",false],[1891,1897,"",false],[2062,2071,"arm. But",false],[2160,2166,"pretty",false],[2226,2234,"weekend.",false],[2240,2240,"am",false],[2346,2352,"because",false],[2373,2378,"",false],[2433,2440,"cannot",false],[2687,2691,"skins . OK.",false],[2821,2837,"OK. 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OK.",false],[9139,9163,"",false],[9184,9212,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day hx\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, erythematous, pruritic, cracked skin on \"chest, hands and antecubital areas\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies bleeding, pus or other discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"Pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work concentration and hiking\"."],["The note captures: Known eczema and past asthma.","yes","\"PMH: eczema; remote asthma\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","\"Tried previous eczema treatments and OTC steroid cream last night without benefit\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"recent antihistamine trial without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified trigger; denies changes in shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Probable eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"trial of stronger prescription topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollient/moisturiser, including use in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"stronger antihistamine, e.g. fexofenadine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers, including clothing, soaps and shower products\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review next week if symptoms not improving\"."]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx sore, erythematous, intensely pruritic rash.\nDistribution: chest, hands and antecubital areas. Denies facial involvement.\nSkin cracked in some areas; denies bleeding, pus or other discharge.\nPruritus disrupting sleep, work concentration and hiking.\nHx eczema, previously mainly affecting arms; prior prescribed cream and shower product had helped. Current episode more extensive and more pruritic.\nTried previous eczema treatments and OTC steroid cream last night without benefit.\nReports recent antihistamine trial without benefit.\nNo identified trigger; denies changes in shower gel or clothing.\nDenies fever, cough or SOB. Bowels normal. Reports passing urine, no concerns stated.\nPMH: eczema; remote asthma, no longer active per pt.\nRegular meds: none. Allergies: none reported.\nNon-smoker. Drinks a few beers/week.\nObjective\nClinician reported visual review of rash; described appearance as familiar, without documented morphology or further examination findings.\nAssessment\nProbable eczema flare.\nSupported by prior eczema, acute pruritic/sore erythematous skin with dryness/cracking, and distribution involving hands/antecubital areas/chest.\nNo reported fever, discharge, bleeding or respiratory symptoms.\nPlan\nDiscussed trial of stronger prescription topical steroid; clinician stated this would be prescribed.\nDiscussed emollient/moisturiser, including use in bath/shower.\nUse steroid treatment and emollients regularly for 7–10 days before assessing response.\nDiscussed stronger antihistamine, e.g. fexofenadine, for pruritus; clinician stated this could be provided.\nKeep diary of potential triggers, including clothing, soaps and shower products.\nReview next week if symptoms not improving.","review":75.78947368421052,"saved":240.71052631578948,"clean":true,"effort":0.0,"sig":[],"mb":11.812573,"latency":26.551,"signable":102.34047368421052},{"label":"Run 4","wer":14.063435068821065,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms, like— like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, uh, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying because I can't actually think about, uh, what I have to say. I'm always, like, uh, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and, uh, we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Uh, earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did that help?\n\n  Um, I mean, at that time, yes, but the symptoms, like, these symptoms are, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying.\n\n  No. Well, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts. Like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm noticing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago. Are you—\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else—\n\n  No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest, hands, and, like, like, inside the elbows.\n\n  Okay. And anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your, your bowels are working okay? Your chest is okay? No cough, no breathing difficulties?\n\n  No.\n\n  You're passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well. Uh, and it's been very itchy. And so with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I usually, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything? Hello?\n\n  Hello? Yes?\n\n  Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I've— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I want to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, th-this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh, before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just I— I have tri\n\n ed antihistamines, uh, lately, but it didn't really help. Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't. Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um, something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully c-control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay. Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[[765,773,"I can",false],[842,845,"I can't",false],[853,857,"I can't",false],[1042,1061,"OK. I'm certain",false],[1140,1156,"this sorted out",false],[1504,1511,"That's those",false],[1543,1546,"appear",false],[1559,1564,"the",false],[1900,1922,"OK.",false],[1927,1933,"",false],[2098,2107,"arm. But",false],[2196,2202,"pretty",false],[2262,2270,"weekend.",false],[2276,2276,"am",false],[2347,2354,"wanted",false],[2357,2357,"do",false],[2381,2387,"because",false],[2408,2413,"",false],[2468,2475,"cannot",false],[2722,2726,"skins . OK.",false],[2856,2872,"OK. You've not haven't uh seen",false],[3019,3033,"",false],[3142,3142,"Four days ago.",false],[3257,3265,".",false],[3292,3296,"really",false],[3411,3426,"I cannot",false],[3479,3486,"cannot",false],[3596,3607,"",false],[3679,3691,"resummarize.",false],[3967,3972,"Am I",false],[4154,4157,"",false],[4163,4187,"very itchy.",false],[4208,4213,"Itchy. 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OK.",false],[9112,9136,"",false],[9157,9185,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'4-day hx sore, erythematous, intensely pruritic skin rash.'"],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, erythematous, pruritic, cracked skin on 'chest, hands and antecubital fossae'."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Denies bleeding, discharge or pus.'"],["The note captures: Itching disturbs sleep.","yes","'disrupting sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","'disrupting... concentration at work and hiking.'"],["The note captures: Known eczema and past asthma.","yes","'PMH: eczema; past asthma, no longer active per pt.'"],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previous treatments 'not with current flare'; pharmacy steroid cream last night without relief."],["The note captures: Antihistamines already tried have not helped.","yes","'Tried antihistamines recently without benefit.'"],["The note captures: No clear new trigger or change in toiletries identified.","yes","'No identified trigger or recent change in shower gel/clothing reported.'"],["The note captures: Assessment is a likely eczema flare.","yes","'Probable eczema flare.'"],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid cream.'"],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollient for regular use including in bath/shower."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine for pruritus.'"],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'Advise keeping a diary of potential triggers, including clothing, shower gels and soaps.'"],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review next week if symptoms do not improve.'"]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx sore, erythematous, intensely pruritic skin rash.\nDistribution: chest, hands and antecubital fossae. No facial involvement.\nPruritus persistent; disrupting sleep, concentration at work and hiking.\nSkin cracked in places. Denies bleeding, discharge or pus.\nDenies fever, cough, SOB, bowel concerns or urinary concerns.\nSimilar to prior eczema but more pruritic and more widespread; previous eczema mainly affected arms.\nNo identified trigger or recent change in shower gel/clothing reported.\nPrevious eczema treatments included cream and shower product; initially effective but not with current flare.\nTried pharmacy-purchased topical steroid cream last night without relief.\nTried antihistamines recently without benefit.\nPMH: eczema; past asthma, no longer active per pt.\nNo regular meds. NKDA.\nNon-smoker. Drinks a few beers/week.\nObjective\nRemote consultation; audio quality intermittently poor.\nClinician reports visual assessment of rash; appearance described as familiar/consistent with eczema.\nNo objective examination details documented.\nAssessment\nProbable eczema flare.\nSupported by prior eczema, marked pruritus, dry/cracked skin and affected flexural areas/chest.\nNo reported fever, purulent discharge or bleeding to suggest infective complication from history.\nPlan\nPrescribe stronger topical steroid cream; strength/directions not documented.\nPrescribe emollient/moisturiser for regular use, including as bath/shower substitute.\nAdvise consistent steroid and emollient use for 7–10 days before assessing response.\nPrescribe fexofenadine for pruritus; discussed that alternative antihistamines may be more effective despite recent unsuccessful antihistamine trial.\nAdvise keeping a diary of potential triggers, including clothing, shower gels and soaps.\nReview next week if symptoms do not improve.","review":80.21052631578947,"saved":236.28947368421052,"clean":true,"effort":0.0,"sig":[],"mb":11.82695,"latency":22.234,"signable":102.44452631578946},{"label":"Run 5","wer":14.422501496110113,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts in your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always— like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get a source of that for you. Um, have you had anything like this before in the past?\n\n  Um, so yes. Earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to— when I, like, was shower— when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did it help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms are— like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream?\n\n  Okay, steroid. Okay. That's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I wanted to do that last weekend and it was super painful, and I think I have to take, like, showers every day to be able to kind of ease this itching part, which is very, very annoying.\n\n  No. Well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm noticing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something, because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly.\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. Any— anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay.\n\n  And.\n\n  Your chest is okay. No cough, no breathing difficulties?\n\n  No.\n\n  Your passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\n\n  Yeah.\n\n  Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma, in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I use, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job, and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in a way of alcohol?\n\n  Uh, you know, o-once in a while, I can— I like hanging out with people once in a while, so yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you some— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh, before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritan, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay.\n\n  Just— I— I have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I say anything using the steroids and the emollients, um, on a regular basis. Um, over the next week to 10 days, should hopefully cure— control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[[752,760,"I can",false],[825,828,"I can't",false],[836,840,"I can't",false],[1003,1022,"OK. I'm certain",false],[1091,1107,"get this sorted out",false],[1439,1446,"That's those",false],[1478,1481,"appear",false],[1494,1499,"the",false],[1835,1853,"OK.",false],[1858,1864,"",false],[2029,2038,"arm. But",false],[2127,2133,"pretty",false],[2193,2201,"weekend.",false],[2207,2207,"am",false],[2313,2319,"because",false],[2341,2346,"",false],[2401,2408,"cannot uh",false],[2644,2648,"skins . OK.",false],[2778,2794,"OK. 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OK.",false],[9084,9108,"",false],[9129,9157,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'4-day hx sore, erythematous, intensely pruritic skin rash.'"],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, erythematous, cracked skin on chest, hands, arms/antecubital fossae; no legs invented."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Denies bleeding, pus or other discharge.'"],["The note captures: Itching disturbs sleep.","yes","'disrupting sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","'disrupting... work concentration and hiking.'"],["The note captures: Known eczema and past asthma.","yes","'PMH: eczema; past asthma, no longer active.'"],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previous eczema cream/shower product not helping current flare; OTC steroid cream without benefit."],["The note captures: Antihistamines already tried have not helped.","yes","'Reports antihistamines recently tried without relief.'"],["The note captures: No clear new trigger or change in toiletries identified.","yes","'No identified trigger; denies changes to shower gel or clothing.'"],["The note captures: Assessment is a likely eczema flare.","yes","'Suspected eczema flare.'"],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid cream.'"],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Provide emollients/moisturisers, including for use in bath/shower.'"],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Offer fexofenadine for pruritus.'"],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'Keep diary of potential triggers, including clothing, soap and shower products.'"],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review next week if symptoms do not improve.'"]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx sore, erythematous, intensely pruritic skin rash.\nDistribution: chest, hands, arms/antecubital fossae. No facial involvement.\nPruritus constant; disrupting sleep, work concentration and hiking.\nSkin cracked in places. Denies bleeding, pus or other discharge.\nDenies fever, cough or SOB. Bowels normal; reports passing urine adequately.\nHx eczema, previously limited to arms; current episode more widespread and more pruritic.\nPrevious eczema cream and shower product helped historically but not with current flare.\nTried OTC steroid cream since previous night without benefit. Reports antihistamines recently tried without relief.\nNo identified trigger; denies changes to shower gel or clothing.\nPMH: eczema; past asthma, no longer active.\nNo regular meds. No known allergies.\nNon-smoker. Drinks a few beers/week.\nLives with flatmates; works full-time as a project manager at a pharmaceutical company.\nObjective\nRash reportedly viewed during consultation; detailed morphology not documented.\nNo objective observations/vitals documented.\nAssessment\nSuspected eczema flare.\nSupported by prior eczema and current pruritic, sore, erythematous, cracked rash affecting chest, hands and flexural elbows.\nSymptoms are more extensive and itchier than previous eczema episodes.\nNo reported fever, bleeding, purulent discharge, cough or SOB.\nPlan\nPrescribe stronger topical steroid cream; strength, regimen and duration not documented.\nProvide emollients/moisturisers, including for use in bath/shower.\nUse topical steroid and emollients regularly for 7–10 days before assessing response.\nOffer fexofenadine for pruritus despite limited response to previous antihistamine trial.\nKeep diary of potential triggers, including clothing, soap and shower products.\nReview next week if symptoms do not improve.","review":80.84210526315789,"saved":235.6578947368421,"clean":true,"effort":0.0,"sig":[],"mb":11.815073,"latency":26.268,"signable":107.11010526315789}],"heidi":[{"label":"Run 1","wer":17.41472172351885,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts on your skin is it affected? Mostly, like, my chest, my my hands, my arms, like\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes, but the symptoms like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more like only in the arms, and now it's al- also on the chest and in the, in the, on the hands as well. Okay. Yeah, when- like, I like, for instance, hiking- Yeah... during the weekend, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No, well, well, okay, that's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um- Yeah. Have you, have you noticed any, uh, bleeding or discharge from your skins?\n\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have noticed any other pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone? No. I I haven't it's actually, like, it's really annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I have now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well? No. Just the chest Mains and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itchy. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like, something sorry? Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it correct do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. There's a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm gonna give you something some emollients, which helps to moisturize the skin, which you use in a bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or piritone, which can help with the itchiness of your Okay. Skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the Imolements on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nNo. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you later. Bye.","marks":[[130,135,"",false],[724,728,"I can",false],[794,797,"I can't",false],[804,808,"I can't",false],[974,994,"OK. 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OK.",false],[8373,8394,"",false],[8412,8438,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"itchy, sore, red skin\"; \"chest, hands, inner elbows\"; cracked skin."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Denies bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"impacting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"concentration at work\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema..., asthma (resolved)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior Rx \"helped at the time but current flare unresponsive\"; OTC steroid \"no improvement\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines recently - no relief\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No known triggers; no recent changes to shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected eczema flare-up\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Stronger topical steroid cream prescribed\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for moisturising, to be used in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Fexofenadine prescribed for itchiness\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Follow-up in one week if symptoms do not improve\"."]],"claims":[],"note":"Subjective:\n\n- 4-day history of very itchy, sore, red skin\n\n- Widespread, primarily chest, hands, inner elbows\n\n- Cracked skin in some areas\n\n- Constant, severe itchiness impacting sleep and concentration at work\n\n- Denies bleeding or discharge\n\n- No known triggers; no recent changes to shower gel or clothing\n\n- Denies fever, cough, breathing difficulties, bowel/urinary issues\n\n- PMHx: eczema (previously managed with cream and shower product), asthma (resolved)\n\n- Meds: OTC steroid cream last night - no improvement; previously prescribed eczema cream/shower product - helped at the time but current flare unresponsive; antihistamines recently - no relief\n\n- Allergies: NKDA\n\n- Social: lives with flatmates, full-time project manager at pharmaceutical company, non-smoker, few beers/week\n\n\n\n\nObjective:\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment:\n\n- Suspected eczema flare-up; more widespread and itchier than previous episodes\n\n\n\n\nPlan:\n\n- Stronger topical steroid cream prescribed\n\n- Emollients for moisturising, to be used in bath/shower\n\n- Use steroid cream and emollients regularly for 7-10 days, then review effectiveness\n\n- Fexofenadine prescribed for itchiness\n\n- Keep diary of potential triggers (clothing, shower gels, soaps)\n\n- Follow-up in one week if symptoms do not improve","review":56.21052631578947,"saved":260.2894736842105,"clean":true,"effort":0.0,"sig":[],"mb":37.781067,"latency":27.283,"signable":83.49352631578947},{"label":"Run 2","wer":16.63674446439258,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problems. I'm happy to help. Whereabouts on your skin, is it affected?\n\nMostly like my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And\n\nThey gave me, like, some cream and something to when I, like, was shower when I was in the shower, had to put something. Okay. But Did it help? I mean, at that time, yes. But the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's al- also on the chest and in the, and the, on the hands as well. Okay. Like, itchy, yeah, when, like, I like, for instance, hiking- Yeah... during the weekends, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No. Well, well, okay, that's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you, have you noticed any, uh, bleeding or discharge from your skin?\n\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You have noticed any other pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone? No. I I haven't it's actually, like, it's really annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I'm help now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest Maine. Hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nUh, your background of eczema. Um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of? Uh, no, I just had asthma in the past, but not anymore. Not anymore, okay. And do you take any regular medications at the moment? Uh, no. No. Okay. Do you have any allergies to anything? I like something. Sorry. Yeah. Sorry, I was gonna say, do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Oh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No. Okay. Um, and tell me about your, um-\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say that the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm gonna give you something some emollients, which helps to moisturize the skin, which you have to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or piritone, which can help with the itchiness of your Okay. Skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[130,135,"",false],[407,416,"problem.",false],[725,729,"I can",false],[795,798,"I can't",false],[805,809,"I can't",false],[975,993,"OK. I'm certain",false],[1380,1387,"That's those",false],[1418,1418,"appear",false],[1431,1436,"the",false],[1750,1758,"OK. um",false],[1915,1924,"arm. But",false],[1934,1937,"",false],[2011,2016,"pretty",false],[2058,2073,"hiking",false],[2085,2093,"weekend.",false],[2102,2104,"am",false],[2210,2216,"because",false],[2232,2244,"and I",false],[2299,2306,"cannot",false],[2550,2554,"skins . OK.",false],[2667,2683,"OK. You've not haven't uh seen",false],[2789,2803,"Are you",false],[2850,2852,"or",false],[2928,2928,"Four days ago.",false],[3022,3022,"else",false],[3030,3039,".",false],[3186,3201,"I cannot um",false],[3250,3257,"cannot",false],[3361,3364,"I your",false],[3419,3431,"resummarize.",false],[3611,3617,"",false],[3659,3668,"Yeah. OK.",false],[3699,3704,"Am I",false],[3880,3901,"very itchy.",false],[3916,3921,"Itchy. 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OK.",false],[8419,8440,"",false],[8458,8486,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Sore, red, intensely itchy skin rash x4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin \"Affecting chest, hands, inner elbows\" with legs correctly not included."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"interfering with sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"interfering with... concentration at work\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema...; asthma (resolved)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"no relief\" captured, but prior eczema treatments are noted only as effective at the time, not as failing now."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines recently - ineffective\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No known triggers identified (no change in shower gel, clothing, or contacts)\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Stronger topical steroid cream to affected areas\" with no invented name/dose."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for use during bathing/showering; use 7-10 days\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Fexofenadine for itch relief\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep trigger diary (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Follow-up in 1 week if no improvement\"."]],"claims":[],"note":"Subjective\n\n- Sore, red, intensely itchy skin rash x4 days\n\n- Affecting chest, hands, inner elbows\n\n- Constant, severe itch; interfering with sleep and concentration at work\n\n- Skin cracked in some areas; denies bleeding or discharge\n\n- No fever or other systemic symptoms\n\n- Bowels and urinary function normal; respiratory system clear\n\n- No known triggers identified (no change in shower gel, clothing, or contacts)\n\n- PMHx: eczema (previously treated with cream and bath emollients, effective at the time; current symptoms more widespread and itchy than prior flares confined to arms); asthma (resolved)\n\n- Meds: nil regular; OTC steroid cream from pharmacy yesterday - no relief; antihistamines recently - ineffective\n\n- Allergies: NKDA\n\n- Social: lives with flatmates; works full-time as project manager at pharmaceutical company; non-smoker; occasional alcohol (few beers/week)\n\n\n\n\nObjective\n\n- Rash appears familiar on examination\n\n\n\n\nAssessment\n\n- Suspected flare-up of eczema\n\n\n\n\nPlan\n\n- Stronger topical steroid cream to affected areas\n\n- Emollients for use during bathing/showering; use 7-10 days then review effectiveness\n\n- Fexofenadine for itch relief\n\n- Keep trigger diary (clothing, shower gels, soaps) to discuss next visit\n\n- Follow-up in 1 week if no improvement","review":75.46052631578948,"saved":241.03947368421052,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":37.712102,"latency":27.984,"signable":103.44452631578949},{"label":"Run 3","wer":16.39736684619988,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problems. I'm happy to help. Whereabouts with your skin is it affected?\n\nMostly like my chest, my my hands, my arms, like, like really it's it's super annoying. Like it's itching a lot, like all the time. And I can't even sleep at night. Like I really need something quickly to to solve it. Because even at work, I like, um, when I'm in the meeting and I have to, like, think about my work, I focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always like, uh, disturbed by this disease. No, no, okay, I understand this is obviously affecting you, and, uh, we'll try our very best to get get it sorted out for you. Um, have you had anything like this before in the past? Um, so yes. Uh, earlier I was like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something to, when I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes, but the symptoms, like, these symptoms app like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more, like, only in the arms, and now it's al- also on the chest and in the, and the, on the hands as well. Okay. Like, itchy, yeah, when-- Like, I like, for instance, hiking- Yeah... during the weekend, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No, well, well, okay, that's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um- Yeah. Have, have you noticed any, uh, bleeding or discharge from your skin?\n\nNo. Um, so my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But, uh, yeah. You don't have noticing any other, uh, pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you- Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So for example, have you changed your, uh, shower drill, any clothing? Have you been around anyone else? No, I, I haven't... It's actually, like, it's very annoying because I'm thinking about may- maybe I should change something because I, I haven't, and I don't understand, and I'm kind of-\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I don't have now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers? No. Just the itching. Itching? Nothing else. Okay. So your your bowels are working okay?\n\nYour chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? Uh, I think so. Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arm, so I'm not sure. I, I really have no idea. Okay. No, that's okay. So, um, normally at this stage, I like to examine you, um, to see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's- you've got some dry skin and some, uh, cracked skin as well, uh, and it's been very itchy. And so with your, um-\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like sorry. Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it corrected Do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. There's a couple of questions I want to ask you, which can sometimes affect your symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the the sound quality is not great, but I'll I'll continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's medicating your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you use in a bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or pyritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You you can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[130,135,"",false],[407,416,"problem.",false],[722,730,"I can",false],[799,799,"can't",false],[807,811,"I can't",false],[973,991,"OK. I'm certain",false],[1395,1402,"That's those",false],[1434,1437,"appear",false],[1449,1454,"the",false],[1768,1776,"OK. um",false],[1931,1940,"arm. But",false],[1950,1953,"",false],[2027,2032,"pretty",false],[2075,2090,"hiking",false],[2118,2120,"am",false],[2226,2232,"because",false],[2248,2260,"and I",false],[2315,2322,"cannot",false],[2494,2497,"",false],[2568,2572,"skins . OK.",false],[2694,2717,"OK. 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OK.",false],[8473,8494,"",false],[8512,8540,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"itchy skin rash x4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on \"chest, hands, arms (including inside elbows)\"; no legs claimed."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Denies bleeding, discharge, pus\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe itch, disturbing sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disturbing sleep and concentration at work\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema...; asthma (currently asymptomatic)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"no improvement\" captured, but failure of previously helpful eczema treatments this time is not stated."],["The note captures: Antihistamines already tried have not helped.","yes","\"OTC antihistamines recently - no relief\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No known triggers identified\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for itch\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"keep diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if no improvement\"."]],"claims":[],"note":"Subjective:\n\n- 31yo male, sore, red, intensely itchy skin rash x4 days\n\n- Rash on chest, hands, arms (including inside elbows)\n\n- Severe itch, disturbing sleep and concentration at work\n\n- Skin cracked in some areas\n\n- Denies bleeding, discharge, pus\n\n- No fevers or systemic symptoms\n\n- Bowels, chest, urine output normal\n\n- No known triggers identified\n\n- PMHx: eczema (previously managed with cream + shower treatment); asthma (currently asymptomatic)\n\n- Meds: nil regular; OTC steroid cream last night - no improvement; OTC antihistamines recently - no relief\n\n- Allergies: nil known\n\n- Social: lives with flatmates; full-time project manager at pharmaceutical company; non-smoker; few beers/week\n\n\n\n\nObjective:\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment:\n\n- Suspected flare-up of eczema - intensely itchy, sore, cracked skin on chest, hands, arms\n\n- More widespread and itchier than previous eczema episodes\n\n\n\n\nPlan:\n\n- Prescribe stronger topical steroid\n\n- Prescribe emollients for bath/shower, use for 7-10 days\n\n- Prescribe fexofenadine for itch\n\n- Advised to keep diary of potential triggers (clothing, shower gels, soaps)\n\n- Review in 1 week if no improvement","review":70.40789473684211,"saved":246.0921052631579,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":42.599253,"latency":27.942,"signable":98.34989473684212},{"label":"Run 4","wer":16.935966487133452,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts on your skin is it affected? Mostly, like, my chest, my my hands, my arms, like\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and in the and the on the hands as well. Okay. Yeah. When like I like, for instance, hiking during the weekends and I am I can't really do it anymore because it's like very like like I wanted to do that last weekend and it was super painful. And I have to take like showers every day to be able to kind of ease this itching part, which is very, very annoying. No. Well okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Um have you noticed any, uh, bleeding or discharge from your skins?\n\nNo. Um, so my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But, uh, yeah. You don't have noticing any other, uh, pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you- Four days ago. Four days ago. Are you aware of any triggers, so anything that you may have done that may have caused your symptoms to start? So for example, have you changed your, uh, shower gel, any clothing? Have you been around anyone else? No, I, I haven't... It's actually, like, it's really annoying because I'm thinking about may- maybe I should change something because I, I haven't, and I don't understand, and I'm kind of-\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I'll help now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest Maine. Hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like, something sorry? Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it crack do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your your situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, again, I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say that the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you have to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or pyritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You you can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay, well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you later. Bye.","marks":[[121,126,"",false],[715,719,"I can",false],[786,789,"I can't",false],[796,800,"I can't",false],[966,984,"OK. 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OK.",false],[8359,8380,"",false],[8398,8424,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"skin rash x4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on \"chest, hands, inner elbows\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupting sleep and work concentration\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema..., asthma (resolved)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream ineffective noted, but prior eczema treatments failing this time is not stated."],["The note captures: Antihistamines already tried have not helped.","yes","\"Previous antihistamines ineffective\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identifiable triggers; no change in shower gel/clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Possible eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for use in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for itch\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"keep diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Follow-up next week if symptoms do not improve\"."]],"claims":[],"note":"Subjective:\n\n- 31yo male, sore, red, intensely itchy skin rash x4 days\n\n- Affecting chest, hands, inner elbows; denies facial involvement\n\n- Itching constant and severe, disrupting sleep and work concentration\n\n- Skin cracked in some areas; denies bleeding or discharge\n\n- Symptoms more itchy and widespread than previous eczema flares (previously confined to arms)\n\n- Relieving with daily showers; OTC steroid cream purchased recently ineffective\n\n- Previous antihistamines ineffective\n\n- No identifiable triggers; no change in shower gel/clothing\n\n- Denies fever, cough, breathing difficulty; bowels and urine normal\n\n- PMHx: eczema (previously prescribed cream and shower additive), asthma (resolved)\n\n- Meds: nil\n\n- Allergies: NKDA\n\n- Social: lives with flatmates, works full-time as project manager at pharmaceutical company, non-smoker, occasional alcohol (few beers/week)\n\n\n\n\nObjective:\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment:\n\n- Possible eczema flare, given previous history and current highly itchy, widespread rash\n\n\n\n\nPlan:\n\n- Prescribe stronger topical steroid cream\n\n- Prescribe emollients for use in bath/shower\n\n- Prescribe fexofenadine for itch\n\n- Counselled to use steroid cream and emollients regularly for 7-10 days to assess efficacy\n\n- Advised to keep diary of potential triggers (clothing, shower gels, soaps)\n\n- Follow-up next week if symptoms do not improve","review":78.30263157894737,"saved":238.19736842105263,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":42.583804,"latency":31.482,"signable":109.78463157894737},{"label":"Run 5","wer":16.935966487133452,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway. Okay. Okay, so let's start again. So how can I help you, sir?\n\nYes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts in your skin is it affected? Mostly, like, my chest, my my hands, my arms, like\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get us sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I like was shower when I was in the shower, I had to put something. Okay. But did it help? I mean, at that time, yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more like only in the arms, and now it's al- also on the chest and in the, and the, on the hands as well. Okay. Yeah, when- like, I like, for instance, hiking- Yeah... during the weekends, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No, well, well, okay, that's good. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have, have you noticed any, uh, bleeding or discharge from your skin?\n\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You have noticed any other pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you Four days ago? Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone? No. I I haven't it's actually, like, it's really annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I refer your help now. No, no. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest hands and like, like inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers? No. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay?\n\nYour chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? Uh, I think so. Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arm, so I'm not sure. I I really have no idea. Okay. No, that's okay. So, um, normally at this stage, I like to examine you, um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some, uh, cracked skin as well, uh, and it's been very itchy. And so with your, um-\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like, something sorry? Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it cracked. Do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We are working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've gotta say at this stage, I've gotta say that the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you have to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or piritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay, well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[130,135,"",false],[724,728,"I can",false],[795,798,"I can't",false],[805,809,"I can't",false],[975,993,"OK. 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OK.",false],[8412,8433,"",false],[8451,8479,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'4-day history of sore, red, intensely itchy skin'."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy skin on 'chest, hands, inner elbows'; skin cracked."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'denies bleeding, discharge, pus'."],["The note captures: Itching disturbs sleep.","yes","'disrupting sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration and 'Hiking on weekends now painful'."],["The note captures: Known eczema and past asthma.","yes","PMHx eczema and 'Asthma (past, resolved)'."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","Pharmacy steroid cream no relief recorded; failure of previously helpful eczema treatments now not stated."],["The note captures: Antihistamines already tried have not helped.","no","Prior antihistamine use without benefit not recorded; plan instead recommends OTC loratadine/Piriton."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'Denies specific triggers'."],["The note captures: Assessment is a likely eczema flare.","yes","'Suspected eczema flare-up'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Stronger topical steroid cream prescribed'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Emollients for bath/shower, use consistently 7-10 days'."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Fexofenadine prescribed for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'Keep diary of potential triggers (clothing, shower gels, soaps)'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review in 1 week if no improvement'."]],"claims":[],"note":"Subjective\n\n- 4-day history of sore, red, intensely itchy skin\n\n- Predominantly chest, hands, inner elbows\n\n- Constant itch, disrupting sleep and concentration at work\n\n- PMHx eczema (previously arms only, less itchy), managed with cream + bath additive\n\n- Tried pharmacy-bought steroid cream last night - no relief\n\n- Denies specific triggers\n\n- Skin cracked in some areas; denies bleeding, discharge, pus, fevers\n\n- Denies cough, SOB, bowel or urinary issues\n\n- Hiking on weekends now painful; daily showers to ease itch\n\n\n\n\nPast Medical History\n\n- Eczema\n\n- Asthma (past, resolved)\n\n\n\n\nMedications\n\n- Nil regular\n\n\n\n\nAllergies\n\n- NKDA\n\n\n\n\nSocial History\n\n- Lives with flatmates\n\n- Full-time project manager at pharmaceutical company\n\n- Non-smoker\n\n- Alcohol: few beers/week\n\n\n\n\nObjective\n\n- Rash appears familiar to previous eczema presentations\n\n\n\n\nAssessment\n\n- Suspected eczema flare-up\n\n\n\n\nPlan\n\n- Stronger topical steroid cream prescribed\n\n- Emollients for bath/shower, use consistently 7-10 days\n\n- OTC antihistamines (loratadine or Piriton) for itch\n\n- Fexofenadine prescribed for itch\n\n- Keep diary of potential triggers (clothing, shower gels, soaps)\n\n- Review in 1 week if no improvement","review":83.46052631578948,"saved":233.03947368421052,"clean":false,"effort":10.0,"sig":[],"mb":39.129327,"latency":26.59,"signable":110.05052631578948},{"label":"Run 6","wer":16.27767803710353,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts on your skin is it affected? Mostly, like, my chest, my my hands, my arms, like,\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I'm saying this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes. But the symptoms like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more like only in the arms, and now it's also on the chest and in the and the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And I have to take, like, showers every day to be able to kind of ease this itching part, which is very, very annoying. No. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have have you noticed any bleeding or discharge from your skins?\n\nNo. Um, so my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But, uh, yeah. You don't have noticing any other, uh, pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you- Four days ago. Four days ago. Are you aware of any triggers, so anything that you may have done that may have caused your symptoms to start? So for example, have you changed your, uh, shower gel, any clothing? Have you been around anyone at all? No, I, I haven't. It's actually, like, it's really annoying because I'm thinking about maybe I should change something because I, I haven't, and I don't understand, and I'm kind of-\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I refer your head now. No, no. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I'd like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nUh, your background of eczema. Um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of? Uh, no, I just had asthma in the past, but not anymore. Not anymore, okay. And do you take any regular medications at the moment? Uh, no. No. Okay. Do you have any allergies to anything? I like something. Sorry. Yeah. Sorry, I was gonna say, do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Oh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No. Okay. Um, and tell me about your, um-\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you want to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or pyritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[130,135,"",false],[725,729,"I can",false],[796,799,"I can't",false],[806,810,"I can't",false],[986,992,"certain",false],[1381,1388,"That's those",false],[1418,1418,"appear",false],[1431,1436,"the",false],[1750,1771,"OK. um",false],[1924,1933,"arm. But",false],[2002,2007,"OK. Like pretty",false],[2065,2073,"weekend.",false],[2187,2193,"because",false],[2267,2274,"cannot uh",false],[2494,2494,". OK.",false],[2616,2639,"OK. You've not haven't uh seen",false],[2754,2773,"you",false],[2820,2822,"or",false],[2898,2898,"Four days ago.",false],[2997,3003,"else",false],[3012,3022,".",false],[3170,3186,"I cannot um",false],[3235,3242,"cannot",false],[3348,3353,"",false],[3359,3363,"help",false],[3413,3425,"resummarize.",false],[3646,3655,"Yeah. OK.",false],[3686,3691,"Am I",false],[3867,3888,"very itchy.",false],[3903,3908,"Itchy. 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OK.",false],[8400,8421,"",false],[8439,8467,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","4-day history recorded."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked skin on chest, hands and inner elbows; legs not listed."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies bleeding/discharge."],["The note captures: Itching disturbs sleep.","yes","Sleep disturbance recorded."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration and hiking impact recorded."],["The note captures: Known eczema and past asthma.","yes","Eczema and past asthma recorded."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid last night no improvement recorded; prior eczema treatments listed but their current failure not stated."],["The note captures: Antihistamines already tried have not helped.","yes","Antihistamines tried without benefit."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identified trigger; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Suspected eczema flare."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","Stronger topical steroid prescribed."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollient including bath/shower use."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Fexofenadine for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Trigger diary covering clothing, soaps, shower products."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Review next week if not improving; 7–10 day trial."]],"claims":[],"note":"Subjective\n\n- 4-day history of sore, red, intensely itchy skin rash\n\n- Affecting chest, hands, inner elbows\n\n- Constant itch, disturbing sleep and work concentration\n\n- Denies facial involvement\n\n- Cracked skin in some areas; denies bleeding, discharge, pus\n\n- No obvious triggers identified (no change in shower gel, clothing, contacts)\n\n- Difficulty hiking due to pain; requires daily showers for relief\n\n- Current symptoms more extensive and itchier than previous eczema episodes\n\n- PMHx: eczema (previously managed with topical cream and shower treatment); asthma (resolved)\n\n- Meds: OTC steroid cream last night - no improvement; previously tried antihistamines - no relief\n\n- Allergies: NKDA\n\n- Social: lives with flatmates; full-time project manager at pharmaceutical company; non-smoker; few beers/week\n\n- ROS: denies fever, cough, breathing difficulty; bowel function normal; urine output normal\n\n\n\n\nObjective\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment\n\n- Suspected flare-up of eczema\n\n\n\n\nPlan\n\n- Prescribe stronger topical steroid cream to affected areas\n\n- Prescribe emollients for use during baths/showers\n\n- Recommend fexofenadine for itch relief\n\n- Use steroid and emollients regularly for 7-10 days\n\n- Keep diary of potential triggers (clothing, shower gels, soap)\n\n- Follow-up in one week if no improvement","review":76.40789473684211,"saved":240.0921052631579,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":38.326817,"latency":33.439,"signable":109.8468947368421}],"freed":[{"label":"Run 1","wer":20.047875523638538,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but the symptoms, like these symptoms, like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay.\n  Yeah.\n  Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay, steroid, okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, that's okay. So you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  Have you noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties? No. You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to ask, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So I live with a few flatmates. So you know I'm 31. I have a full-time job and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye.\n  Thank you, Victor.\n  Bye.","marks":[[74,74,"a bit it's a bit it's",false],[463,463,"my",false],[491,491,"it's",false],[660,664,"I I can",false],[726,729,"I can't",false],[737,741,"I can't",false],[904,916,"OK. I'm certain",false],[984,986,"get this",false],[1156,1156,"uh when I like shower",false],[1256,1263,"That's those",false],[1293,1293,"appear",false],[1305,1310,"the",false],[1783,1791,"arm. But",false],[1844,1844,"OK. Like pretty yeah when",false],[1888,1896,"weekend.",false],[1900,1900,"I am",false],[1960,1969,"wanted to do",false],[1992,2001,"because",false],[2072,2079,"cannot uh",false],[2134,2138,"Yes. No. Well OK.",false],[2225,2225,"Yeah. Um have you",false],[2279,2283,"skins . OK.",false],[2397,2413,"OK. You've not haven't uh seen",false],[2460,2460,"No.",false],[2552,2552,"or",false],[2629,2629,"Four days ago.",false],[2722,2722,"else",false],[2728,2728,"I .",false],[2756,2760,"really",false],[2873,2888,"I cannot um",false],[2936,2943,"cannot",false],[3048,3052,"",false],[3058,3062,"help",false],[3114,3126,"resummarize.",false],[3375,3380,"Am I",false],[3563,3581,"very itchy.",false],[3601,3605,"Itchy. OK.",false],[3609,3609,"your",false],[3744,3760,"OK alright. Um",false],[3970,3974,"disease",false],[4045,4045,"I'm",false],[4255,4255,"it's",false],[4316,4320,"has",false],[4345,4349,"would your um Yeah. Uh",false],[4390,4390,"to say",false],[4746,4746,"I like some sorry Yeah",false],[4757,4773,"said",false],[4850,4855,"That's alright",false],[4868,4876,". Uh",false],[4913,4915,"Ohh",false],[4961,4961,"your um uh",false],[5041,5041,"I'm a",false],[5058,5061,"thirty one. Uh I yeah I'm",false],[5225,5225,"it's been a",false],[5240,5240,"Uh it's uh",false],[5265,5265,"We're working",false],[5277,5277,"kind of",false],[5294,5294,"Uh I mean",false],[5356,5356,"that's",false],[5403,5409,"want",false],[5568,5568,"I can",false],[5641,5641,"a few",false],[5678,5678,"Nothing",false],[5754,5754,"it's been",false],[5937,5940,"Sarah",false],[6028,6032,"it was",false],[6387,6387,"something",false],[6443,6450,"",false],[6671,6687,"over counter.",false],[6956,6959,"your",false],[7010,7033,"an eczema CU. OK. Yes",false],[7097,7097,"Ohh",false],[7205,7205,"it's",false],[7262,7266,"types",false],[7481,7490,"",false],[7766,7766,"Thank you very much. Bye. Thank you as well. Bye.",false],[7816,7839,"",false],[7857,7889,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked/dry skin on chest, hands and inner elbows; \"denies involvement of the face or legs\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies any bleeding, discharge, or pus\"."],["The note captures: Itching disturbs sleep.","yes","Itching \"significantly disrupts his sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work focus and hiking both captured."],["The note captures: Known eczema and past asthma.","yes","\"Eczema\" and \"Asthma, resolved\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previous treatments tried without improvement and OTC steroid cream from the night prior not helping."],["The note captures: Antihistamines already tried have not helped.","yes","\"tried antihistamines without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"unable to identify any specific triggers, including changes in shower gel, clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema Flare-up\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger prescription steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients in bath and shower, used regularly."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for itch control\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return for follow-up next week if symptoms do not improve\"."]],"claims":[],"note":"Subjective\nCliniTech Benchmark ea24bd0b, a 31-year-old male with a history of eczema and resolved asthma, presents with a 4-day history of itchy, sore, red skin affecting the chest, hands, and inner elbows. He describes the rash as intensely pruritic, with cracked skin in some areas, and reports that the itching is constant and significantly disrupts his sleep and ability to focus at work. He denies any bleeding, discharge, or pus from the affected skin. He denies involvement of the face or legs. He denies fever, cough, breathing difficulties, or urinary symptoms.\n\nThe patient reports a prior history of eczema, which previously affected only his arms and was treated with a prescribed cream and a shower product. He states that when the current symptoms recurred, he tried those previous treatments without improvement. He also purchased an over-the-counter steroid cream from the pharmacy the night prior, which has not provided relief. He has also tried antihistamines without benefit. He is unable to identify any specific triggers, including changes in shower gel, clothing, or environmental exposures. He notes that the current presentation is more widespread and more intensely itchy than his prior eczema episodes. He reports that outdoor activities such as hiking have become difficult due to the symptoms, and he has been taking daily showers in an attempt to ease the itching.\n\nMedical History  \n- Eczema  \n- Asthma, resolved\n\nMedications and Supplements  \n- Over-the-counter steroid cream  \n- Previously prescribed eczema cream  \n- Previously prescribed shower product for eczema  \n- Antihistamines\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: A few beers per week socially  \n- Exercise: Enjoys hiking on weekends  \n- Occupation: Works as a project manager at a pharmaceutical company\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties  \n- Genitourinary: Denies urinary symptoms\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with 4-day onset of intensely itchy, sore skin rash affecting chest, hands, and inner elbows, disrupting sleep and work.\n\nEczema Flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy and sore skin rash affecting the chest, hands, and inner elbows, consistent with an eczema flare-up given his past medical history of eczema. The distribution has expanded beyond his previous eczema pattern, which was limited to arms, now involving chest and hands. The rash is characterized by dryness, cracking, and intense pruritus that significantly impacts his sleep and work concentration. Previous over-the-counter steroid cream purchased yesterday has been ineffective. The patient has tried antihistamines recently without relief. No systemic symptoms, fever, or secondary infection signs such as bleeding or discharge are present.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for moisturizing skin, to be used in bath and shower  \n- Use emollients and steroids regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine for itch control  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up next week if symptoms do not improve\n","review":156.3157894736842,"saved":160.1842105263158,"clean":true,"effort":0.0,"sig":[],"mb":16.153109,"latency":44.892,"signable":189.11578947368417},{"label":"Run 2","wer":20.047875523638538,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but the symptoms, like these symptoms, like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay.\n  Yeah.\n  Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay, steroid, okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, that's okay. So you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  Have you noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties? No. You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to ask, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So I live with a few flatmates. So you know I'm 31. I have a full-time job and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye.\n  Thank you, Victor.\n  Bye.","marks":[[74,74,"a bit it's a bit it's",false],[463,463,"my",false],[491,491,"it's",false],[660,664,"I I can",false],[726,729,"I can't",false],[737,741,"I can't",false],[904,916,"OK. I'm certain",false],[984,986,"get this",false],[1156,1156,"uh when I like shower",false],[1256,1263,"That's those",false],[1293,1293,"appear",false],[1305,1310,"the",false],[1783,1791,"arm. But",false],[1844,1844,"OK. Like pretty yeah when",false],[1888,1896,"weekend.",false],[1900,1900,"I am",false],[1960,1969,"wanted to do",false],[1992,2001,"because",false],[2072,2079,"cannot uh",false],[2134,2138,"Yes. No. Well OK.",false],[2225,2225,"Yeah. Um have you",false],[2279,2283,"skins . OK.",false],[2397,2413,"OK. You've not haven't uh seen",false],[2460,2460,"No.",false],[2552,2552,"or",false],[2629,2629,"Four days ago.",false],[2722,2722,"else",false],[2728,2728,"I .",false],[2756,2760,"really",false],[2873,2888,"I cannot um",false],[2936,2943,"cannot",false],[3048,3052,"",false],[3058,3062,"help",false],[3114,3126,"resummarize.",false],[3375,3380,"Am I",false],[3563,3581,"very itchy.",false],[3601,3605,"Itchy. OK.",false],[3609,3609,"your",false],[3744,3760,"OK alright. Um",false],[3970,3974,"disease",false],[4045,4045,"I'm",false],[4255,4255,"it's",false],[4316,4320,"has",false],[4345,4349,"would your um Yeah. Uh",false],[4390,4390,"to say",false],[4746,4746,"I like some sorry Yeah",false],[4757,4773,"said",false],[4850,4855,"That's alright",false],[4868,4876,". Uh",false],[4913,4915,"Ohh",false],[4961,4961,"your um uh",false],[5041,5041,"I'm a",false],[5058,5061,"thirty one. Uh I yeah I'm",false],[5225,5225,"it's been a",false],[5240,5240,"Uh it's uh",false],[5265,5265,"We're working",false],[5277,5277,"kind of",false],[5294,5294,"Uh I mean",false],[5356,5356,"that's",false],[5403,5409,"want",false],[5568,5568,"I can",false],[5641,5641,"a few",false],[5678,5678,"Nothing",false],[5754,5754,"it's been",false],[5937,5940,"Sarah",false],[6028,6032,"it was",false],[6387,6387,"something",false],[6443,6450,"",false],[6671,6687,"over counter.",false],[6956,6959,"your",false],[7010,7033,"an eczema CU. OK. Yes",false],[7097,7097,"Ohh",false],[7205,7205,"it's",false],[7262,7266,"types",false],[7481,7490,"",false],[7766,7766,"Thank you very much. Bye. Thank you as well. Bye.",false],[7816,7839,"",false],[7857,7889,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identifiable triggers; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Return for follow-up next week if symptoms do not improve'."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 1540ec38, a 31-year-old male with a history of eczema and resolved asthma, presents with a 4-day history of sore, red, itchy skin affecting the chest, hands, and inside the elbows. He reports the rash is severely pruritic, causing significant sleep disturbance and impaired ability to focus at work during meetings. He describes the skin as cracked in some areas but denies any bleeding, discharge, or pus. He notes the distribution is more widespread than his prior eczema, which was limited to the arms.\n\nThe patient reports that previous eczema treatments, including a prescribed cream and a shower product, were helpful at the time but have not been effective for the current episode. He purchased an over-the-counter steroid cream from the pharmacy the night prior, which has not provided relief. He has also tried antihistamines without improvement. He denies any identifiable triggers, including changes in shower gel or clothing.\n\nMedical History\n- Eczema\n- Asthma, resolved\n\nMedications and Supplements\n- Over-the-counter steroid cream, applied topically\n- Antihistamines\n- Previously prescribed eczema cream\n- Previously prescribed shower product for eczema\n\nAllergies\n- No known allergies\n\nSocial History\n- Tobacco: Non-smoker\n- Alcohol: A few beers per week socially\n- Occupation: Works as a project manager at a pharmaceutical company, full-time\n- Living Situation: Lives with several flatmates\n- Hobbies: Enjoys hiking on weekends\n\nReview of Systems\n- General: Denies fever\n- Respiratory: Denies cough, breathing difficulties\n- Genitourinary: Denies urinary symptoms\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with 4-day onset of intensely itchy, sore skin rash affecting chest, hands, and arms, disrupting sleep and work.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy, sore skin rash affecting the chest, hands, and inner elbows, consistent with an eczema flare-up given his past medical history of eczema. The distribution has expanded beyond his previous eczema pattern, which was limited to arms, and the symptoms are more severely pruritic than his prior episodes. The rash is characterized by dry, cracked skin without bleeding or discharge. Previous over-the-counter steroid cream purchased yesterday provided no relief. The patient has tried antihistamines without improvement. No fever, systemic symptoms, or other concerning features are present. The clinical presentation is most consistent with an eczema exacerbation requiring prescription-strength treatment.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for moisturizing skin, to be used in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch relief  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up next week if symptoms do not improve\n","review":139.26315789473682,"saved":177.23684210526318,"clean":true,"effort":0.0,"sig":[],"mb":16.226082,"latency":62.151,"signable":188.15215789473683},{"label":"Run 3","wer":20.047875523638538,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but the symptoms, like these symptoms, like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay.\n  Yeah.\n  Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay, steroid, okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, that's okay. So you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  Have you noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties? No. You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to ask, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So I live with a few flatmates. So you know I'm 31. I have a full-time job and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye.\n  Thank you, Victor.\n  Bye.","marks":[[74,74,"a bit it's a bit it's",false],[463,463,"my",false],[491,491,"it's",false],[660,664,"I I can",false],[726,729,"I can't",false],[737,741,"I can't",false],[904,916,"OK. I'm certain",false],[984,986,"get this",false],[1156,1156,"uh when I like shower",false],[1256,1263,"That's those",false],[1293,1293,"appear",false],[1305,1310,"the",false],[1783,1791,"arm. But",false],[1844,1844,"OK. Like pretty yeah when",false],[1888,1896,"weekend.",false],[1900,1900,"I am",false],[1960,1969,"wanted to do",false],[1992,2001,"because",false],[2072,2079,"cannot uh",false],[2134,2138,"Yes. No. Well OK.",false],[2225,2225,"Yeah. Um have you",false],[2279,2283,"skins . OK.",false],[2397,2413,"OK. You've not haven't uh seen",false],[2460,2460,"No.",false],[2552,2552,"or",false],[2629,2629,"Four days ago.",false],[2722,2722,"else",false],[2728,2728,"I .",false],[2756,2760,"really",false],[2873,2888,"I cannot um",false],[2936,2943,"cannot",false],[3048,3052,"",false],[3058,3062,"help",false],[3114,3126,"resummarize.",false],[3375,3380,"Am I",false],[3563,3581,"very itchy.",false],[3601,3605,"Itchy. OK.",false],[3609,3609,"your",false],[3744,3760,"OK alright. Um",false],[3970,3974,"disease",false],[4045,4045,"I'm",false],[4255,4255,"it's",false],[4316,4320,"has",false],[4345,4349,"would your um Yeah. Uh",false],[4390,4390,"to say",false],[4746,4746,"I like some sorry Yeah",false],[4757,4773,"said",false],[4850,4855,"That's alright",false],[4868,4876,". Uh",false],[4913,4915,"Ohh",false],[4961,4961,"your um uh",false],[5041,5041,"I'm a",false],[5058,5061,"thirty one. Uh I yeah I'm",false],[5225,5225,"it's been a",false],[5240,5240,"Uh it's uh",false],[5265,5265,"We're working",false],[5277,5277,"kind of",false],[5294,5294,"Uh I mean",false],[5356,5356,"that's",false],[5403,5409,"want",false],[5568,5568,"I can",false],[5641,5641,"a few",false],[5678,5678,"Nothing",false],[5754,5754,"it's been",false],[5937,5940,"Sarah",false],[6028,6032,"it was",false],[6387,6387,"something",false],[6443,6450,"",false],[6671,6687,"over counter.",false],[6956,6959,"your",false],[7010,7033,"an eczema CU. OK. Yes",false],[7097,7097,"Ohh",false],[7205,7205,"it's",false],[7262,7266,"types",false],[7481,7490,"",false],[7766,7766,"Thank you very much. Bye. Thank you as well. Bye.",false],[7816,7839,"",false],[7857,7889,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identifiable triggers; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Reassess after 7-10 days and return if symptoms do not improve."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 093c4fb7, a 31-year-old male with a history of eczema, presents with a 4-day history of sore, red, itchy skin affecting the chest, hands, and inside the elbows. He describes the rash as intensely pruritic, with cracked skin in some areas, but denies any bleeding, discharge, or pus from the affected areas. He reports the itching is constant and severe enough to disrupt his sleep and significantly impair his ability to focus at work during meetings. He also notes that outdoor activities such as hiking have become painful and difficult due to the symptoms. He has been taking daily showers in an attempt to ease the itching.\n\nThe patient has a history of eczema, which previously affected only his arms. He reports that the current symptoms are similar but more pruritic and more widespread than his prior eczema episodes. He was previously prescribed a cream and a shower product for eczema, which helped at that time. However, when the current symptoms appeared, he tried those same treatments without improvement. He also purchased an over-the-counter steroid cream from the pharmacy the night prior, which has not provided relief. He has also tried antihistamines, which did not help. He denies any known triggers, including changes in shower gel, clothing, or exposure to anyone with similar symptoms. He denies fever, cough, breathing difficulties, or urinary symptoms. He denies any involvement of the face.\n\nMedical History  \n- Eczema  \n- Asthma in the past, no longer active\n\nMedications and Supplements  \n- Over-the-counter steroid cream, applied topically  \n- Previously prescribed eczema cream  \n- Previously prescribed shower product for eczema  \n- Over-the-counter antihistamines\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: Occasional, a few beers per week  \n- Occupation: Works as a project manager at a pharmaceutical company, full-time  \n- Living Situation: Lives with several flatmates in a shared accommodation  \n- Hobbies: Enjoys hiking on weekends, though currently unable to participate due to symptoms\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with a 4-day history of itchy, sore skin rash affecting chest, hands, and arms.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy, sore skin rash affecting the chest, hands, and inner elbows. The rash is characterized by dry, cracked skin without bleeding or discharge. Patient has a history of eczema that previously affected only the arms, but current presentation shows similar characteristics with expanded distribution. Previous eczema treatments and over-the-counter steroid cream purchased yesterday have been ineffective. The distribution pattern, itching severity, and skin appearance are consistent with an eczema flare-up, though the expanded distribution beyond previous patterns warrants monitoring.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for moisturizing skin, to be used in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch relief  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up if symptoms do not improve\n","review":161.3684210526316,"saved":155.1315789473684,"clean":true,"effort":0.0,"sig":[],"mb":15.979855,"latency":54.773,"signable":202.0604210526316},{"label":"Run 4","wer":20.586475164572114,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, okay, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay. Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, so you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  You haven't noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties?\n  No.\n  You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to say, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So, I live with a few flatmates. So, you know, I'm 31. I have a full-time job, and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned you were using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[74,74,"a bit it's a bit it's",false],[463,463,"my",false],[491,491,"it's",false],[660,664,"I I can",false],[726,729,"I can't",false],[737,741,"I can't",false],[904,922,"OK. I'm certain",false],[990,992,"get this",false],[1162,1162,"uh when I like shower",false],[1262,1270,"That's those symptoms like",false],[1276,1276,"symptoms appear like when the",false],[1564,1569,"OK steroid OK. um",false],[1722,1730,"arm. But",false],[1783,1783,"OK. Like pretty yeah when",false],[1827,1835,"weekend.",false],[1839,1839,"I am",false],[1899,1908,"wanted to do",false],[1931,1940,"because",false],[2011,2018,"cannot uh",false],[2073,2077,"Yes. No. Well OK. That's",false],[2151,2151,"Yeah. Um have you",false],[2205,2209,"skins . OK.",false],[2323,2326,"OK. 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Bye.",false],[7762,7785,"",false],[7803,7831,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identifiable triggers; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Reassess after 7-10 days and return if symptoms do not improve."]],"claims":[["He went hiking last weekend and the symptoms were 'super painful'.","Transcript says he 'wanted to do that last weekend' and 'can't really do it anymore'; it does not say he went hiking."]],"note":"Subjective\nCliniTech Benchmark 95def2c6, a 31-year-old male with a history of eczema and asthma (no longer active), presents with a 4-day history of itchy, sore, red skin affecting the chest, hands, and inside the elbows. He describes the rash as \"super annoying\" and reports constant itching that is significantly impacting his daily functioning, including difficulty sleeping at night and inability to focus at work during meetings. He also notes that the rash has interfered with his recreational activities, reporting that he went hiking last weekend and the symptoms were \"super painful,\" requiring daily showers to ease the itching.\n\nHe reports the skin appears cracked in some areas but denies any bleeding, discharge, or pus. He has a history of eczema, which previously affected only his arms, and notes that the current symptoms are similar but more itchy and more widespread than his prior eczema episodes. He was previously prescribed a cream and a shower product for his eczema, which helped at that time, but when he tried those same treatments for the current symptoms, they were ineffective. He purchased an over-the-counter steroid cream from the pharmacy the night prior to presentation, which also did not help. He has also tried antihistamines recently without relief. He is unaware of any specific triggers and has not changed his shower gel, clothing, or been around anyone new.\n\nMedical History  \n- Eczema  \n- Asthma, no longer active\n\nMedications and Supplements  \n- Over-the-counter steroid cream applied topically  \n- Previously prescribed eczema cream applied topically  \n- Previously prescribed shower product for eczema  \n- Over-the-counter antihistamines\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Denies smoking  \n- Alcohol: Occasional, a few beers per week  \n- Occupation: Works as a project manager at a pharmaceutical company, full-time  \n- Living Situation: Lives with several flatmates in a shared accommodation  \n- Hobbies: Enjoys hiking on weekends, though currently limited by symptoms\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties  \n- Genitourinary: Denies urinary symptoms\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with a 4-day history of itchy, sore skin rash affecting chest, hands, and inner elbows.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy, sore skin rash affecting the chest, hands, and inner elbows. The rash is characterized by dry, cracked skin without bleeding or discharge. Current symptoms are more widespread and severe than previous eczema episodes, with significant impact on sleep and daily functioning. Patient has tried over-the-counter steroid cream without improvement and has also tried antihistamines without relief. No fever, respiratory symptoms, or other systemic complaints. Physical examination findings appear consistent with eczema flare-up given the clinical presentation and patient's history.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for use in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch relief  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up if symptoms do not improve\n","review":170.5263157894737,"saved":145.9736842105263,"clean":false,"effort":10.0,"sig":[],"mb":16.014195,"latency":49.007,"signable":207.3103157894737},{"label":"Run 5","wer":20.586475164572114,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, okay, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay. Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, so you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  You haven't noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties?\n  No.\n  You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to say, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So, I live with a few flatmates. So, you know, I'm 31. I have a full-time job, and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned you were using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[74,74,"a bit it's a bit it's",false],[463,463,"my",false],[491,491,"it's",false],[660,664,"I I can",false],[726,729,"I can't",false],[737,741,"I can't",false],[904,922,"OK. I'm certain",false],[990,992,"get this",false],[1162,1162,"uh when I like shower",false],[1262,1270,"That's those symptoms like",false],[1276,1276,"symptoms appear like when the",false],[1564,1569,"OK steroid OK. um",false],[1722,1730,"arm. But",false],[1783,1783,"OK. Like pretty yeah when",false],[1827,1835,"weekend.",false],[1839,1839,"I am",false],[1899,1908,"wanted to do",false],[1931,1940,"because",false],[2011,2018,"cannot uh",false],[2073,2077,"Yes. No. Well OK. That's",false],[2151,2151,"Yeah. Um have you",false],[2205,2209,"skins . OK.",false],[2323,2326,"OK. 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Bye.",false],[7762,7785,"",false],[7803,7831,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'no identifiable triggers and has not changed any personal care products or clothing'."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Reassess after 7-10 days and return if symptoms do not improve."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 88acd250, a 31-year-old male with a history of eczema and asthma (no longer active), presents with a 4-day history of intensely itchy, sore, red skin affecting the chest, hands, and inner elbows. He describes the rash as severely pruritic, with cracked skin in some areas, and reports the itching is constant and disrupts his sleep and ability to focus at work. He notes that the current symptoms are more widespread than his prior eczema, which was limited to the arms, and are significantly more itchy. He denies any bleeding, pus, or discharge from the skin. He denies fever, cough, breathing difficulties, or urinary symptoms.\n\nThe patient reports no identifiable triggers and has not changed any personal care products or clothing. He has tried an over-the-counter steroid cream purchased from the pharmacy the previous night without improvement. He has also tried antihistamines without relief. He previously used a prescribed eczema cream and a shower product during a prior eczema episode, which helped at that time but are no longer effective for the current symptoms. The rash has significantly impacted his daily functioning, including his ability to sleep, concentrate at work during meetings, and engage in outdoor activities such as hiking on weekends. He reports having to take daily showers in an attempt to ease the itching.\n\nMedical History  \n- Eczema  \n- Asthma, no longer active\n\nMedications and Supplements  \n- Over-the-counter steroid cream, applied topically  \n- Antihistamines  \n- Previously prescribed eczema cream  \n- Previously prescribed shower product for eczema\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: A few beers per week socially  \n- Exercise: Enjoys hiking on weekends  \n- Occupation: Project manager at a pharmaceutical company\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with 4-day onset of intensely itchy, sore skin affecting chest, hands, and inner elbows, disrupting sleep and work.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy and sore skin affecting the chest, hands, and inner elbows, consistent with an eczema flare-up. The distribution has expanded beyond his previous eczema pattern, which was limited to arms, now involving chest and hands. The rash is characterized by dryness, cracking, and intense pruritus that significantly impacts sleep and work performance. Previous over-the-counter steroid cream purchased from pharmacy has been ineffective. No systemic symptoms, fever, or other concerning features. The clinical presentation is most consistent with an eczema exacerbation requiring stronger prescription therapy.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for use in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch control  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up if symptoms do not improve\n","review":149.3684210526316,"saved":167.1315789473684,"clean":true,"effort":0.0,"sig":[],"mb":15.99375,"latency":53.402,"signable":190.56742105263157}],"cliniscripts":[{"label":"Run 1","wer":14.90125673249551,"text":"Hello.\nHello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying. Okay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like all the time, and I can't even sleep at night.\nLike, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get a source of that for you. Um, have you had anything like this before in the past?\nUm, so, yes. Uh, earlier I was, like, prescribed for my eczema. Okay.\nAnd they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time, yes, but the symptoms, like, these symptoms are, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more, like, itchy and my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well. Okay. Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so, my skin is a bit cracked in some parts. Like, kind of cracked, if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers, anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I, I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate, and so I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest, hands, and, like, like, inside the elbows. Okay. And anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo, no. Just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay? And. Your chest is okay? No cough, no breathing difficulties?\nNo. Your passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure.\nI, I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\nUh, and it's been very itchy. And so, with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma.\nIn the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I use, like, something— sorry, yeah. Just, uh, sorry, I was going to say, do you have any allergies to anything?\nHello?\nHello? Yes? Oh, can you hear me? Sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\nUh, so, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So, it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it? Okay. Uh, no, no, no. That's absolute— that's absolute fine.\nUm, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay.\nI'm going to say, at this stage, I'm going to say, th-this sound quality is not, uh, great, but I'll, I'll continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, th-th-the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial. Okay.\nUh, which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin.\nUm, which I'm going to use in the bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh. Okay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter. Things like loratadine or piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower\ngels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Okay. Just, I, I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again, sorry? I have tried the antihistamines. Okay.\nUh, but it didn't really help.\nIt didn't. Okay. So it's something for you to think about. You can get different type of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully c-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it.\nOkay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[727,735,"I can",false],[800,803,"I can't",false],[811,815,"I can't",false],[975,994,"OK. I'm certain",false],[1063,1079,"get this sorted out",false],[1418,1425,"That's those",false],[1457,1460,"appear",false],[1473,1478,"the",false],[1799,1821,"OK.",false],[1826,1832,"",false],[1993,2002,"arm. But",false],[2085,2091,"pretty",false],[2151,2159,"weekend.",false],[2165,2165,"am",false],[2236,2243,"wanted",false],[2246,2246,"do",false],[2270,2276,"because",false],[2297,2302,"",false],[2357,2364,"cannot",false],[2614,2618,"skins . OK.",false],[2740,2756,"OK. 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OK.",false],[8840,8861,"",false],[8879,8907,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Sore, red, itchy, cracked skin on chest, hands and inside elbows captured, but the patient correcting that legs are not affected is omitted."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding, discharge, pus\"."],["The note captures: Itching disturbs sleep.","yes","\"causing sleep disturbance\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"difficulty concentrating at work\"."],["The note captures: Known eczema and past asthma.","yes","History of eczema and \"asthma (not currently active)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior treatment \"ineffective for current symptoms\" and OTC steroid cream last night did not help."],["The note captures: Antihistamines already tried have not helped.","yes","\"patient reported previous antihistamine use was unhelpful\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"Unable to identify specific triggers\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"suspects a flare-up of the patient's eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe a stronger prescription steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients \"to be used in the bath and shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine fexofenadine offered."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels or soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Follow-up in one week if not improving."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 4-day history of sore, red, and intensely itchy skin, primarily affecting their chest, hands, and arms (specifically inside the elbows).\n- Symptoms are significantly bothersome, causing sleep disturbance and difficulty concentrating at work.\n- Patient has a history of eczema, previously treated with a cream and a shower product, which helped at the time but is ineffective for current symptoms.\n- Self-treated with an over-the-counter steroid cream last night, which did not alleviate the itching.\n- Describes current symptoms as much more itchy and widespread compared to previous eczema, which was confined to the arms.\n- Reports cracked skin in some areas, but no bleeding, discharge, pus, fever, cough, breathing difficulties, or issues with bowel movements or urination.\n- Unable to identify specific triggers for the current flare-up and expresses discomfort discussing their condition with others.\n- Patient has a history of asthma (not currently active) and no known allergies. They are 31 years old, live with flatmates, and work as a project manager at a pharmaceutical company. They do not smoke and consume a few beers per week.\n\nO (Objective):\n- The doctor noted poor sound quality during the consultation.\n- Patient appeared cooperative during the interaction.\n- The doctor inferred the rash appears familiar, suggesting a possible flare-up of eczema.\n\nA (Assessment):\n- The doctor suspects a flare-up of the patient's eczema, given the itchiness, distribution on the chest, hands, and arms (inside elbows), and previous history.\n- The previous steroid cream used by the patient was ineffective, suggesting a need for a stronger prescription.\n\nP (Plan):\n- Prescribe a stronger prescription steroid cream for the affected areas.\n- Prescribe emollients for moisturizing the skin, to be used in the bath and shower for 7-10 days.\n- Recommend over-the-counter antihistamines (e.g., loratadine or piritin) for itch relief, or prescribe a stronger antihistamine (fexofenadine) as patient reported previous antihistamine use was unhelpful.\n- Advise the patient to keep a diary of potential triggers, including clothing, shower gels, or soaps.\n- Schedule a follow-up appointment in one week to reassess symptoms if they do not improve.\n","review":132.14473684210526,"saved":184.35526315789474,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":27.781054,"latency":24.492,"signable":142.11973684210525},{"label":"Run 2","wer":15.140634350688211,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like all the time, and I can't even sleep at night.\nLike, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No, no.\nOkay. I understand. This is obviously affecting you, and we'll try our very best to get a source that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was, like, prescribed for my eczema. Okay.\nAnd they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time yes, but the symptoms, like, these symptoms app— like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay. Steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms or different?\nUm, it's much more, like, itchy and my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well. Okay. Like, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts. Like, kind of cracked if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No, I— I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest and hands and, like, like, inside the elbows. Okay. And anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo.\nN just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay. And. Your chest is okay. No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure.\nI— I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\nMm-hmm. Uh, and it's been very itchy. And so with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma, in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I use, like, something— sorry, yeah. Just sorry, I was going to say, do you have any allergies to anything?\nHello? Hello? Yes? Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with? Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it? Okay. Uh, no, no, no. That's absolute— that's absolute fine.\nUm, just a couple of questions I want to ask you, which can sometimes affect your symptoms.\nIs— do you smoke at all?\nNo. No. And do you drink much in the way of alcohol?\nUh, you know, o-once in a while, I can— I like hanging out with people once in a while, so yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay. I'm going to say at this stage, I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, the having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st of a steroid may be beneficial.\nOkay. Uh, which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\nOkay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Ok\nay. Just, I, I have to write antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis.\nUm, over the next week to 10 days, should hopefully c-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it. Okay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[726,734,"I can",false],[799,802,"I can't",false],[810,814,"I can't",false],[974,993,"OK. I'm certain",false],[1062,1075,"get this sorted out",false],[1412,1419,"That's those",false],[1451,1454,"appear",false],[1467,1472,"the",false],[1793,1815,"OK.",false],[1820,1826,"",false],[1986,1995,"arm. But",false],[2076,2076,"pretty",false],[2136,2144,"weekend.",false],[2150,2150,"am",false],[2221,2228,"wanted",false],[2231,2231,"do",false],[2255,2261,"because",false],[2282,2287,"",false],[2342,2349,"cannot",false],[2605,2609,"skins . OK.",false],[2729,2745,"OK. 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OK.",false],[8852,8873,"",false],[8891,8919,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","partial","Eczema captured but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream from previous night failed, but not stated that previously helpful eczema treatments failed this time."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients used regularly and in baths/showers for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine (fexofenadine) for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","partial","Follow-up next week is stated unconditionally; the 'if not improving' condition is missing."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 4-day history of sore, red, and intensely itchy skin, primarily affecting the chest, hands, and inner elbows.\n- Symptoms are described as \"super annoying,\" causing sleep disturbance and difficulty concentrating at work.\n- Patient has a past medical history of eczema, for which they were previously prescribed cream and a shower additive that helped at the time.\n- Current symptoms are more intensely itchy and widespread compared to previous eczema flare-ups, which were primarily limited to the arms.\n- Patient attempted self-treatment with a steroid cream purchased from a pharmacy the previous night, which provided no relief. They also tried antihistamines previously, which did not help.\n- Patient reports skin is cracked in some areas, but denies bleeding, discharge, pus, or fever. Hiking during weekends is now painful due to the skin condition.\n\nO (Objective):\n- Patient's speech was affected by poor sound quality during the consultation.\n- Patient is 31 years old, lives with flatmates, and works full-time as a project manager at a pharmaceutical company.\n- Patient denies smoking.\n- Patient reports occasional alcohol consumption, \"a few beers per week.\"\n- Patient denies any known allergies.\n\nA (Assessment):\n- Suspected flare-up of eczema, given the patient's history and current symptoms of intense itchiness, redness, and cracked skin.\n- The widespread nature of the rash, affecting the chest and hands in addition to previously affected areas, suggests a more severe presentation than prior episodes.\n- Previous self-treatment with over-the-counter steroid cream and antihistamines was ineffective.\n\nP (Plan):\n- Prescribe a stronger prescription steroid cream to be applied to affected areas.\n- Prescribe emollients for skin moisturization, to be used regularly and potentially in baths/showers for 7-10 days.\n- Prescribe a stronger antihistamine (fexofenadine) to help manage the itchiness.\n- Advise patient to keep a diary of potential triggers, including clothing, shower gels, or soaps, to identify factors exacerbating symptoms.\n- Schedule a follow-up appointment for next week to reassess symptoms and treatment effectiveness.\n","review":163.13157894736844,"saved":153.36842105263156,"clean":false,"effort":16.666666666666664,"sig":[["partial","Review next week or after roughly 7–10 days if not improving.","Records a scheduled follow-up next week when the doctor said to return only if not improving, misstating the follow-up plan."]],"mb":27.582752,"latency":24.628,"signable":173.14257894736843},{"label":"Run 3","wer":14.961101137043686,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like it's itching a lot, like all the time, and I can't even sleep at night.\nLike I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always like, uh, disturbed by this disease. No, no.\nOkay. I understand. This is obviously affecting you and, uh, we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was like prescribed for my eczema. Okay. And they gave me like some cream and something to, uh, when I like was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time yes, but the symptoms, like these symptoms are like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought like a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay. Steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more like itchy and my eczema was more like only in the arms, and now it's also on the chest and in the— and the on the hands as well. Okay. Like really, yeah, when like I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's like very like— like I want it to— that last weekend and it was super painful and I think I have to take like showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No. I— it's actually like it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest, hands, and like, like inside the elbows. Okay.\nAny— anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo.\nN just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay. And. Your chest is okay. No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like my eczema was only on the arms, so I'm, I'm not sure.\nI, I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's you've got some dry skin and some, uh, cracked skin as well.\nMm-hmm. Uh, and it's been very itchy. And so with your, um, uh, your, your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma, in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I usually like something sorry, yeah. Just sorry, I was going to say, do you have any allergies to anything?\nHello? Hello? Yes? Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with? Uh, so I live with a few flatmates. I'm a so you know I'm 31. Uh, I yeah, I'm I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working I'm a like a kind of project manager. Uh, I'm in do you want to, to know more about it? Okay. Uh, no, no, no. That's absolutely that's absolutely fine.\nUm, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms.\nIs do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while, I can I like hanging out with people once in a while. So yeah, I'd say a few a few beers per week, something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger, but it's been. Mm-hmm. It's been a while. Okay. Okay. I'm going to say at this stage, I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st of a steroid may be beneficial.\nOkay. Uh, which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\nOkay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Ok\nay. Just I, I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You, you can get different type of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I say anything using the steroids and the emollients, um, on a regular basis.\nUm, over the next week to 10 days, should hopefully cu-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it. Okay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[724,732,"I can",false],[797,800,"I can't",false],[808,812,"I can't",false],[974,993,"OK. I'm certain",false],[1071,1087,"this sorted out",false],[1418,1425,"That's those",false],[1456,1459,"appear",false],[1470,1475,"the",false],[1793,1815,"OK.",false],[1820,1826,"",false],[1983,1992,"arm. But",false],[2073,2079,"pretty",false],[2137,2145,"weekend.",false],[2151,2151,"am",false],[2218,2225,"wanted",false],[2228,2228,"do",false],[2252,2258,"because",false],[2279,2284,"",false],[2337,2344,"cannot",false],[2600,2604,"skins . OK.",false],[2724,2740,"OK. You've not haven't uh seen",false],[2875,2889,"",false],[2921,2923,"or",false],[3000,3000,"Four days ago.",false],[3137,3141,"really",false],[3256,3271,"I cannot",false],[3324,3331,"cannot",false],[3367,3379,"comfortable",false],[3432,3444,"that.",false],[3450,3461,"",false],[3530,3542,"resummarize.",false],[3767,3776,"Yeah. 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OK.",false],[8800,8821,"",false],[8839,8867,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Past medical history of eczema and past history of asthma."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'unable to identify any specific triggers'."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe a stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for moisturising, used in baths and showers."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine (fexofenadine) for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'follow-up appointment in one week to reassess symptoms if they do not improve'."]],"claims":[],"note":"S (Subjective):\n- The patient reports a 4-day history of sore, red, and intensely itchy skin, primarily affecting the chest, hands, and inside the elbows.\n- Symptoms are described as \"super annoying\" and disruptive, causing difficulty sleeping at night and impacting focus at work during meetings.\n- The patient has a past medical history of eczema, for which they were previously prescribed cream and a shower product, which helped at the time.\n- Current symptoms are noted to be \"much more itchy\" and more widespread than previous eczema flare-ups, which were confined to the arms.\n- Self-treatment attempts include trying previously prescribed eczema creams (which did not work) and a steroid cream bought from a pharmacy last night (which also did not help).\n- The patient reports some cracked skin in affected areas but no bleeding or discharge, pus, or blood. They deny any associated fever or temperature, cough, breathing difficulties, or issues with bowel movements or urination.\n- The patient is unable to identify any specific triggers for the current symptoms. They mention being 31 years old, living with flatmates, and working as a project manager at a pharmaceutical company.\n- The patient denies smoking and reports occasional alcohol consumption (a few beers per week). They also have a past history of asthma but are not currently on any regular medications and report no known allergies.\n\nO (Objective):\n- The patient's voice quality was noted to be unclear at times during the conversation.\n- The patient was cooperative and engaged during the interaction, providing detailed descriptions of their symptoms and medical history.\n- The patient reported the inability to hike during weekends due to pain and the need for daily showers to ease itching.\n\nA (Assessment):\n- The doctor suspects a flare-up of the patient's eczema, given the intensely itchy nature of the rash, its distribution primarily on the chest, hands, and elbows, and the patient's history of eczema.\n- The current symptoms are more severe and widespread than previous eczema episodes.\n- Previous at-home treatments with over-the-counter steroid cream and antihistamines have not provided relief.\n\nP (Plan):\n- Prescribe a stronger prescription steroid cream to be used for 7-10 days.\n- Prescribe emollients for moisturizing the skin, which can also be used in baths and showers.\n- Prescribe a stronger antihistamine (fexofenadine) to help with the itchiness, as previous over-the-counter antihistamines were ineffective.\n- Advise the patient to keep a diary of potential triggers, such as clothing, shower gels, or soaps, to identify factors that may be exacerbating symptoms.\n- Schedule a follow-up appointment in one week to reassess symptoms if they do not improve.\n","review":136.42105263157896,"saved":180.07894736842104,"clean":true,"effort":0.0,"sig":[],"mb":27.624344,"latency":22.998,"signable":147.44705263157897},{"label":"Run 4","wer":15.020945541591862,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like it's itching a lot, like all the time, and I can't even sleep at night.\nLike I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always like, uh, disturbed by this disease. No, no.\nOkay. I understand. This is obviously affecting you and, uh, we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was like prescribed for my eczema. Okay. And they gave me like some cream and something to, uh, when I like was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time yes, but the symptoms, like these symptoms are like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought like a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay. Steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more like itchy and my eczema was more like only in the arms, and now it's also on the chest and in the— and the on the hands as well. Okay. Like really, yeah, when like I like for instance hiking during the weekends and I— I can't really do it anymore because it's like very like— like I want it to that last weekend and it was super painful and I think I have to take like showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No. I— it's actually like it's very annoying because I'm thinking about maybe I should change something because I— I haven't and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest and hands and like— like inside the elbows. Okay. And anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo.\nN just the itching. Itching. Nothing else. Okay. So your— your bowels are working okay? And. Your chest is okay? No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like my eczema was only on the arms, so I'm— I'm not sure.\nI— I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's you've got some dry skin and some, uh, cracked skin as well.\nMm-hmm. Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I usually like something sorry, yeah. Just sorry, I was going to say do you have any allergies to anything?\nHello? Hello? Yes? Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\nUh, so I live with a few flatmates. I'm a so you know I'm 31. Uh, I yeah, I'm I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been a it's been a few years now. Uh, it's a it's kind of interesting. We are working I'm a like a kind of project manager. Uh, I'm in do you want to, to know more about it? Okay. Uh, no, no, no. That's absolute that's absolute fine.\nUm, just a couple of questions I want to ask you, which can sometimes affect your symptoms.\nIs do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while I can I like hanging out with people once in a while. So yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay. I'm going to say at this stage I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, the having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st of a steroid may be beneficial. Okay. Uh, which I'm happy to prescribe to you today.\nAs well as I'm going to give you something some emollients, which helps to moisturize the skin.\nUm, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh. Okay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter. Things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower\ngels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Okay. Just I— I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully cure control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it.\nOkay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[724,732,"I can",false],[797,800,"I can't",false],[808,812,"I can't",false],[974,993,"OK. I'm certain",false],[1071,1087,"this sorted out",false],[1418,1425,"That's those",false],[1456,1459,"appear",false],[1470,1475,"the",false],[1793,1815,"OK.",false],[1820,1826,"",false],[1983,1992,"arm. But",false],[2073,2079,"pretty",false],[2135,2143,"weekend.",false],[2149,2149,"am",false],[2216,2223,"wanted",false],[2226,2226,"do",false],[2249,2255,"because",false],[2276,2281,"",false],[2334,2341,"cannot",false],[2597,2601,"skins . OK.",false],[2720,2736,"OK. You've not haven't uh seen",false],[2871,2885,"",false],[2917,2919,"or",false],[2996,2996,"Four days ago.",false],[3132,3136,"really",false],[3250,3265,"I cannot",false],[3318,3325,"cannot",false],[3361,3373,"comfortable",false],[3426,3438,"that.",false],[3444,3455,"",false],[3524,3536,"resummarize.",false],[3803,3808,"Am I",false],[3978,3979,"",false],[3985,4006,"very itchy.",false],[4021,4026,"Itchy. 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OK.",false],[8778,8799,"",false],[8817,8845,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Sore, red, itchy, cracked skin on 'the chest, hands, and arms' - inner elbows not specified and leg correction not captured."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","partial","Eczema history captured but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients to moisturise skin, used in bath or shower, for 7 to 10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine (fexofenadine) prescribed for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'return for a follow-up next week if symptoms do not improve'."]],"claims":[],"note":"S (Subjective):\n- The Patient reports a several-day history (four days) of sore, red, and intensely itchy skin, which is \"super annoying\" and is interfering with sleep and work concentration.\n- Symptoms primarily affect the chest, hands, and arms, and are more widespread and itchy than previous eczema flare-ups, which were confined to the arms.\n- The Patient notes their skin is \"a bit cracked in some parts\" but denies bleeding, discharge, pus, or blood.\n- They have a history of eczema, for which they were previously prescribed a cream and a shower product, which initially helped, but current symptoms did not respond to these old medications.\n- The Patient attempted self-treatment with an over-the-counter steroid cream purchased last night, which did not alleviate the itching; they also tried antihistamines recently without success.\n\nO (Objective):\n- The Patient's voice quality was noted to be \"not very clear\" and \"cracked\" at times during the conversation.\n- The Patient appears cooperative and provides detailed responses regarding their symptoms and medical history.\n- The Patient is 31 years old and lives with flatmates.\n- They work full-time as a project manager at a pharmaceutical company.\n- The Patient denies smoking and reports occasional alcohol consumption (a few beers per week).\n\nA (Assessment):\n- The Doctor suspects a flare-up of eczema, given the Patient's history and the reported symptoms of itchiness and affected areas.\n- The current symptoms are more severe and widespread compared to previous eczema episodes.\n- Previous treatments, including a prescribed cream and shower product for eczema, and an over-the-counter steroid cream, have been ineffective for the current presentation.\n\nP (Plan):\n- The Doctor plans to prescribe a stronger steroid cream and emollients to moisturize the skin, to be used for 7 to 10 days.\n- The Patient is advised to use emollients in the bath or shower.\n- The Doctor will prescribe a stronger antihistamine (fexofenadine) for the itchiness, as over-the-counter options were ineffective.\n- The Patient is advised to keep a diary of potential triggers, such as clothing, shower gels, or soaps, to discuss at a follow-up appointment.\n- The Patient is instructed to return for a follow-up next week if symptoms do not improve.\n","review":164.1315789473684,"saved":152.3684210526316,"clean":false,"effort":13.333333333333334,"sig":[],"mb":27.871156,"latency":24.424,"signable":174.11457894736841},{"label":"Run 5","wer":14.602034709754639,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts in your skin is it affected? Uh, mostly like my chest, my— my hands, my arms, like— like really it's— it's super annoying. Like it's itching a lot, like all the time, and I can't even sleep at night.\nLike I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always— like, uh, disturbed by this disease. No, no.\nOkay, I understand. This is obviously affecting you, and we'll try our very best to get a source that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did it help?\nUm, I mean, at that time yes, but the symptoms, like these symptoms, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more like itchy and my eczema was more like only in the arms, and now it's also on the chest and in the— and the— on the hands as well. Okay. Like really, yeah, when— like I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like I wanted to do that last weekend and it was super painful and. Yes. I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No, I— it's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest and hands and, like, like inside the elbows. Okay.\nAnd anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo, no. Just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay? And. Your chest is okay? No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure.\nI— I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\nUh. Mm-hmm. And it's been very itchy. And so with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma, in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I use, like, something— sorry, yeah. Just— sorry, I was going to say, do you have any allergies to anything?\nHello? Hello? Yes? Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with? Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it? Okay. Uh, no, no, no. That's absolutely— that's absolutely fine.\nUm, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms.\nIs— do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay. I'm going to say at this stage, I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be. Beneficial? Uh.\nOkay. Which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\nOkay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Ok\nay. Just, I, I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different types of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I say anything using the steroids and the emollients, um, on a regular basis.\nUm, over the next week to 10 days, should hopefully cu-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it. Okay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[[724,732,"I can",false],[797,800,"I can't",false],[808,812,"I can't",false],[975,994,"OK. I'm certain",false],[1063,1076,"get this sorted out",false],[1411,1418,"That's those",false],[1448,1448,"appear",false],[1461,1466,"the",false],[1786,1808,"OK.",false],[1813,1819,"",false],[1976,1985,"arm. But",false],[2067,2073,"pretty",false],[2132,2140,"weekend.",false],[2146,2146,"am",false],[2251,2257,"because",false],[2284,2289,"",false],[2344,2351,"cannot",false],[2601,2605,"skins . OK.",false],[2725,2741,"OK. You've not haven't uh seen",false],[2876,2890,"",false],[2922,2924,"or",false],[3001,3001,"Four days ago.",false],[3140,3144,"really",false],[3259,3274,"I cannot",false],[3327,3334,"cannot",false],[3370,3382,"comfortable",false],[3435,3447,"that.",false],[3453,3464,"",false],[3533,3545,"resummarize.",false],[3813,3818,"Am I",false],[3988,3991,"",false],[3997,4018,"very itchy.",false],[4033,4038,"Itchy. 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OK.",false],[8837,8858,"",false],[8876,8904,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States \"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Captures sore, red, itchy, cracked skin on chest, hands and inside elbows, but omits the patient correcting that legs are not affected."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies any associated bleeding, discharge, pus\"."],["The note captures: Itching disturbs sleep.","yes","\"causing sleep disturbance\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Notes difficulty concentrating at work and hiking being \"super painful\"."],["The note captures: Known eczema and past asthma.","partial","Eczema history captured, but past asthma is not mentioned."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously prescribed eczema cream and OTC steroid cream \"have provided no relief\"."],["The note captures: Antihistamines already tried have not helped.","yes","Antihistamines listed among self-treatments that provided no relief."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger or change in toiletries was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"acute flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribed a stronger topical steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for regular hydration \"including during bathing or showering\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribed fexofenadine, a stronger oral antihistamine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers such as clothing, shower gels or soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Follow-up next week if no improvement."]],"claims":[],"note":"S (Subjective):\n- Patient reports a 4-day history of sore, red, and intensely itchy skin affecting the chest, hands, and arms (specifically inside elbows).\n- The pruritus is severe, causing sleep disturbance and difficulty concentrating at work, and was described as \"super painful\" during a recent hiking attempt.\n- Patient has a past medical history of eczema, previously managed with cream and a shower product, but current symptoms are more widespread and significantly more itchy than prior episodes.\n- Self-treatment with a previously prescribed eczema cream, an over-the-counter steroid cream, and antihistamines have provided no relief.\n- Patient reports some cracked skin but denies any associated bleeding, discharge, pus, fever, cough, breathing difficulties, or issues with bowel or urinary function.\n\nO (Objective):\n- The patient presented with clear distress and frustration regarding the severity and impact of their skin condition on daily life.\n- Patient was cooperative and provided a detailed account of their symptoms, history, and previous attempts at self-management.\n- No objective physical examination findings are available from this remote consultation.\n\nA (Assessment):\n- The patient's symptoms are highly suggestive of an acute flare-up of eczema, consistent with their established medical history.\n- The increased distribution and intensity of pruritus indicate a significant exacerbation of their underlying skin condition.\n\nP (Plan):\n- Prescribed a stronger topical steroid cream to address the inflammatory and pruritic components of the rash.\n- Recommended emollients for regular skin hydration, to be used consistently for 7 to 10 days, including during bathing or showering.\n- Prescribed fexofenadine, a stronger oral antihistamine, given the ineffectiveness of previous over-the-counter antihistamines in alleviating pruritus.\n- Advised the patient to keep a detailed diary of potential environmental or product triggers, such as clothing, shower gels, or soaps, for future discussion.\n- Scheduled a follow-up appointment for next week to reassess symptoms and treatment efficacy if no improvement is observed.\n","review":146.44736842105263,"saved":170.05263157894737,"clean":false,"effort":13.333333333333334,"sig":[],"mb":27.613942,"latency":35.613,"signable":167.47136842105263}],"lyrebird":[{"label":"Run 1","wer":18.55176540993417,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone at all? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, and, like like, inside the eyebrows. Okay. And anything on your face at all? In my what?\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything? I like, something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[124,129,"",false],[344,349,"",false],[432,443,"Um whereabouts in",false],[715,719,"I can",false],[786,789,"I can't",false],[797,801,"I can't",false],[927,937,"uh disturbed",false],[963,981,"OK. 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OK.",false],[8227,8248,"",false],[8266,8294,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Sites \"chest, hands, inner arms\" and cracked skin captured, but sore/red character not stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"No bleeding, discharge or purulent drainage\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work concentration\"; unable to hike."],["The note captures: Known eczema and past asthma.","partial","Eczema captured but asthma recorded as \"childhood asthma (resolved)\", adding an unsupported childhood onset."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid \"no improvement\" captured, but failure of previously helpful prescribed eczema treatments is not."],["The note captures: Antihistamines already tried have not helped.","yes","\"Trialled antihistamines - no improvement\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers (no recent changes to shower gel, clothing...)\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribed stronger topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients for bath and shower use\"; regularly 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribed fexofenadine for pruritus\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"trigger diary documenting clothing and shower products\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review appointment in 1 week if no improvement\"."]],"claims":[["childhood asthma (resolved)","Transcript only says \"I just had asthma in the past\"; no childhood onset is stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner arms\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nNo bleeding, discharge or purulent drainage\n\nSymptoms worse than previous eczema episodes\n\nPrevious eczema confined to arms only\n\nUnable to participate in usual weekend hiking activities due to discomfort\n\nRequires daily showers for symptom relief\n\nPurchased OTC steroid cream on 20/09/2026 - no improvement\n\nTrialled antihistamines - no improvement\n\nNo identified triggers (no recent changes to shower gel, clothing or environmental exposures)\n\nDenies fever, cough, shortness of breath, bowel or urinary symptoms\n\nPast medical history: eczema (previous episodes affecting arms), childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, alcohol consumption few beers per week\n\nNo known drug allergies\n\nNo current regular medications\n\n\n\n\nObjective:\n\nExamination findings consistent with eczematous rash\n\nDry, cracked skin noted on affected areas\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribed stronger topical corticosteroid\n\nPrescribed emollients for bath and shower use\n\nPrescribed fexofenadine for pruritus\n\nAdvised to use topical corticosteroid and emollients regularly for 7-10 days\n\nAdvised to maintain trigger diary documenting clothing and shower products\n\nReview appointment in 1 week if no improvement","review":126.98684210526316,"saved":189.51315789473682,"clean":false,"effort":16.666666666666664,"sig":[],"mb":18.177454,"latency":20.464,"signable":147.45084210526318},{"label":"Run 2","wer":18.791143028126868,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone else? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, like like, inside the eyebrows. Okay. And anything on your face at all? In my what? Oh,\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well. Yeah. And it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do have any allergies to anything? I something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully cure.\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[124,129,"",false],[344,349,"",false],[432,443,"Um whereabouts in",false],[715,719,"I can",false],[786,789,"I can't",false],[797,801,"I can't",false],[927,937,"uh disturbed",false],[963,981,"OK. 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OK.",false],[8226,8247,"",false],[8265,8293,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","no","Distribution given as \"chest, hands, inner eyebrows\"; inner elbows mislocated to the face, which the patient denied."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Denies bleeding, discharge, or purulent drainage\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work concentration\" and \"Unable to participate in weekend hiking\"."],["The note captures: Known eczema and past asthma.","partial","Eczema captured, but asthma recorded as \"childhood asthma\" when only \"asthma in the past\" was stated."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"without improvement\" captured, but prior eczema treatments failing this time not recorded."],["The note captures: Antihistamines already tried have not helped.","yes","\"Trialled antihistamines without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers (no recent changes to shower gel, clothing...)\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for use in bath and shower\" and continue regimen 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for pruritus management\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"maintain trigger diary (clothing, shower products...)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if symptoms persist or worsen\"."]],"claims":[["Distribution: chest, hands, inner eyebrows","Patient said \"inside the elbows\" and explicitly denied face involvement; eyebrows is a wrong site."],["childhood asthma (resolved)","Transcript says only \"I just had asthma in the past\"; childhood onset was never stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner eyebrows\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nMore extensive than previous eczema episodes (previously limited to arms only)\n\nUnable to participate in weekend hiking due to symptoms\n\nRequires daily showers for symptom relief\n\nDenies bleeding, discharge, or purulent drainage\n\nNo identified triggers (no recent changes to shower gel, clothing, or environmental exposures)\n\nPurchased over-the-counter steroid cream on 21/09/2026 without improvement\n\nTrialled antihistamines without benefit\n\nDenies fever, cough, dyspnoea, bowel changes, or urinary symptoms\n\nPast medical history: eczema (previously treated with topical cream and shower product), childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, consumes few beers per week\n\nNo regular medications\n\nNo known allergies\n\n\n\n\nObjective:\n\nExamination findings consistent with eczematous changes\n\nDry, cracked skin noted on affected areas\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribe stronger topical steroid cream\n\nPrescribe emollients for use in bath and shower\n\nPrescribe fexofenadine for pruritus management\n\nContinue treatment regimen for 7-10 days\n\nAdvise patient to maintain trigger diary (clothing, shower products, environmental factors)\n\nReview in 1 week if symptoms persist or worsen","review":155.92105263157896,"saved":160.57894736842104,"clean":false,"effort":26.666666666666668,"sig":[["missing","Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","Affected site recorded as inner eyebrows instead of inner elbows; face involvement was denied."]],"mb":18.260935,"latency":20.587,"signable":176.50805263157895},{"label":"Run 3","wer":18.91083183722322,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked if you see what I mean. Okay. But yeah. You don't have any any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone else? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, like like, inside the eyebrows. Okay. And anything on your face at all? In my what? Oh,\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I'd like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well. Yeah. And it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do have any allergies to anything? I something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help with the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully cure.\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[124,129,"",false],[344,349,"",false],[432,443,"Um whereabouts in",false],[715,719,"I can",false],[786,789,"I can't",false],[797,801,"I can't",false],[927,937,"uh disturbed",false],[963,981,"OK. I'm certain",false],[1258,1270,"shower",false],[1377,1384,"That's those",false],[1415,1418,"appear",false],[1633,1639,"itching",false],[1745,1766,"OK. um",false],[1923,1932,"arm. But",false],[2000,2005,"OK. Like pretty",false],[2063,2071,"weekend.",false],[2185,2191,"because",false],[2272,2279,"cannot uh",false],[2290,2301,"itching part",false],[2360,2365,"",false],[2444,2444,"Um have you",false],[2503,2503,". OK.",false],[2614,2632,"OK. You've not haven't uh seen",false],[2735,2746,"Are you",false],[2867,2867,"Four days ago.",false],[2965,2965,"No I .",false],[2992,2996,"really",false],[3110,3125,"I cannot um",false],[3173,3180,"cannot",false],[3292,3296,"help",false],[3346,3355,"resummarize.",false],[3562,3581,"elbows. Yeah. 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OK.",false],[8236,8257,"",false],[8275,8303,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Distribution chest/hands/inner elbows and cracked skin captured, but soreness and redness of the skin are not recorded (\"pruritic rash\")."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupting sleep and work concentration\"; unable to hike."],["The note captures: Known eczema and past asthma.","yes","\"eczema\" and asthma resolved in PMH."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"no improvement\" is captured, but the note lists prior eczema treatments without saying they failed this flare."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines trialled - ineffective\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers, no recent changes to shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescription topical steroid (stronger than OTC preparation)\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for bath and shower use\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Fexofenadine prescribed for pruritus\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Advised to maintain trigger diary documenting clothing and shower products\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if no improvement\"; \"Trial treatment for 7-10 days\"."]],"claims":[["childhood asthma (resolved)","Transcript only says \"I just had asthma in the past. But not anymore\"; no timing (childhood) is given."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days (onset 18/09/2026)\n\nDistribution: chest, hands, inner elbows\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in areas, no bleeding or discharge\n\nMore widespread and severe than previous eczema episodes (previously limited to arms only)\n\nUnable to participate in usual weekend hiking activities due to discomfort\n\nRequires daily showers for symptom relief\n\nNo identified triggers, no recent changes to shower gel or clothing\n\nDenies fever, cough, shortness of breath, bowel or urinary symptoms\n\nPast medical history: eczema (previously treated with topical cream and shower emollient), childhood asthma (resolved)\n\nMedications: nil regular\n\nAllergies: nil known\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, alcohol consumption few beers per week\n\nSelf-treatment attempted: OTC steroid cream purchased 21/09/2026 - no improvement, antihistamines trialled - ineffective\n\n\n\n\nObjective:\n\nExamination findings: dry and cracked skin noted on affected areas\n\nNo pus or blood discharge observed\n\nRash appearance consistent with eczematous changes\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescription topical steroid (stronger than OTC preparation)\n\nEmollients for bath and shower use\n\nTrial treatment for 7-10 days\n\nFexofenadine prescribed for pruritus\n\nAdvised to maintain trigger diary documenting clothing and shower products\n\nReview in 1 week if no improvement","review":120.44736842105263,"saved":196.05263157894737,"clean":false,"effort":16.666666666666664,"sig":[],"mb":18.013948,"latency":17.264,"signable":137.71136842105264},{"label":"Run 4","wer":18.791143028126868,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone at all? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, and, like like, inside the eyebrows. Okay. And anything on your face at all? In my what?\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do have any allergies to anything? I something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help with the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully cure\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[124,129,"",false],[344,349,"",false],[432,443,"Um whereabouts in",false],[715,719,"I can",false],[786,789,"I can't",false],[797,801,"I can't",false],[927,937,"uh disturbed",false],[963,981,"OK. I'm certain",false],[1258,1270,"shower",false],[1377,1384,"That's those",false],[1415,1418,"appear",false],[1633,1639,"itching",false],[1745,1766,"OK. um",false],[1923,1932,"arm. But",false],[2000,2005,"OK. Like pretty",false],[2063,2071,"weekend.",false],[2185,2191,"because",false],[2272,2279,"cannot uh",false],[2290,2301,"itching part",false],[2360,2365,"",false],[2444,2444,"Um have you",false],[2503,2503,". OK.",false],[2615,2633,"OK. You've not haven't uh seen",false],[2736,2747,"Are you",false],[2868,2868,"Four days ago.",false],[2962,2968,"else No I .",false],[2995,2999,"really",false],[3113,3128,"I cannot um",false],[3176,3183,"cannot",false],[3295,3299,"help",false],[3349,3358,"resummarize.",false],[3570,3589,"elbows. Yeah. 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OK.",false],[8231,8252,"",false],[8270,8298,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'pruritic rash for 4 days'."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Pruritus, cracked skin on 'chest, hands, inner arms' recorded, but soreness and redness not captured."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Denies bleeding, discharge, or purulent drainage'."],["The note captures: Itching disturbs sleep.","yes","'Severe pruritus disrupting sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration disrupted and 'Unable to participate in hiking last weekend'."],["The note captures: Known eczema and past asthma.","yes","PMH eczema and asthma (resolved)."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream with no improvement recorded, but not that previously helpful eczema treatments now fail."],["The note captures: Antihistamines already tried have not helped.","yes","'Trialled antihistamines with no improvement'."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'No identified triggers (no recent changes to shower gel, clothing...)'."],["The note captures: Assessment is a likely eczema flare.","yes","'Eczema flare'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Prescribe emollient for bath and shower use' with 7-10 day trial."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine for pruritus management'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'maintain trigger diary (clothing, shower products...)'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review in 1 week if no improvement' and 7-10 day reassessment."]],"claims":[["childhood asthma (resolved)","Transcript only says 'I just had asthma in the past. But not anymore'; childhood onset is never stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner arms\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nMore extensive than previous eczema episodes (previously limited to arms only)\n\nUnable to participate in hiking last weekend due to discomfort\n\nRequires daily showers for symptom relief\n\nPurchased OTC steroid cream on 21/09/2026 with no improvement\n\nTrialled antihistamines with no improvement\n\nNo identified triggers (no recent changes to shower gel, clothing, or new exposures)\n\nDenies bleeding, discharge, or purulent drainage\n\nDenies fever, cough, dyspnoea, bowel changes, or urinary symptoms\n\nPast medical history: eczema (previously treated with topical cream and shower emollient), childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, alcohol consumption few beers per week\n\nNo regular medications\n\nNo known allergies\n\n\n\n\nObjective:\n\nExamination findings consistent with dry, cracked skin\n\nRash appearance consistent with eczematous dermatitis\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribe stronger topical steroid cream\n\nPrescribe emollient for bath and shower use\n\nPrescribe fexofenadine for pruritus management\n\nTrial treatment for 7-10 days before reassessing efficacy\n\nAdvise patient to maintain trigger diary (clothing, shower products, potential irritants)\n\nReview in 1 week if no improvement","review":118.23684210526316,"saved":198.26315789473682,"clean":false,"effort":16.666666666666664,"sig":[],"mb":18.165381,"latency":19.539,"signable":137.77584210526317},{"label":"Run 5","wer":18.67145421903052,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone at all? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, and, like like, inside the eyebrows. Okay. And anything on your face at all? In my what?\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything? I like, something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nAnd then do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[124,129,"",false],[344,349,"",false],[432,443,"Um whereabouts in",false],[715,719,"I can",false],[786,789,"I can't",false],[797,801,"I can't",false],[927,937,"uh disturbed",false],[963,981,"OK. 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OK.",false],[8222,8243,"",false],[8261,8289,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Captures itch, cracked skin, chest/hands/inner arms, but omits soreness/redness and the patient's correction that legs are not affected."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"No bleeding, discharge or purulent drainage\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Disrupts work concentration; unable to go hiking."],["The note captures: Known eczema and past asthma.","partial","Eczema and resolved asthma captured, but asthma is labelled \"childhood\", which the patient never said."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior eczema treatments ineffective now; OTC steroid cream bought with no improvement."],["The note captures: Antihistamines already tried have not helped.","yes","\"Antihistamines trialled without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers, no recent changes to shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for bath and shower use\" over 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for pruritus\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"maintain trigger diary (clothing, shower products, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if no improvement\"."]],"claims":[["childhood asthma (resolved)","Patient only said \"I just had asthma in the past. But not anymore\"; no age of onset or childhood timing was given."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner arms\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nNo bleeding, discharge or purulent drainage\n\nSymptoms worse than previous eczema episodes\n\nPrevious eczema confined to arms only\n\nPurchased OTC steroid cream on 21/09/2026 with no improvement\n\nPrevious eczema treatments (topical cream and shower product) ineffective for current episode\n\nAntihistamines trialled without benefit\n\nDaily showers provide temporary symptom relief\n\nUnable to participate in hiking (attempted last weekend, too painful)\n\nNo identified triggers, no recent changes to shower gel or clothing\n\nDenies fever, cough, shortness of breath, bowel or urinary symptoms\n\nPast medical history: eczema, childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company\n\nNon-smoker\n\nAlcohol: few beers per week\n\n\n\n\nObjective:\n\nExamination findings consistent with dry, cracked skin\n\nRash appearance familiar with previous eczema presentation\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribe stronger topical corticosteroid\n\nPrescribe emollients for bath and shower use\n\nPrescribe fexofenadine for pruritus\n\nContinue treatment regimen for 7-10 days\n\nAdvise patient to maintain trigger diary (clothing, shower products, soaps)\n\nReview in 1 week if no improvement","review":105.21052631578947,"saved":211.28947368421052,"clean":false,"effort":13.333333333333334,"sig":[],"mb":18.081891,"latency":21.2,"signable":126.41052631578947}],"preve":[{"label":"Run 1","wer":19.449431478156793,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now,\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nit because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus my work, it\n\nreally annoying because I can't actually think about what\n\nto say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. Understand this is obviously\n\naffecting you, and we'll try our very best to get get it sorted out for you.\n\nHave you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something\n\nto\n\nwhen I, like, was shower when I was in the shower, I had to put something.\n\nOkay.\n\nBut\n\nyeah. Did it help?\n\nI mean, at that time, yes. But the symptoms\n\nLike, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at\n\na pharmacy last night, but it apparently didn't help because it's still itchy.\n\nItchy today. Okay. Yeah. Do\n\nyou remember the name of the cream you bought?\n\nSteroid\n\ncream. Okay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was\n\nsuper painful. And Yes. I I have to take, like, showers every day to be able to\n\nkind of ease this itching part\n\nwhich is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo for example, have you changed your\n\nshower gel, any clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's very annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about\n\nthese questions. It's kind of intimate, and so I your help now.\n\nNo.\n\nNo. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face.\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nItching?\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties? No.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be\n\ncausing your symptoms?\n\nAny whats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my eczema was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nYeah. And it's been very itchy. And so with your\n\nbackground of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but Okay. Not any problem.\n\nNot anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything?\n\nI like\n\nsomething.\n\nSorry. Yeah.\n\nSorry. I didn't get any allergies to anything.\n\nHello? Hello? Yes.\n\nOh,\n\ncan\n\nyou hear me? Sorry. I think you're you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay.\n\nAnd tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect\n\nyour symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's\n\nbeen it's been a while.\n\nOkay. Okay.\n\nI'm gonna say at this stage, I'm gonna say\n\nthe\n\nthe sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. Reason being that you said\n\nit's quite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines, which\n\ncan sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your Okay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't really help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well.\n\nOkay.\n\nSomething like fexifenadine, which I\n\ncan give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget\n\nbetter. That\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well,\n\nI wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[123,128,"",false],[349,354,"",false],[440,454,"Um whereabouts in",false],[698,698,"solve",false],[725,729,"I I can",false],[796,799,"I can't",false],[806,810,"I can't",false],[836,838,"It's",false],[897,897,"I have",false],[962,978,"OK. I'm certain",false],[1382,1389,"That's those",false],[1421,1424,"appear",false],[1639,1652,"itching a lot",false],[1755,1777,"OK. um",false],[1934,1943,"arm. But",false],[2013,2018,"OK. 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OK.",false],[8338,8360,"",false],[8378,8406,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset ~4 days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"chest, hands, and antecubital fossae\"; pruritic, sore, red, dry, cracking."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"sleep disturbed\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"difficulty focusing at work meetings\"; hiking avoided."],["The note captures: Known eczema and past asthma.","yes","Previous eczema documented; \"Past asthma (not current)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior regimen \"not responding this time\"; OTC steroid \"without benefit\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Recent OTC antihistamines tried without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","Absence of an identified trigger/toiletry change is not recorded; only a future diary and trigger discussion."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Use prescribed stronger topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients in bath/shower and regularly thereafter\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Trial fexofenadine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"diary of potential triggers (clothing, soaps/shower gels)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return next week if not better\"."]],"claims":[["(Consent obtained)","No consent discussion for examination or treatment occurs anywhere in the transcript."]],"note":"Presenting Condition\n\nOnset ~4 days ago\n\nPruritic, sore, red skin affecting chest, hands, and antecubital fossae; very itchy “all the time”\n\nSkin feels dry with some cracking; no bleeding or discharge\n\nWorse at night; sleep disturbed; difficulty focusing at work meetings\n\nHiking last weekend was “super painful,” now avoiding\n\nTried prior prescribed eczema regimen; recurrence not responding this time\n\nTried OTC steroid cream yesterday without benefit\n\nShowers temporarily ease itch\n\nPrevious eczema mainly on arms; current flare more widespread and itchier\n\nNo fevers, cough, breathing issues, bowel or urinary issues\n\n\n\n\nRadiology\n\nNone mentioned\n\n\n\n\nPrevious MSK injuries\n\nPrior eczema treated previously with cream and shower product; helped at that time\n\n\n\n\nPast Medical History\n\nPast asthma (not current)\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular meds\n\nRecent OTC antihistamines tried without benefit\n\nOTC steroid cream tried without benefit\n\n\n\n\nRed Flag/Screening Questions\n\nBleeding/discharge: denies\n\nFever/temperature: denies\n\nRespiratory symptoms: denies cough/breathing difficulties\n\nBowel/urinary issues: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nWorks full-time in a pharmaceutical company (project management)\n\nNon-smoker\n\nAlcohol: a few beers per week\n\nEnjoys hiking on weekends\n\n\n\n\nGoals\n\nRapid relief of itch and skin soreness to sleep and function at work\n\nReturn to hiking without pain\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Clinician reports rash appearance “quite familiar” with eczema\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPrognosis: Expected improvement within 7–10 days with prescribed regimen; review if not improving\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical corticosteroid\n\nUse emollients in bath/shower and regularly thereafter for 7–10 days\n\nKeep diary of potential triggers (clothing, soaps/shower gels)\n\nMeds:\n\nPrescribed antihistamine (fexofenadine) to trial despite prior OTC antihistamines not helping\n\nPrescribed stronger topical steroid and emollients\n\n// Plan to monitor symptoms over 7–10 days; return sooner if worsening\n\n\n\n\nPlan\n\nUse steroid + emollients consistently for 7–10 days\n\nTrial fexofenadine\n\nReturn next week if not better; earlier if deteriorating or new symptoms arise\n\nDiscuss triggers and response at next review\n","review":131.86842105263156,"saved":184.63157894736844,"clean":false,"effort":16.666666666666664,"sig":[],"mb":15.733947,"signable":156.48342105263157},{"label":"Run 2","wer":19.80849790544584,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now,\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about from your skin is affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nsolve it because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus on my work, it's\n\nreally annoying because I can't actually think about what I have to say. I'm always\n\nlike, disturbed by this disease.\n\nNo. No. Okay. Understand. I understand.\n\nObviously affecting you, and we'll try our very best to get get us\n\nsorted out for you. Have you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, pre\n\nfor my eczema.\n\nOkay. And\n\nthey gave me, like, some\n\ncream and something to when I, like, was shower\n\nwhen I was in the shower, I had to put something. Okay. But yeah.\n\nDid it help?\n\nAnd\n\nI mean, at that time, yes. But the symptoms like, these symptoms are, like,\n\nwhen the symptoms appear again, I tried those and it didn't work. I've tried a few things, like,\n\nI bought, like, a steroid cream at the pharmacy last night, but\n\nit apparently didn't help because it's still itching a lot today. Okay.\n\nYeah. Do you remember the name of the cream you bought?\n\nSteroid cream.\n\nOkay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's all also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was super painful and\n\nI I have to take, like, showers every day to be able to kind of\n\nease this itching parts, which is very, very annoying.\n\nNo. Well well, okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore. Yeah.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo for example, have you changed your\n\nshower gel and your clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's really annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about these questions. It's kind\n\nintimate and so I your head now.\n\nNo. No. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face?\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Etching? Nothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties?\n\nNo.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be causing your\n\nAny what?\n\nAny ideas as to what\n\ncould be causing your symptoms?\n\nI so I had eczema before, so maybe it's\n\nthis, but it seems like more like, my eczema was only on the arms.\n\nSo I'm I'm not sure. I I really have no idea.\n\nOkay. That's okay. So\n\nnormally, at these days, I like to examine you.\n\nTo see the rash itself, to see exactly what type of rash it is.\n\nBut from what you've told me, you mentioned it's you've got some dry skin and some,\n\ncracked skin as well. Yeah. And it's been very itchy.\n\nAnd so with your\n\nyour your background of eczema,\n\nthere's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the\n\ndo you have any other medical problems I should be aware of?\n\nNo.\n\nI just had asthma in the past, but\n\nOkay. Not anymore. Not anymore. Okay. And do you take any regular medication at the moment?\n\nNo.\n\nNo. Okay. Do you have any allergies to anything? I like\n\nsomething. Sorry. Yeah.\n\nSorry. I didn't get any allergies. Do you think?\n\nHello?\n\nHello? Yes.\n\nOh, can you hear me? Sorry. I think you're crack\n\ndo you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay. And tell me about your,\n\nyour situation at home. Who do you live\n\nwith?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on\n\nbackup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay. No. No. No. That's actually\n\nthat's absolutely fine. Just a couple of questions I want to ask you, which can sometimes\n\naffect your symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's been it's been a while.\n\nOkay. Okay. I'm\n\ngonna say at this stage, I'm gonna say the the sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, sir, I I\n\nI do wonder whether this is a flare up of your eczema.\n\nThe reason being that you said it's quite itchy. It's\n\nmany affecting your chest and your back. And\n\nhaving looked at your skin, the the rash does pick\n\nquite familiar. You mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you\n\nstronger prescription of a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nWell as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth, using antihistamines.\n\nWhich can sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help with the itchiness of your Okay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to have\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really\n\nhelp.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't\n\nreally help. It didn't. Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well. Okay. Something that affects\n\nwhich I can give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut I say anything using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back\n\nsee me next week if things don't get better.\n\nThat sounds good. Okay.\n\nDo you have any questions for me?\n\nNo.\n\nThat's it.\n\nOkay. Well, I wish you all the best.\n\nThank you very much. Thank you.\n\nHave\n\na good day.\n\nBye. Thank you, Victor. Bye.","marks":[[123,128,"",false],[434,450,"Um whereabouts in",false],[724,728,"I I can",false],[795,798,"I can't",false],[805,809,"I can't",false],[971,1002,"OK. I'm certain this is",false],[1068,1070,"this",false],[1176,1179,"prescribed",false],[1396,1403,"That's those",false],[1434,1437,"appear",false],[1464,1470,"appeared",false],[1770,1792,"OK. um",false],[1949,1958,"arm. But",false],[1968,1971,"",false],[2032,2037,"OK. Like pretty",false],[2096,2104,"weekend.",false],[2111,2111,"am",false],[2216,2222,"because",false],[2298,2305,"cannot uh",false],[2325,2330,"part",false],[2391,2396,"",false],[2478,2483,"Um have you",false],[2537,2541,"skins . OK.",false],[2657,2671,"OK. You've not haven't uh seen",false],[2682,2687,"uh pus",true],[2781,2795,"Are you",false],[2920,2920,"Four days ago.",false],[2973,2981,"any",false],[3025,3025,"No I .",false],[3119,3119,"something.",false],[3166,3181,"I cannot um",false],[3230,3237,"cannot",false],[3345,3349,"help",false],[3682,3687,"Am I",false],[3866,3886,"very itchy.",false],[3903,3908,"Itchy. OK.",false],[4012,4016,"You're",false],[4158,4158,"symptoms",false],[4267,4271,"disease",false],[4418,4428,"this stage",false],[4636,4640,"has",false],[4666,4670,"would",false],[4707,4707,"Um So Sorry to say",false],[4816,4816,"eczema",false],[4987,4997,"medications",false],[5076,5086,"some",false],[5110,5135,"said",false],[5143,5148,"have any allergies to anything",false],[5193,5199,"That's alright",false],[5208,5220,"it . Uh",false],[5257,5259,"Ohh",false],[5411,5419,"thirty one. Uh I",false],[5662,5672,"I'm a like a",false],[5705,5705,"do",false],[5769,5777,"",false],[6222,6244,"OK. OK. OK I've got to",false],[6264,6273,"I've got to",false],[6403,6411,"Sarah",false],[6500,6504,"it was",false],[6524,6528,"mainly",false],[6616,6620,"appear",false],[6652,6658,"",false],[6842,6842,"As",false],[6856,6861,"going to",false],[6938,6953,"use in",false],[7215,7223,"Piriton",true],[7523,7561,"an eczema CU. OK. Yes",false],[7627,7629,"Ohh",false],[7729,7745,"OK. OK. So it's",false],[7803,7807,"types",false],[7906,7918,"like Fexofenadine",true],[7993,7998,"going to",false],[8023,8035,"think",false],[8310,8315,"Thank you very much. Bye. Thank you as well. Bye. OK.",false],[8358,8379,"",false],[8400,8428,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset 4 days ago of very itchy, sore, red skin\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"chest, hands, inside elbows\", \"dry with some cracked areas\"; legs not included."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupts sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work focus; unable to hike last weekend\"."],["The note captures: Known eczema and past asthma.","yes","History of eczema and \"Past asthma (not current)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","\"Tried OTC steroid cream last night without improvement\" but prior eczema treatments noted only as helpful then, not failing now."],["The note captures: Antihistamines already tried have not helped.","yes","\"Tried antihistamines recently without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified; only a trigger diary is planned."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Use prescribed stronger topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Use emollients in bath/shower and as moisturiser\" regularly."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Consider stronger antihistamine (clinician to prescribe)\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review next week if no improvement\" and 7-10 day reassessment."]],"claims":[["(Consent obtained)","Transcript contains no consent discussion for examination or treatment; this is asserted without support."]],"note":"Presenting Condition\n\nOnset 4 days ago of very itchy, sore, red skin\n\nLocations: chest, hands, inside elbows; no face involvement\n\nSkin described as dry with some cracked areas; no bleeding or discharge\n\nItch severe, disrupts sleep and work focus; unable to hike last weekend due to pain/itch\n\nSelf‑management: frequent daily showers to ease itch\n\nPrior eczema historically limited to arms; current episode more widespread and itchier\n\nTried OTC steroid cream last night without improvement\n\nTried antihistamines recently without benefit\n\nDenies fevers, cough, breathing difficulty, bowel or urinary issues\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nHistory of eczema previously treated with creams and shower product; helped at that time\n\n\n\n\nPast Medical History\n\nPast asthma (not current)\n\nNo other medical problems reported\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular medications\n\nRecent OTC steroid cream tried\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory symptoms/cough/breathing difficulty: denies\n\nBowel function: okay\n\nUrination: okay\n\nBleeding/discharge from skin: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nAge 31\n\nWorks full‑time as project manager at a pharmaceutical company\n\nNon‑smoker\n\nAlcohol: a few beers per week\n\nHiking on weekends (currently limited by symptoms)\n\n\n\n\nGoals\n\nRapid relief of itch/pain to sleep and function at work\n\nReturn to hiking\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Clinician states rash appearance looks familiar for eczema (viewed during consult)\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPlan to reassess response over 7–10 days\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical steroid regularly for 7–10 days\n\nUse emollients in bath/shower and as moisturiser\n\nKeep diary of potential triggers (clothing, shower gels, soaps)\n\nMeds:\n\nConsider stronger antihistamine (clinician to prescribe); prior OTC antihistamine ineffective\n\n// Advised steroid + emollient regimen expected to control symptoms within 7–10 days\n\n\n\n\nPlan\n\nTrial prescribed topical steroid and emollients regularly for 7–10 days\n\nConsider stronger antihistamine as adjunct\n\nReview next week if no improvement\n\nMonitor and record triggers for discussion at follow‑up\n","review":150.17105263157896,"saved":166.32894736842104,"clean":false,"effort":20.0,"sig":[],"mb":15.042649,"signable":185.23205263157897},{"label":"Run 3","wer":19.449431478156793,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now.\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nit because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus my work, it\n\nreally annoying because I can't actually think about what\n\nto say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. Understand this is obviously\n\naffecting you, and we'll try our very best to get get it sorted out for you.\n\nHave you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something\n\nto\n\nwhen I, like, was shower when I was in the shower, I had to put something.\n\nOkay.\n\nBut\n\nyeah. Did it help?\n\nI mean, at that time, yes. But the symptoms\n\nLike, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at\n\na pharmacy last night, but it apparently didn't help because it's still\n\nitchy today. Okay. Yeah. Do\n\nyou remember the name of the cream you bought?\n\nSteroid\n\ncream. Okay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was\n\nsuper painful. And Yes. I I have to take, like, showers every day to be able to\n\nkind of ease this itching part\n\nwhich is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo, for example, have you changed your\n\nshower gel, any clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's very annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about\n\nthese questions. It's kind of intimate, and so I your help now.\n\nNo.\n\nNo. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face.\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nItching?\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties? No.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be\n\ncausing your symptoms?\n\nAny whats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my eczema was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nYeah. And it's been very itchy. And so with your\n\nbackground of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but Okay. Not any problem.\n\nNot anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything?\n\nI like\n\nsomething.\n\nSorry. Yeah.\n\nSorry. I didn't get any allergies to anything.\n\nHello? Hello? Yes.\n\nOh,\n\ncan\n\nyou hear me? Sorry. I think you're you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay.\n\nAnd tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect\n\nyour symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's\n\nbeen it's been a while.\n\nOkay. Okay.\n\nI'm gonna say at this stage, I'm gonna say\n\nthe\n\nthe sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. Reason being that you said\n\nit's quite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines, which\n\ncan sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your Okay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't really help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well.\n\nOkay.\n\nSomething like fexifenadine, which I\n\ncan give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget\n\nbetter. That\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well,\n\nI wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[123,128,"",false],[349,354,"",false],[440,454,"Um whereabouts in",false],[698,698,"solve",false],[725,729,"I I can",false],[796,799,"I can't",false],[806,810,"I can't",false],[836,838,"It's",false],[897,897,"I have",false],[962,978,"OK. I'm certain",false],[1382,1389,"That's those",false],[1421,1424,"appear",false],[1640,1645,"itching a lot",false],[1748,1770,"OK. um",false],[1927,1936,"arm. But",false],[2006,2011,"OK. Like pretty",false],[2070,2078,"weekend.",false],[2085,2085,"am",false],[2190,2196,"because",false],[2279,2286,"cannot uh",false],[2369,2374,"",false],[2455,2455,"Um have you",false],[2509,2513,"skins . OK.",false],[2629,2643,"OK. You've not haven't uh seen",false],[2654,2659,"uh pus",true],[2753,2767,"Are you",false],[2892,2892,"Four days ago.",false],[2994,2994,"No I .",false],[3024,3028,"really",false],[3086,3086,"something.",false],[3133,3148,"I cannot um",false],[3197,3204,"cannot",false],[3654,3659,"Am I",false],[3838,3859,"very itchy.",false],[3877,3882,"Itchy. OK.",false],[3985,3989,"You're",false],[4148,4153,"what",false],[4248,4252,"disease",false],[4310,4313,"arms.",false],[4410,4413,"I",false],[4618,4622,"has",false],[4647,4651,"would your um Yeah. Uh your",false],[4683,4683,"Sorry to say",false],[4901,4923,"",false],[4938,4943,"OK. Not anymore OK.",false],[5062,5072,"some",false],[5097,5107,"said do you have",false],[5179,5185,"That's alright",false],[5194,5200,"it . 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OK.",false],[8332,8354,"",false],[8372,8400,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset 4 days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked skin on \"chest, hands and antecubital fossae\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Bleeding/discharge from skin: denies\"."],["The note captures: Itching disturbs sleep.","yes","\"disturbing sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Affects focus at work and hiking."],["The note captures: Known eczema and past asthma.","yes","\"Previous eczema\" and \"Past asthma, no current issues\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior prescribed creams \"without benefit this time\" and OTC steroid \"without relief\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Tried antihistamines recently without help\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Use prescribed stronger topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Use emollients in bath/shower regularly\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Start fexofenadine as prescribed\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (clothing, shower gels/soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review next week if not better\"."]],"claims":[],"note":"Presenting Condition\n\nOnset 4 days ago\n\nVery itchy, sore, red skin affecting chest, hands and antecubital fossae\n\nSkin cracked in some parts\n\nItch severe, disturbing sleep and ability to focus at work; hiking last weekend was “super painful”\n\nPrevious eczema but current episode more itchy and broader distribution than prior (previously arms only)\n\nTried prior prescribed eczema creams and shower products without benefit this time\n\nTried OTC steroid cream last night without relief\n\nShowers provide temporary easing\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nPrior eczema treated with creams and shower product; helped previously\n\n\n\n\nPast Medical History\n\nPast asthma, no current issues\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular medications\n\nTried antihistamines recently without help\n\nPlan to use prescribed stronger topical steroid, emollients, and fexofenadine per clinician today\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory: no cough, no breathing difficulties\n\nGI: bowels ok\n\nGU: passing urine ok\n\nBleeding/discharge from skin: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nAge 31\n\nFull‑time job in a pharmaceutical company (project management)\n\nNon‑smoker\n\nAlcohol: a few beers per week\n\nHiking on weekends (limited by symptoms)\n\n\n\n\nGoals\n\nRapid relief of itching/pain to sleep and function at work; return to hiking\n\n\n\n\nObjective\n\n(Consent obtained)\n\nRemote consult; clinician reports rash appearance familiar with eczema\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPrognosis: expects improvement with regular steroids/emollients within 7–10 days\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical steroid\n\nUse emollients in bath/shower regularly for 7–10 days\n\nConsider fexofenadine; different antihistamines may help itch\n\nKeep diary of potential triggers (clothing, shower gels/soaps)\n\nPlan to review response in 7–10 days; return sooner if not improving\n\n// Patient agrees; symptoms unchanged today despite OTC steroid and prior antihistamines\n\n\n\n\nPlan\n\nUse steroid and emollients consistently for 7–10 days\n\nStart fexofenadine as prescribed\n\nKeep trigger diary\n\nReview next week if not better; continue if improving\n","review":116.07894736842105,"saved":200.42105263157896,"clean":false,"effort":6.666666666666667,"sig":[],"mb":15.507057,"signable":136.52294736842106},{"label":"Run 4","wer":19.449431478156793,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now.\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nit because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus my work, it\n\nreally annoying because I can't actually think about what\n\nto say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. Understand this is obviously\n\naffecting you, and we'll try our very best to get get it sorted out for you.\n\nHave you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something\n\nto\n\nwhen I, like, was shower when I was in the shower, I had to put something.\n\nOkay.\n\nBut\n\nyeah. Did it help?\n\nI mean, at that time, yes. But the symptoms\n\nLike, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at\n\na pharmacy last night, but it apparently didn't help because it's still\n\nitchy today. Okay. Yeah. Do\n\nyou remember the name of the cream you bought?\n\nSteroid\n\ncream. Okay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was\n\nsuper painful. And Yes. I I have to take, like, showers every day to be able to\n\nkind of ease this itching part\n\nwhich is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo for example, have you changed your\n\nshower gel, any clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's very annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about\n\nthese questions. It's kind of intimate, and so I your help now.\n\nNo.\n\nNo. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face.\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nItching?\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties? No.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be\n\ncausing your symptoms?\n\nAny whats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my eczema was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nYeah. And it's been very itchy. And so with your\n\nbackground of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but Okay. Not any problem.\n\nNot anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything?\n\nI like\n\nsomething.\n\nSorry. Yeah.\n\nSorry. I didn't get any allergies to anything.\n\nHello? Hello? Yes.\n\nOh,\n\ncan\n\nyou hear me? Sorry. I think you're you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay.\n\nAnd tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect\n\nyour symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's been it's been a while.\n\nOkay.\n\nOkay. I'm gonna say at this stage, I'm gonna say the the sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. Reason being that you said\n\nit's quite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines, which\n\ncan sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your\n\nOkay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't really help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well.\n\nOkay.\n\nSomething like fexifenadine, which I\n\ncan give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget\n\nbetter. That\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well,\n\nI wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[123,128,"",false],[349,354,"",false],[440,454,"Um whereabouts in",false],[698,698,"solve",false],[725,729,"I I can",false],[796,799,"I can't",false],[806,810,"I can't",false],[836,838,"It's",false],[897,897,"I have",false],[962,978,"OK. I'm certain",false],[1382,1389,"That's those",false],[1421,1424,"appear",false],[1640,1645,"itching a lot",false],[1748,1770,"OK. um",false],[1927,1936,"arm. But",false],[2006,2011,"OK. 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OK.",false],[8329,8351,"",false],[8369,8397,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset 4 days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, dry/cracked skin on \"chest, hands, and inside elbows\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disturbs sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Disturbs \"concentration at work\" and hiking limited."],["The note captures: Known eczema and past asthma.","yes","\"Past eczema\" and \"Past asthma, currently no issues\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","OTC steroid cream without benefit; \"prior prescribed eczema creams helped in past but not this time\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Tried OTC antihistamines recently without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"Probable eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Rx: stronger prescription topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients for bath/shower use; regular moisturising\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Rx: antihistamine (fexofenadine)\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (clothing, shower gels/soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return next week if no improvement\"."]],"claims":[],"note":"Presenting Condition\n\nOnset 4 days ago\n\nVery itchy, sore, red skin affecting chest, hands, and inside elbows\n\nItch severe, constant; disturbs sleep and concentration at work\n\nSkin noted dry with some cracked areas; no bleeding or discharge\n\nWorse with hiking; daily showers provide some relief\n\nPrevious similar eczema limited to arms; current flare more widespread and itchier\n\nTried OTC steroid cream last night without benefit; prior prescribed eczema creams helped in past but not this time\n\nReason for visit: rapid relief for severe itch/rash\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nNo musculoskeletal injuries mentioned\n\n\n\n\nPast Medical History\n\nPast eczema\n\nPast asthma, currently no issues\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular medications\n\nTried OTC antihistamines recently without benefit\n\nTried OTC steroid cream yesterday without benefit\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory: no cough, no breathing difficulties\n\nBowel: normal\n\nUrinary: passing urine ok\n\nBleeding/discharge from skin: denies\n\nFace involvement: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nAge 31\n\nWorks full-time at a pharmaceutical company (project management role)\n\nNon-smoker\n\nAlcohol: a few beers per week\n\nEnjoys weekend hiking; currently limited by symptoms\n\n\n\n\nSport & Exercise History\n\nHiking on weekends; avoided last weekend due to pain/itch\n\n\n\n\nGoals\n\nQuick relief of itch and rash to sleep and function at work\n\n\n\n\nObjective\n\n(Consent obtained)\n\nClinician reports rash appearance familiar with eczema on visual inspection\n\n\n\n\nDiagnosis\n\nProbable eczema flare\n\nPrognosis: expected improvement with regular steroids/emollients over 7–10 days; review if not improving\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nRx: stronger prescription topical corticosteroid\n\nRx: emollients for bath/shower use; regular moisturising\n\nRx: antihistamine (fexofenadine) to trial despite limited response to prior OTC antihistamines\n\nEd:\n\nUse steroids and emollients regularly for 7–10 days before judging effect\n\nKeep diary of potential triggers (clothing, shower gels/soaps) for discussion next visit\n\n// Plan to monitor response; patient agrees\n\n\n\n\nPlan\n\nTrial prescribed steroid + emollients + fexofenadine for 7–10 days\n\nKeep trigger diary\n\nReturn next week if no improvement; otherwise continue as advised\n","review":121.44736842105263,"saved":195.05263157894737,"clean":false,"effort":6.666666666666667,"sig":[],"mb":15.409156,"signable":146.07336842105263},{"label":"Run 5","wer":19.50927588270497,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, let's let's continue anyway.\n\nOkay. Okay.\n\nSo let's start again. So how can I help\n\nyou, sir?\n\nYes. So it's been a few days now.\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\ncan't even sleep at night. Like, I really need something\n\nquickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like,\n\nthink about my work and focus like, actually focus on my work, it\n\nreally annoying because I can't actually think about\n\nwhat I have to say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. I understand this is obviously affecting you,\n\ntry our very best to get get it sorted out for you. Have you had anything like this before in the past?\n\nSo, yes,\n\nearlier, I was, like, prescribed for my eczema.\n\nOkay. And\n\nthey gave me, like, some cream and something to\n\nwhen I, like, was shower when I was in the shower, had to put something. Okay.\n\nBut yeah.\n\nDid it help?\n\nI mean, at that time, yes. But the symptoms\n\nlike, these symptoms are, like when the symptoms appear again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but\n\nit apparently didn't help because it's still itching a lot today. Okay.\n\nYeah. Do you remember the name of the cream you bought?\n\nSteroid cream.\n\nOkay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was super painful and\n\nI I have to take, like, showers every day to be able to kind of\n\nease this itching parts, which is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore. Yeah.\n\nYou noticed any bleeding or discharge from your skin?\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I\n\nmean. Okay.\n\nBut\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin?\n\nNo. No. And you mentioned it all started three days ago.\n\nFour days ago. Four days ago. Are you aware of any triggers, anything that you may have done\n\nthat may have caused your symptoms to start? So for example,\n\nhave you changed your, shower gel, any clothing,\n\nHave you been around anyone else?\n\nI\n\nhaven't\n\nit's actually, like,\n\nit's really annoying because I'm thinking about maybe I\n\nchange something because I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about these questions. It's kind of\n\nintimate and so I your help now.\n\nNo. No. Okay. That's\n\nokay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the eyebrows.\n\nOkay. And anything on your face at\n\nall?\n\nIn my what?\n\nOn your face?\n\nOh, on my face? No. No.\n\nOkay. And\n\napart\n\nfrom\n\nthis, any\n\nother symptoms\n\nhave\n\nyou noticed? For example,\n\nhave you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nEtching.\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties?\n\nNo.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to\n\ncould be causing your symptoms?\n\nAny\n\nwhats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nAnd it's been very itchy. And so with your\n\nyour background of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but\n\nnot anymore.\n\nNot anymore. Okay. And do you take any regular medication at the moment?\n\nNo.\n\nNo. Okay. Do you have any allergies to anything?\n\nLike, something.\n\nSorry.\n\nYeah.\n\nSorry. I didn't see any ID statement.\n\nK.\n\nHello?\n\nHello? Yes.\n\nOh, can you hear me? Sorry. I think it\n\ncrack\n\nDo you have any allergies at all?\n\nOh, allergies.\n\nNo.\n\nNo. Okay. And tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We are working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's actually fine. Just a couple of questions I wanted to ask you, which can sometimes\n\naffect your symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's been\n\nit's been a while.\n\nOkay. Okay.\n\nI'm gonna say at this stage, I'm gonna say the the sound\n\nquality\n\nis not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. The reason being that you said\n\nquite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines which can sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your Okay.\n\nSkin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again?\n\nSorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't\n\nreally help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well. Okay. Something like fexifenadine, which I\n\ngive to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget better.\n\nThat\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well, I wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day.\n\nBye. Thank you, Victor. Bye.","marks":[[113,118,"But",false],[345,350,"",false],[436,450,"Um whereabouts in",false],[727,731,"I can",false],[799,802,"I can't",false],[809,813,"I can't",false],[842,844,"It's",false],[975,993,"OK. I'm certain",false],[1025,1025,"And uh we'll",false],[1384,1391,"That's those",false],[1423,1426,"appear",false],[1451,1457,"appeared",false],[1757,1779,"OK. um",false],[1936,1945,"arm. But",false],[2015,2020,"OK. Like pretty",false],[2079,2087,"weekend.",false],[2094,2094,"am",false],[2199,2205,"because",false],[2281,2288,"cannot uh",false],[2308,2313,"part",false],[2373,2378,"",false],[2458,2458,"Um have you have",false],[2508,2512,"skins . OK.",false],[2630,2644,"OK. You've not haven't uh seen",false],[2655,2660,"uh pus",true],[2755,2769,"Are you",false],[2814,2814,"or",false],[2892,2892,"Four days ago.",false],[2993,2993,"No",false],[2999,3006,".",false],[3085,3085,"should",false],[3149,3164,"I cannot um",false],[3213,3220,"cannot",false],[3619,3639,"elbows. Yeah. OK.",true],[3672,3677,"Am I",false],[3863,3885,"very itchy.",false],[3902,3907,"Itchy. OK.",false],[4011,4015,"You're",false],[4130,4130,"what",false],[4170,4175,"what",false],[4270,4274,"disease",false],[4308,4308,"eczema",false],[4325,4328,"arms.",false],[4425,4428,"I",false],[4627,4631,"has",false],[4656,4660,"would your um Yeah. Uh",false],[4697,4697,"Sorry to say",false],[4977,4987,"medications",false],[5065,5075,"some",false],[5101,5111,"said do you have",false],[5116,5133,"allergies to anything",false],[5177,5183,"That's alright",false],[5196,5201,". Uh",false],[5238,5240,"Ohh",false],[5391,5399,"thirty one. Uh I",false],[5628,5634,"We're",false],[5643,5645,"I'm",false],[5648,5654,"like a",false],[5687,5687,"do",false],[5753,5761,"",false],[5770,5778,"absolutely",false],[5814,5820,"want",false],[6209,6231,"OK. OK. OK I've got to",false],[6251,6260,"I've got to",false],[6390,6390,"Sarah",false],[6627,6633,"",false],[6834,6839,"going to",false],[6916,6931,"use in",false],[7190,7198,"Piriton",true],[7469,7469,"have",false],[7490,7528,"an eczema CU. OK. Yes",false],[7593,7595,"Ohh",false],[7696,7712,"OK. OK. So it's",false],[7770,7774,"types",false],[7878,7890,"Fexofenadine",false],[7899,7899,"can",false],[7962,7967,"going to",false],[7990,8001,"I think",false],[8281,8286,"Thank you very much. Bye. Thank you as well. Bye. OK.",false],[8329,8351,"",false],[8370,8398,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'Onset 4 days ago'."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","no","Lists 'inside eyebrows' as an affected site; patient said inside the elbows and denied facial involvement."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Skin cracked in some areas; no bleeding or discharge'."],["The note captures: Itching disturbs sleep.","yes","'sleep disturbed'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","'difficulty concentrating at work; hiking last weekend \"super painful\"'."],["The note captures: Known eczema and past asthma.","yes","'Past eczema' and 'Past asthma (no longer active)'."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior eczema regimen 'not responding this time' and OTC steroid last night without relief."],["The note captures: Antihistamines already tried have not helped.","yes","'Recent OTC antihistamines tried without benefit'."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","'Likely eczema flare'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribed stronger topical corticosteroid'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Use emollients in bath/shower and as moisturiser'."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribed fexofenadine (stronger antihistamine) to trial'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'Keep trigger diary (clothing, soaps, shower gels)'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'review next week if not improving' and 7-10 day reassessment."]],"claims":[["Rash affecting 'inside eyebrows'","Patient said 'inside the elbows' and answered 'No' to anything on the face; eyebrow involvement is a wrong-site claim."]],"note":"Presenting Condition\n\nOnset 4 days ago\n\nVery itchy, sore, red skin affecting chest, hands, arms, inside eyebrows\n\nItch severe, persistent; sleep disturbed; difficulty concentrating at work; hiking last weekend “super painful”\n\nSkin cracked in some areas; no bleeding or discharge\n\nTried prior prescribed eczema regimen previously effective; recurrence not responding this time\n\nTried OTC steroid cream last night without relief\n\nShowers daily to ease itch\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nPast eczema treated previously with creams and shower products; helped at that time\n\n\n\n\nPast Medical History\n\nPast eczema\n\nPast asthma (no longer active)\n\nNo known allergies reported\n\n\n\n\nMedications\n\nNo regular medications\n\nRecent OTC antihistamines tried without benefit\n\nRecent OTC topical steroid tried without benefit\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory: no cough, no breathing difficulties\n\nGU: passing urine ok\n\nBowels: ok\n\nBleeding/discharge from skin: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nFull‑time job at a pharmaceutical company (project management)\n\nNon‑smoker\n\nAlcohol: a few beers per week\n\nEnjoys hiking; currently limited by symptoms\n\n\n\n\nSport & Exercise History\n\nHiking on weekends; currently unable due to pain/itch\n\n\n\n\nGoals\n\nRapid relief of itch and soreness to sleep and function at work\n\n\n\n\nObjective\n\n(Consent obtained)\n\nRemote consultation; clinician reports rash appearance “familiar” with eczema on inspection\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPlan to reassess response in 7–10 days; review next week if not improving\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical steroid regularly for 7–10 days\n\nUse emollients in bath/shower and as moisturiser\n\nKeep trigger diary (clothing, soaps, shower gels)\n\nMeds:\n\nPrescribed stronger topical corticosteroid\n\nPrescribed fexofenadine (stronger antihistamine) to trial\n\nContinue emollients consistently\n\n// Advised to return next week if no improvement\n\n\n\n\nPlan\n\nTrial steroid + emollients + fexofenadine for 7–10 days\n\nReturn next week if not better; discuss triggers and adjust management at review\n","review":164.10526315789474,"saved":152.39473684210526,"clean":false,"effort":20.0,"sig":[["missing","Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","Wrong site: 'inside eyebrows' recorded when the patient said inside elbows and denied facial involvement, which would alter steroid potency choice."]],"mb":15.401105,"signable":184.72126315789473}],"patientnotes":[{"label":"Run 1","wer":19.329742669060444,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have, like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problem. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like, my chest, my. My hands, my arms. Like, really, it's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, like when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always.\nLike disturbed by this disease?\nNo, no. Okay this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower, when I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay, Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or.\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. Yeah. Like, I like, for instance, hiking during the weekend and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful. And I have to take, like showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah,\nhave not seen any other pus or blood coming out of your skin.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay, that's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and inside the elbows.\nOkay. Anything on your face at all?\nIn my what? On\nyour face.\nOn my face? No. No. Okay.\nAnd apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine Okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay, so normally at this stage, I like to examine you to see the rash itself.\nSee exactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Completely my apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry. Yeah, sorry. I was going to say, do you have any allergies to anything? Hello? Hello? Yes? Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your situation at home who do you live with?\nSo I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money.\nOkay and what do you do for work?\nI work at a pharmaceutical company so. So it's been a few years now it's kind of interesting we're working I'm like a kind of project manager. Do you want to know more about it?\nOkay no no, no that's absolutely fine. Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo,\nno and do you drink much in a way\nof\nalcohol?\nYou know once in a while I like hanging out with people once in a while so yeah I'd say a few beers per week something like this Nothing crazy I used to.\nDrink a lot more when I was younger, but it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the sound quality is not great but I will continue because we've come this far. So based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps moisturize the skin, use in the bath and shower and it's definitely worth using that for the first time. Seven to ten days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or piriton, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it\ndidn't really help. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It. It's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[515,515,"it's",false],[689,693,"I I can",false],[759,762,"I can't",false],[770,774,"I can't",false],[933,937,"OK. I'm certain",false],[983,983,"our",false],[1001,1016,"get this sorted out",false],[1300,1307,"That's those",false],[1336,1336,"appear",false],[1815,1824,"arm. But",false],[1877,1877,"OK. 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OK.",false],[7819,7829,"",false],[7847,7875,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","partial","States \"three to four days ago\" although the history was confirmed as four days."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"chest, hands, and inside the elbows\"; sore, red, itchy, cracked."],["The note captures: No bleeding or purulent discharge from the skin.","no","Absence of bleeding or pus/discharge is not documented."],["The note captures: Itching disturbs sleep.","yes","\"inability to sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","partial","Only vague \"disturbing... daily activities\"; work concentration and hiking not specified."],["The note captures: Known eczema and past asthma.","partial","Previous eczema noted but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","Pharmacy steroid cream failure captured, but failure of previously helpful eczema treatments is not."],["The note captures: Antihistamines already tried have not helped.","yes","\"tried antihistamines previously without improvement\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"no identified triggers such as changes in shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely flare-up of eczema.\""],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"stronger prescription steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients to moisturise the skin during bath and shower\"; regularly 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Doctor offered a prescription of fexofenadine.\""],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"diary of potential triggers, including soaps and clothing\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"return for review next week if symptoms have not improved\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with a few days' history of sore, red, itchy skin that is disturbing sleep and daily activities.\n\nHistory of Presenting Complaint::\n\nThe itching and soreness began three to four days ago, affecting the chest, hands, and inside the elbows. The patient reports constant itching, cracked skin, and inability to sleep, with no identified triggers such as changes in shower gel or clothing. The symptoms are not relieved by a steroid cream bought from the pharmacy, and previous eczema was limited to the arms.\n\nObjective\n\nExamination revealed a rash with dry and cracked skin on the chest, hands, and inside the elbows.\n\nNot discussed\n\nAssessment\n\nLikely flare‑up of eczema.\n\nPlan\n\nMedications::\n\nPatient previously used a steroid cream purchased from a pharmacy, which did not relieve the current symptoms.\n\nDoctor recommended a stronger prescription steroid cream.\n\nDoctor advised use of emollients to moisturise the skin during bath and shower.\n\nDoctor mentioned over‑the‑counter antihistamines such as loratadine or piriton.\n\nPatient reported having tried antihistamines previously without improvement.\n\nDoctor offered a prescription of fexofenadine.\n\nPatient should apply the prescribed stronger steroid cream and emollients regularly for 7–10 days.\n\nPatient may try a stronger antihistamine such as fexofenadine.\n\nPatient should keep a diary of potential triggers, including soaps and clothing.\n\nPatient to return for review next week if symptoms have not improved.","review":140.61842105263156,"saved":175.88157894736844,"clean":false,"effort":20.0,"sig":[["missing","No bleeding or purulent discharge from the skin.","The note omits the negative infection screen (no bleeding or pus), which justifies steroids without antimicrobials."]],"mb":27.49414,"latency":27.154,"signable":167.77242105263156},{"label":"Run 2","wer":19.569120287253142,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have like, a sore and a red skin. It's kind of. It's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\nNo, no problems. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like, my chest, my hands, my arms. Like, really, it's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. I really need something quickly to solve it. Because even at work, when I'm in the meeting and I have to think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always disturbed.\nBit by this disease?\nNo, no. Okay, I understand this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower. When I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes, but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or different?\nAnd it's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. I like, for instance, hiking during the weekends and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful and I have to take showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay, that's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah,\nI'm not seeing any other pus or blood coming out of your skin. No.\nAnd you\nmentioned it all started three days ago.\nAre you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now?\nNo. No. Okay, that's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and, like, inside the elbows.\nOkay. Anything on your face at all?\nIn my what? On\nyour face.\nOn my face.\nNo.\nNo. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay. So your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties?\nNo.\nYou're passing urine okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms?\nSo I had eczema before, so maybe it's this. But it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay. That's okay. So, normally at this stage, I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin.\nAnd some cracked skin as well. And it's been very itchy. And so with your background of eczema. So there's a couple of questions I wanted to ask you. Richard completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of?\nNo, I just had asthma in the past. But not\nanymore? Not anymore. Okay. And do you take any regular medications at the\nMemantine.\nNo. Okay. Do you have any allergies to anything?\nSorry. Yeah,\nsorry. I'm going to get an allergy to anything.\nHello? Hello? Yes. Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\nOh, allergies.\nNo. Okay. And tell me about your situation at home. Who do you live with?\nSo I live with a few flatmates. So, you know, I'm 31, I have a full time job and so I'm living with a few people to save money.\nOkay, and what do you do for work?\nI work at a pharmaceutical company. So it's been, it's been a few years now. It's kind of interesting. We're working. I'm a. Like a kind of project manager. I mean, do you want to know more about it?\nOkay. No, no, no, that's absolutely, that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\nNo.\nNo. And do you drink much in the way\nof alcohol? You know, once in a while I can. I like hanging out with people once in a while. So yeah, I'd say a few. A few beers per week. Something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger. But it's been a while. Okay.\nI've got to say at this stage, I've got to say the sound corporation.\nIs not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema, the reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps to moisturize the skin, use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter. So.\nThings like loratadine or pirfenidone, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it\ndidn't really help. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It's not going to do you any harm. But I say you think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds.\nGood. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you. Bye.","marks":[[387,396,"problem.",false],[483,483,"my",false],[512,512,"it's",false],[678,678,"I I can",false],[738,741,"I can't",false],[749,753,"I can't",false],[882,885,"",false],[911,929,"OK. I'm certain",false],[975,975,"our",false],[993,1008,"get this sorted out",false],[1293,1300,"That's those",false],[1329,1329,"appear",false],[1811,1820,"arm. But",false],[1873,1873,"OK. Like pretty yeah when like",false],[1914,1922,"weekend.",false],[1926,1926,"I am",false],[2021,2027,"because",false],[2093,2100,"cannot uh",false],[2178,2183,"",false],[2256,2256,"Yeah. Um have you",false],[2310,2314,"skins . 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OK.",false],[7870,7891,"",false],[7909,7929,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","no","States \"Onset 3 days ago\" although the clinician corrected to four days and the patient confirmed \"Four days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"sore, red, cracked skin, intense itching on chest, hands, inside elbows\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"constant itching disturbing sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"concentration\" and \"interfering with... work\"."],["The note captures: Known eczema and past asthma.","partial","Eczema recorded but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","Pharmacy steroid cream \"no relief\" recorded; prior cream noted as helping then, not as failing now."],["The note captures: Antihistamines already tried have not helped.","yes","\"Patient tried antihistamines previously without improvement\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","Absence of a new trigger or toiletry change is not recorded."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Doctor prescribed stronger prescription steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"regular emollients in bath/shower for 7-10 days\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Doctor offered fexofenadine as stronger antihistamine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (soaps, detergents, clothing)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return for review next week if no improvement\"."]],"claims":[["Patient currently taking memantine.","Patient said he takes no regular medications; memantine never mentioned."],["OTC antihistamines (loratadine or pirfenidone)","Clinician said \"Loratadine or Piriton\"; pirfenidone (an antifibrotic) is a wrong medication."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports a few days of sore, red, very itchy skin on the chest, hands and arms that is interfering with sleep and work.\n\nHistory of Presenting Complaint::\n\nOnset 3 days ago; sore, red, cracked skin, intense itching on chest, hands, inside elbows; constant itching disturbing sleep and concentration; tried daily showers, prior steroid cream from pharmacy ineffective; no bleeding or discharge.\n\nObjective\n\nRash appears familiar, consistent with eczema; dry, cracked skin; no pus or bleeding observed.\n\nNot discussed\n\nAssessment\n\nLikely flare‑up of eczema.\n\nPlan\n\nMedications::\n\nPreviously prescribed cream for eczema, used during showers, helped at that time.\n\nBought steroid cream from pharmacy last night, no relief.\n\nDoctor prescribed stronger prescription steroid cream.\n\nDoctor recommended regular emollients in bath/shower for 7–10 days.\n\nDoctor suggested OTC antihistamines (loratadine or pirfenidone).\n\nPatient tried antihistamines previously without improvement.\n\nDoctor offered fexofenadine as stronger antihistamine.\n\nPatient currently taking memantine.\n\nApply prescribed stronger steroid cream and emollients daily for 7–10 days.\n\nKeep diary of potential triggers (soaps, detergents, clothing).\n\nReturn for review next week if no improvement.\n\nConsider alternative antihistamine if needed.","review":145.60526315789474,"saved":170.89473684210526,"clean":false,"effort":40.0,"sig":[["fabrication","Patient currently taking memantine.","Invents current memantine use in a patient on no regular medications."],["fabrication","OTC antihistamines (loratadine or pirfenidone)","Records pirfenidone (an antifibrotic) instead of Piriton as a suggested antihistamine."]],"mb":25.790102,"latency":26.252,"signable":171.85726315789475},{"label":"Run 3","wer":19.389587073608617,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have, like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problems. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like, my chest, my. My hands, my arms. Like, really, it's. It's super annoying. Like, it's itching a lot, like, all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, like when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always.\nLike\ndisturb\nit by this\ndisease? No, no. Okay, I understand this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower. When I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes, but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay. Steroid.\nOkay.\nWould you say these symptoms are very similar to your eczema symptoms or demonstration?\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well.\nOkay.\nYeah. Like I like, for instance, hiking during the weekend and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful and I have to take like showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah.\nHave noticed any other pus or blood coming out of your skin?\nNo.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay, That's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and like. Like inside the elbows. Okay.\nAnd anything on your face at all?\nIn\nmy what?\nOn your face.\nOn my face? No.\nNo. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo, just the itching. Nothing\nelse. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what? Any\nideas as to what could be causing your symptoms?\nSo I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay. That's okay. So normally at this stage, I like to examine you to see the rash itself.\nExactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy and so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Richard, please. Forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry? Yeah, Sorry. I was going to say, do you have any allergies to anything? Hello? Hello? Yes? Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your\nsituation at home who do you live with? So I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money\nokay and what do you do for work?\nI work at a pharmaceutical company so so it's been a few years now it's kind of interesting we're working I'm like a kind of project manager do you want to know more about it?\nOkay no no, no that's absolutely fine Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo\nno and do you drink much in a way of alcohol?\nYou know once in a while I like hanging out with people once in a while so yeah I'd say a few. A few beers per week something like this Nothing, nothing crazy I used to.\nDrink a lot more when I was younger, but it's been okay. I've got to say at this stage, I've got to say the sound quality is not great. But I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps moisturize the skin, use in the bath and shower. And it's definitely worth using that for the first time. Seven to ten days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or Piriton, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say that again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it didn't really\nhelp. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It. It's not going to do you any harm. But I say anything using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[387,396,"problem.",false],[697,701,"I I can",false],[767,770,"I can't",false],[778,782,"I can't",false],[906,916,"uh disturbed",false],[942,960,"OK. I'm certain",false],[1006,1006,"our",false],[1024,1039,"get this sorted out",false],[1324,1331,"That's those",false],[1360,1360,"appear",false],[1760,1773,"",false],[1853,1862,"arm. But",false],[1916,1921,"OK. Like pretty",false],[1927,1927,"when",false],[1984,1984,"I am",false],[2079,2085,"because",false],[2156,2163,"cannot uh",false],[2319,2319,"Yeah. Um have you",false],[2373,2377,"skins . OK.",false],[2488,2500,"OK. 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OK.",false],[7891,7901,"",false],[7919,7947,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","partial","States \"3-4 days\" although the dialogue settled on four days."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, dry, cracked skin on \"chest, hands, arms, inside elbows\"."],["The note captures: No bleeding or purulent discharge from the skin.","no","Absence of bleeding or discharge is not recorded."],["The note captures: Itching disturbs sleep.","yes","\"disrupts sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupts ... work concentration\"."],["The note captures: Known eczema and past asthma.","partial","Eczema implied but past asthma is not recorded."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","\"Prior eczema cream and OTC steroid cream ineffective\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines tried without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Consider prescription stronger steroid\" and \"Apply prescribed steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for regular use in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Offered fexofenadine as stronger antihistamine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (soaps, clothing, etc.)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return for review next week if symptoms do not improve\"."]],"claims":[["OTC antihistamines (loratadine, Piriton) previously tried without relief.","Clinician suggested loratadine/Piriton as options; patient only said he had tried unnamed antihistamines."]],"note":"Subjective\n\nChief Complaint::\n\nItchy, sore, red skin for 3‑4 days, wants quick relief.\n\nHistory of Presenting Complaint::\n\nOnset 3‑4 days ago; distribution chest, hands, arms, inside elbows.\n\nSkin dry, cracked, intensely itchy, disrupts sleep and work concentration.\n\nPrior eczema cream and OTC steroid cream ineffective; antihistamines tried without benefit.\n\nObjective\n\nDry, cracked skin with rash appearing consistent with eczema.\n\nNot discussed\n\nAssessment\n\nLikely eczema flare involving chest, hands, arms.\n\nPlan\n\nMedications::\n\nPrior OTC steroid cream purchased from pharmacy.\n\nConsider prescription stronger steroid.\n\nEmollients for regular use in bath/shower.\n\nOTC antihistamines (loratadine, Piriton) previously tried without relief.\n\nOffered fexofenadine as stronger antihistamine.\n\nApply prescribed steroid and emollients daily for 7‑10 days.\n\nTrial fexofenadine for itch control.\n\nKeep diary of potential triggers (soaps, clothing, etc.).\n\nReturn for review next week if symptoms do not improve.","review":110.51315789473685,"saved":205.98684210526315,"clean":false,"effort":30.0,"sig":[["fabrication","OTC antihistamines (loratadine, Piriton) previously tried without relief.","Records loratadine and Piriton as tried; patient only reported unnamed antihistamines, falsifying medication history."]],"mb":27.027012,"latency":22.121,"signable":132.63415789473686},{"label":"Run 4","wer":19.090365050867746,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problem. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like my chest, my. My hands, my arms. Like, really, it's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, like when I'm in the meeting and I have to, like, think about my work, focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always.\nLike disturbed by this disease?\nNo, no. Okay this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower, when I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay, Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or.\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. Yeah. Like, I like, for instance, hiking during the weekend and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful. And I have to take, like showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah,\nhave not seen any other pus or blood coming out of your skin.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay, that's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and inside the elbows.\nOkay. Anything on your face at all?\nIn my what? On\nyour face.\nOn my face? No. No. Okay.\nAnd apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine Okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay, so normally at this stage, I like to examine you to see the rash itself.\nSee exactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Richard completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry. Yeah, sorry, I was. Do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your situation at home who do you live with?\nSo I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money.\nOkay and what do you do for work?\nI work at a pharmaceutical company so. So it's been a few years now it's kind of interesting we're working I'm like a kind of project manager. Do you want to know more about it?\nOkay no no, no that's absolutely fine. Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo,\nno and do you drink much in a way\nof\nalcohol?\nYou know once in a while I like hanging out with people once in a while so yeah I'd say a few beers per week something like this Nothing crazy I used to.\nDrink a lot more when I was younger, but it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the sound quality is not great but I will continue because we've come this far. So based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps moisturize the skin, use in the bath and shower and it's definitely worth using that for the first time. Seven to ten days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or Piriton, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it\ndidn't really help. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It. It's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[513,513,"it's",false],[687,691,"I I can",false],[756,756,"I can't",false],[765,769,"I can't",false],[927,931,"OK. I'm certain",false],[977,977,"our",false],[995,1010,"get this sorted out",false],[1294,1301,"That's those",false],[1330,1330,"appear",false],[1809,1818,"arm. But",false],[1871,1871,"OK. Like pretty",false],[1877,1877,"when",false],[1935,1935,"I am",false],[2030,2036,"because",false],[2109,2116,"cannot uh",false],[2272,2272,"Yeah. Um have you",false],[2326,2330,"skins . OK.",false],[2441,2445,"OK. 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OK.",false],[7816,7826,"",false],[7844,7872,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","partial","States '3-4 days' although the history was settled at four days."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy skin on chest, hands, arms; dry cracked skin inside elbows."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'No pus or bleeding observed'."],["The note captures: Itching disturbs sleep.","yes","'Constant itching disturbing sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","'concentration at work' recorded."],["The note captures: Known eczema and past asthma.","partial","Past eczema recorded; past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid last night without improvement recorded; prior creams noted as responsive then, but not that they failed now."],["The note captures: Antihistamines already tried have not helped.","no","Prior antihistamine use without benefit is not recorded."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'No identified triggers (no change in soap, clothing, etc.)'."],["The note captures: Assessment is a likely eczema flare.","yes","'Likely flare of eczema'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe a stronger topical steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'regular use of emollient moisturiser in bath/shower'."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Initiate fexofenadine as a stronger antihistamine'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'diary of potential triggers (soaps, clothing, etc.)'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review in one week if symptoms have not improved'."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nSubjective: - Main complaint: sore, red, intensely itchy skin for 3‑4 days affecting chest, hands and arms; seeks rapid relief.\n\nHistory of Presenting Complaint::\n\nSubjective: - Onset 3‑4 days ago. - Constant itching disturbing sleep and concentration at work. - Tried over‑the‑counter steroid cream last night without improvement. - Past eczema limited to arms, responded to prescribed creams. - No identified triggers (no change in soap, clothing, etc.).\n\nObjective\n\nObjective: - Dry, cracked skin with erythema on chest, hands and inside elbows. - No pus or bleeding observed.\n\nNot discussed\n\nAssessment\n\nAssessment: - Likely flare of eczema.\n\nPlan\n\nMedications::\n\nPlan: - Prescribe a stronger topical steroid cream. - Recommend regular use of emollient moisturiser in bath/shower. - Initiate fexofenadine as a stronger antihistamine. - Advise keeping a diary of potential triggers (soaps, clothing, etc.). - Review in one week if symptoms have not improved.\n\nPlan: - Use prescribed steroid and emollient daily for 7‑10 days. - Continue antihistamine as directed. - Follow‑up appointment in one week or sooner if worsening. - Educate on trigger avoidance and skin care.","review":106.68421052631578,"saved":209.81578947368422,"clean":false,"effort":16.666666666666664,"sig":[],"mb":28.665595,"latency":26.151,"signable":132.8352105263158},{"label":"Run 5","wer":19.50927588270497,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problems. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like my chest, my. My hands, my arms. Like, really, it's. It's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, I. Like when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work. It's really annoying because I can't actually think about what I have to say. I'm always.\nLike disturbed by this\ndisease? No. No. Okay, I understand this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past,\nso. Yes, earlier I was like prescribed for eczema and they gave me like some cream and something to. When I like was shower. When I was in the shower, I had to put something.\nOkay, but did it help?\nI mean, at that time, yes, but the symptoms like these symptoms like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought like a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay. Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or diagnosis?\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. I like, for instance, hiking during the weekends, and I can't really do it anymore because it's like very like, I wanted to do that last weekend and it was super painful. And I have to take showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah.\nHave nothing any other pus or blood coming out of your skin.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay. That's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and inside the elbows.\nOkay. Anything on your face at all?\nIn\nmy what?\nOn your face.\nOn my face? No.\nNo. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine Okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms?\nSo I had eczema before, so maybe it's this, but it seems like more like eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay. That's okay. So normally at this stage, I like to examine you to see the rash itself.\nSee exactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy, and so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Richard, please. Forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry? Yeah. Sorry. Do you have any allergies to anything? Hello? Hello? Yes? Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your situation at home who do you live with?\nSo I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money\nokay and what do you do for work?\nI work at a pharmaceutical company so so it's been a few years now it's kind of interesting we're working I'm like a kind of project manager do you want to know more about it?\nOkay no no, no that's absolutely fine Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo\nno and do you drink much in a way\nof alcohol? You know once in a while I like hanging out with people once in a while so yeah I'd say a few. A few beers per week something like this Nothing, nothing crazy I used to.\nDrink a lot more when I was younger, but it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the sound quality is not great but I will continue because we've come this far. So based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps to moisturize the skin, use in the bath and shower and it's definitely worth using that for the first seven to 10 days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or Pirotin, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it didn't really\nhelp. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It's not going to do you any harm. But I certainly think using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[[386,395,"problem.",false],[697,701,"I can",false],[767,770,"I can't",false],[778,782,"I can't",false],[941,959,"OK. I'm certain",false],[1005,1005,"our",false],[1023,1038,"get this sorted out",false],[1142,1142,"my",false],[1325,1332,"That's those",false],[1361,1361,"appear",false],[1372,1377,"the",false],[1766,1775,"",false],[1855,1864,"arm. But",false],[1917,1917,"OK. Like pretty yeah when like",false],[1958,1966,"weekend.",false],[1971,1971,"I am",false],[2067,2073,"because",false],[2140,2147,"cannot uh",false],[2303,2303,"Yeah. Um have you",false],[2357,2361,"skins . 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OK.",false],[7854,7864,"",false],[7882,7910,"",false]],"facts":[["The note captures: Four-day history of the current skin flare.","partial","States '3-4 days' rather than four days."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red skin on chest, hands, inside elbows; dry cracked skin."],["The note captures: No bleeding or purulent discharge from the skin.","no","Absence of bleeding or discharge not recorded."],["The note captures: Itching disturbs sleep.","yes","'sleep disturbed'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","no","Neither work concentration nor hiking impact recorded."],["The note captures: Known eczema and past asthma.","partial","Prior eczema implied ('previous eczema') but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream not relieving recorded; previously helpful eczema treatments failing now omitted."],["The note captures: Antihistamines already tried have not helped.","partial","Records antihistamines tried without benefit but names '(loratadine/cetirizine)', which the patient never said."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'no identified triggers (no new shower gel, clothing)'."],["The note captures: Assessment is a likely eczema flare.","yes","'Likely flare-up of previous eczema'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","partial","'use emollients daily' recorded but bath/shower use omitted."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Trial fexofenadine'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'keep trigger diary'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Return in 1 week if no improvement'."]],"claims":[["Tried OTC antihistamines (loratadine/cetirizine) without benefit","Patient only said 'I have tried antihistamines'; no product was named and cetirizine is never mentioned (clinician suggested loratadine or Piriton as options)."]],"note":"Subjective\n\nChief Complaint::\n\nItchy, sore, red skin on chest, hands, inside elbows for 3‑4 days; sleep disturbed.\n\nHistory of Presenting Complaint::\n\nOnset 3‑4 days ago with intense itching and soreness.\n\nSymptoms constant, worse at night, not relieved by OTC steroid cream.\n\nDaily showers attempted for relief; no identified triggers (no new shower gel, clothing).\n\nObjective\n\nDry, cracked skin with rash on chest, hands, inside elbows, resembling prior eczema.\n\nRash appearance familiar to eczema.\n\nNot discussed\n\nAssessment\n\nLikely flare‑up of previous eczema.\n\nPlan\n\nMedications::\n\nPreviously used OTC steroid cream without relief.\n\nTried OTC antihistamines (loratadine/cetirizine) without benefit.\n\nClinician prescribed stronger steroid cream and fexofenadine.\n\nRecommended regular emollient use.\n\nPrescribe stronger topical steroid; use emollients daily for 7‑10 days.\n\nTrial fexofenadine; keep trigger diary.\n\nReturn in 1 week if no improvement.","review":153.06578947368422,"saved":163.43421052631578,"clean":false,"effort":36.666666666666664,"sig":[["missing","No bleeding or purulent discharge from the skin.","Screened-for signs of infection (no bleeding, pus or discharge) are absent, the key negative behind steroid-only treatment without antibiotics."],["partial","Antihistamines already tried have not helped.","Records specific antihistamines (loratadine/cetirizine) as failed that the patient never named, which could wrongly steer future drug choice."]],"mb":26.564626,"latency":50.252,"signable":203.31778947368423}]}}