{"reference":"Hello?\n\n Hello there.\n\n Uh, hello. Can you hear me OK?\n\n Yes, I can hear you.\n\n OK, great. . I am, yes. Nice to see you here, Oscar. Um, how can I help you this afternoon?\n\n Are you the doctor?\n\n Um, I'm, contacting you because I've been, quite short of breath lately.\n\n OK. Do you want to tell me a bit more about it? When did it all start?\n\n Uh, well it seems to have been, slowly getting worse over the last couple of weeks.\n\n Um, now it's, become quite troublesome, in the last few days.\n\n Uh, I kind of, normally I can walk to the shops, without a problem but, now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless, just about the house.\n\n And uh, it's got me kind of worried, don't really know what's going on.\n\n OK.\n\n OK. OK. Is there anything you're particularly worried about?\n\n Um, well, I've, I've uh, I've got um, heart failure.\n\n OK.\n\n Uh, I was told that, uh, a while ago.\n\n Um, and I got a bit breathless when I was first diagnosed, and put on some medicine that, that um, that helped, but I'm a bit worried it's just getting worse.\n\n OK.\n\n Right.\n\n Right, OK. So you mentioned you're feeling, uh, short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse.\n\n Um, uh, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, uh, with your breath? So, for example, any pain in your chest?\n\n No pain in my chest.\n\n OK. And have you found yourself coughing, coughing at all?\n\n Um.\n\n Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n OK. OK. And how's your general health otherwise? Are you feeling uh, weak, lethargic?\n\n Um, I'm feeling a little run-down, um, but otherwise, otherwise pretty normal.\n\n OK.\n\n I've noticed my ankles have got a bit bigger.\n\n OK. And what do you mean by that?\n\n Uh, it's just like, it's sort of swollen up a bit.\n\n OK. Um, is that, is that both ?\n\n Kind of . Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n Both ankles?\n\n OK. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n Um, I kind of noticed it the last few days.\n\n Past few days, OK. And is this something that you've had before, in the past?\n\n Uh, I think my ankles did swell up a bit last time, the heart failure was a problem.\n\n OK. OK. Um, fine. OK. So, um, just to really recap, uh, so you're really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\n\n Um, and some swelling in your ankles. Um, reporting no chest pain. Um, and, and have you had any, have you any, have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\n\n No, not really.\n\n OK. And any temperatures or fevers?\n\n Uh, no.\n\n OK. And how about your appetite? Are you eating and drinking OK?\n\n Yeah, I, , I'm, that's fine.\n\n OK. And your waterworks? Are you passing urine OK?\n\n Uh, yeah, but yeah. I usually pee a lot, , ever since the drugs .\n\n Yeah.\n\n Sure, OK. Alright. Um, fine. So, your uh, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n Uh, well I was told I had like a, they called it like a small heart attack.\n\n About, five years ago. Um, I uh, I had, I, I had like some chest pain and, they took me into hospital.\n\n OK.\n\n And um, they, uh, but then I just got better.\n\n OK. And when, when you say a small heart attack, did they give you a name, for what happened, a, a name of a diagnosis?\n\n Um.\n\n Uh, I can't remember. They just called it something a , uh, something like that, a small heart attack.\n\n It's more hard to say. OK. Was it like angina or, um,\n\n Um.\n\n Uh, no they, they said that it, uh, it seemed, it was like, more than angina.\n\n OK.\n\n Um, uh, but um, I didn't, but I only had to stay in hospital for a few days, and, uh.\n\n OK.\n\n OK.\n\n And yeah, I've been OK since then.\n\n You've been OK since then. OK, alright. So, apart from the uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n Uh, no, I think I'm otherwise, I'm OK.\n\n OK. Um, do you take any regular medications, apart from your diuretics that you're taking? And do you know which ones?\n\n Uh, yeah, I take something called Furosemide.\n\n . Do you know which dose you're taking?\n\n I can't remember, I'm sorry doctor. I have to check.\n\n That's OK.\n\n No problems. Um,\n\n Any other medications?\n\n Uh, yeah. I take Aspirin.\n\n OK.\n\n And uh, Bisoprolol.\n\n The Metoprolol, was it?\n\n Or?\n\n Uh, Bisoprolol.\n\n Sorry, the connection's not very good. OK. Thank you, yeah.\n\n Um, .\n\n And a thousand, OK. Alright. Any allergies at all? Any medications?\n\n Uh, no, no allergies.\n\n No.\n\n OK. And is there anything in the family that's, uh, that, that's uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n Uh , my, my father died of a, uh, of a heart attack.\n\n I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n Uh, he was, um, early sixties.\n\n Early sixties, OK. Alright. Anything else I should be aware of?\n\n Um, my mother had osteoporosis.\n\n OK.\n\n Is your mother still with us?\n\n Uh, yeah, she's still living.\n\n OK, alright. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n Uh, I live on my own. Well, I got two cats.\n\n You've got two cats. OK, great. Do they have names?\n\n They're my family. Uh, they're, they're called, um, they're called, Polly and Tim.\n\n OK.\n\n Um, so it's just you and your cats. And um, in terms of day to day, are you working at the moment?\n\n Uh, I work part-time as, a, uh, lorry driver.\n\n OK. And how is that? Is that quite stressful, long hours?\n\n Uh, it's OK. Um, I uh, yeah , when I'm working it's pretty exhausting.\n\n Mm.\n\n Um, I guess I'm a bit worried, that if I get sick I won't, if I get more sick then, I won't be able to work properly.\n\n Yeah, that's certainly a consideration, isn't it? So let's, let's try and get you better soon, so it doesn't have any um, impact on your, on your job.\n\n No.\n\n Uh, and do you find yourself doing a lot of anti-social hours? Do you , do you do a lot of night driving, weekend driving?\n\n Ohh no, I , I , I, I only take shifts during the day, I don't like working at night.\n\n OK.\n\n OK, alright. And what about smoking and alcohol? So, 'cause that can sometimes be very important when it comes to heart problems. Do you, do you smoke at all?\n\n Not any more.\n\n So, you used to smoke?\n\n Yeah.\n\n And how many did you smoke a day, on average?\n\n Ooh it was about, about a pack a day, back in the day.\n\n Um, and how many, how many years was that for?\n\n Ohh that was, oof, good twenty five years.\n\n OK. And what about the stopping? That must have been difficult for you. stopping. Um, and what, what about alcohol?\n\n I don't drink alcohol.\n\n OK. Do you do much in the way of exercise, sir?\n\n Uh, I try and walk to the shops, at least once a day.\n\n OK.\n\n Um, but uh, that's about it, I've. Yeah, I don't, I don't go running like I used to when i was young.\n\n OK.\n\n Right, OK. And certainly now your symptoms, you, you're, you said you're feeling more breathless even walking to the uh, to the shop, she said.\n\n Um, right. Ohh um, based on your, based on you history, and having listened to your story, I, I wonder whether you've had a flare-up of your heart failure, sir. Um,\n\n Which can sometimes happen. Um, um, and uh,\n\n Mmm.\n\n That.\n\n It's . So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously\n\n What's going on.\n\n Um, that's the first thing that comes to my mind. Um, now there's a couple of options move forward. Um,\n\n Mmm.\n\n Given that you're otherwise well at the moment, and having examined you, your chest, and your saturations and blood pressure are all OK,\n\n I'm quite happy to increase your dose of Furosemide. Maybe, rather than one tablet a day, we can do two tablets a day, for the first few days.\n\n Um, and see, and see how you're getting on.\n\n OK. If you think that'll be better.\n\n Uh,\n\n I think, I think, it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n OK.\n\n Is that something you've had before? Yeah, so um, an , it's a, it's a general scan of your heart. You might have had this done before, when you were diagnosed. And it's just to get a good\n\n What does that?\n\n Ohh yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now. .\n\n You remember that. OK, fine. That's something I can organize for you today. And, and that might take a week or two weeks for that to be organized. But, I think certainly in the meantime, let's, um,\n\n Let's, let's get a blood test done. We can check your um, you know your full blood count, look for signs of anemia. We can have a check of your kidney function.\n\n Um, and we can definitely increase your um, your Furosemide, uh, to you know, one tablet twice a day.\n\n But I really like, would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime if you are getting more unwell, feel like you're getting more breathless, or you're having any other symptoms like chest pain, or palpitations or dizziness, then, uh, you know I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n OK. I'll see how I get on.\n\n OK? Do you have any questions for me?\n\n Uh, I think that's all pretty clear. Thank you very much Doctor.\n\n Great, and then well I wish you all the best! Have a good day. OK. Thank you.\n\n OK. See you soon.","products":{"hanah":[{"label":"Run 1","wer":15.002698327037237,"text":"Okay.\n\n  Hello.\n\n  Hello there.\n\n  Uh, hello. Can you hear me okay?\n\n  Yes, I can hear you.\n\n  Okay, great.\n\n  Are you the doctor?\n\n  Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n  Um, I'm contacting you because I've been quite short of breath lately.\n\n  Okay. Do you want to tell me a bit more about it? So when did it all start?\n\n  Uh, well, it seems to have been slowly getting worse over the last couple of weeks, um, and it's become quite troublesome in the last few days.\n\n  Okay.\n\n  Uh, I kind of normally I can walk to the shop without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n  Okay.\n\n  And, uh, it's got me kind of worried. I don't really know what's going on.\n\n  Okay. Okay. Is there anything you're particularly worried about?\n\n  Um, well, I've, I've, uh, I've got, um, heart failure.\n\n  Okay.\n\n  Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed.\n\n  Right.\n\n  And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n  Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n  No pain in my chest.\n\n  Okay. Have you found yourself coughing, coughing at all?\n\n  Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n  Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n  Um, I'm feeling a little run down. Um, but otherwise, otherwise pretty normal.\n\n  Okay.\n\n  I've noticed my ankles have got a bit bigger.\n\n  Okay. And what do you mean by that?\n\n  Uh, it's just like they've sort of swollen up a bit.\n\n  Okay. Um, is that is that both.\n\n  Kind of.\n\n  Both ankles?\n\n  Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n  Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n  Um, I kind of noticed it the last few days.\n\n  Last few days. Okay. And is this something that you've had before in the past?\n\n  Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n  Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so you really in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had have you have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n\n  No, not really.\n\n  Okay. And any temperatures or fevers?\n\n  Uh, no.\n\n  Okay. And how about your appetite? Are you eating and drinking okay?\n\n  Yeah, I'm, I'm that's fine.\n\n  Okay. And your water work, are you passing urine okay?\n\n  Uh, yeah, that yeah. I usually pee a lot.\n\n  Yeah.\n\n  A little bit since the drugs came out.\n\n  Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n  Uh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to the hospital.\n\n  Okay.\n\n  And, um, they, uh but then I just got better.\n\n  Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n  Uh, I can't remember. They just called it a something like that, a small heart attack.\n\n  Small heart attack. Okay. Was it something like angina or, um?\n\n  Um, I know. They, they said they i-it seemed it was, like, more than angina.\n\n  Okay.\n\n  Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and.\n\n  Okay.\n\n  Uh, and yeah, I've been okay since then.\n\n  You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n  Uh, no, I think I'm otherwise I'm okay.\n\n  Okay.\n\n  Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide.\n\n  Furosemide. And do you know which dose you're taking?\n\n  Uh, I can't remember. I'm sorry, doctor.\n\n  That's okay.\n\n  I'd have to check.\n\n  No problems. Um, any other medications?\n\n  Uh, yeah, I take aspirin.\n\n  Okay.\n\n  And, uh, bisoprolol.\n\n  Is that metoprolol, was it? Or.\n\n  Uh, bisoprolol.\n\n  Sorry, the connection's not very good. Okay, thank you. Yep.\n\n  Great.\n\n  Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n  Uh, no.\n\n  No.\n\n  No, no allergies.\n\n  Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n  Uh, my, my father died of a, uh, of a heart attack.\n\n  I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n  Uh, he was, um, early 60s.\n\n  Early 60s. Okay. Uh, anything else I should be aware of?\n\n  Um, my mother had osteoporosis.\n\n  Okay. Is your mother still with us?\n\n  Uh, yeah, she's still living.\n\n  Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n  Uh, I live on my own. Uh, I've got two cats.\n\n  You've got two cats. Okay, great. Do they have names?\n\n  They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n  Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n  Uh, I work part-time as a, uh, lorry driver.\n\n  Okay. And how is that? Is that quite stressful, long hours?\n\n  Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n  Hmm.\n\n  Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n  Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n  Oh, no. I, I, I, I only take shifts during the day.\n\n  Okay.\n\n  I don't like working at night.\n\n  Okay. All right. And what about smoking and alcohol, sir? 'Cause they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n  Not anymore.\n\n  So you used to smoke?\n\n  Yeah.\n\n  And how many did you smoke a day on average?\n\n  Oh, it was about, about a pack a day. Back in the day.\n\n  Um, and how many, how many years was that for?\n\n  Oh, that was oof, a good 25 years.\n\n  Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n  I don't drink alcohol.\n\n  Okay. Do you do much in the way of exercise, sir?\n\n  Uh, I try and walk to the shops, at least once a day.\n\n  Okay.\n\n  Um, but, uh, that's about it. I've yeah, I don't I don't go running like I used to when I was young.\n\n  Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless, even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know.\n\n  That's.\n\n  It's.\n\n  What's going on?\n\n  So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see and see how you're getting on.\n\n  Okay, if you think that would be best.\n\n  I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n  Okay.\n\n  Is that something you've had.\n\n  I design.\n\n  Yeah. So, um, an echo scan, it's a it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n  Oh, yes, I remember now.\n\n  Sorry?\n\n  Uh, yeah, I remember now.\n\n  You remember now. Okay, fine. That's something I can organise for you today, and, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day. But I'd really like we'd like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n  I think that sounds like a good plan.\n\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n  Okay. I'll see how I get on.\n\n  Okay. Do you have any questions for me?\n\n  Uh, nothing else. All pretty clear. Thank you very much, doctor.\n\n  Great. No, I wish you all the best.\n\n  Thank you.\n\n  Have a good day.\n\n  Thank you. See you soon.\n\n  Okay. 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no explicit concern that HF is worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","Note captures mild dry cough."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","Note captures run-down, otherwise normal."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","yes","Note captures ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","Note captures ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","Note captures urine OK, frequent since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Note captures known heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Breathlessness at diagnosis improving with medication not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","Note captures small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'hospitalised for few days' but no chest pain presentation."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Note does not document previous echo."],["The note captures: No other past medical history apart from the heart problems.","partial","PMH lists only cardiac history; no explicit statement of no other history."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","yes","Note captures furosemide one tablet daily, mg unknown."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","yes","Note captures bisoprolol."],["The note captures: No known drug allergies.","yes","Note captures NKDA."],["The note captures: Father died of a heart attack.","yes","Note captures father died of heart attack."],["The note captures: Father was in his early sixties when he died.","yes","Note captures father early sixties."],["The note captures: Mother has osteoporosis.","yes","Note captures mother osteoporosis."],["The note captures: Lives alone.","yes","Note captures lives alone."],["The note captures: Works part-time as a lorry driver.","yes","Note captures part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Worry about ability to work captured but not that work is exhausting."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","Note captures pack a day."],["The note captures: Smoked for about 25 years.","yes","Note captures 25 years."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","Note captures walks to shops daily."],["The note captures: Chest examination OK.","yes","Note captures chest exam OK."],["The note captures: Oxygen saturations OK.","yes","Note captures saturations OK."],["The note captures: Blood pressure OK.","yes","Note captures BP OK."],["The note captures: Otherwise well at the moment.","yes","Note captures otherwise well at moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","Note captures for first few days then review."],["The note captures: Blood test: full blood count to look for anaemia.","yes","Note captures FBC for anaemia."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","Note captures echo requested, 1-2 weeks."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"Date: 27 September 2026\n\nClinician: Ahmed Hakeem — Physiotherapist  \n\nSubjective\nProgressive SOB x2 weeks; markedly worse past few days.\n↓ exercise tolerance: previously able to walk to shops; now needs to stop/sit to catch breath. SOB also occurring around house.\nDry cough, not troublesome.\nBilateral ankle swelling xfew days; similar to previous HF deterioration.\nFeels mildly run down; otherwise feels well.\nDenies CP, palpitations/skipped beats, fever.\nEating/drinking and passing urine normally; reports increased urination since starting medication.\nPMH: HF; “small heart attack” approx. 5 yrs ago, hospitalised for few days.\nMeds: furosemide (dose unknown), aspirin, bisoprolol, simvastatin. NKDA.\nFHx: father died of MI in early 60s; mother has osteoporosis.\nLives alone with 2 cats. Part-time lorry driver; concerned worsening illness may affect ability to work.\nEx-smoker: ~1 pack/day x25 yrs. No alcohol.\nUsually walks to shops daily; currently limited by SOB.\nObjective\nClinician states chest examination, SpO₂ and BP were “okay”; no values documented.\nAssessment\nSuspected HF exacerbation, supported by progressive exertional/minimal-activity SOB, dry cough and new bilateral ankle oedema, with known HF and similar prior episode.\nNo reported CP, palpitations or fever.\nPlan\nIncrease furosemide from 1 tablet daily to 1 tablet BD for first few days.\nArrange blood tests: FBC to assess for anaemia; renal function.\nOrganise echocardiogram to assess cardiac pumping function; may take 1–2 weeks.\nReview in ~1 week.\nSeek earlier review/contact if worsening SOB, CP, palpitations or dizziness.","review":204.10526315789474,"saved":281.89473684210526,"faster":58.003032272038126,"clean":false,"effort":12.264150943396226,"sig":[["partial","Concerned that his heart failure is getting worse.","Only 'concerned worsening illness may affect ability to work'; no explicit concern that HF is worsening."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Breathlessness at diagnosis improving with medication not recorded."],["partial","That episode presented with chest pain and he was admitted to hospital.","'hospitalised for few days' but no chest pain presentation."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Note does not document previous echo."],["partial","No other past medical history apart from the heart problems.","PMH lists only cardiac history; no explicit statement of no other history."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Worry about ability to work captured but not that work is exhausting."],["fabrication","Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]]},{"label":"Run 2","wer":17.05342687533729,"text":"Okay.\n\n  Hello,.\n\n  Hello there.\n\n  Uh, hello, can you hear me okay?\n\n  Yes.\n\n  I can hear you.\n\n  Okay.\n\n  Great.\n\n  Are you the doctor?\n\n  Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n  Um, I'm contacting you because I've been quite short of breath lately.\n\n  Okay. Do you want to tell me a bit more about it? So when did it all start?\n\n  Uh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, it's become quite troublesome in the last few days.\n\n  Okay.\n\n  Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n  Okay.\n\n  And, uh, it's got me kind of worried. I don't really know what's going on.\n\n  Okay. Okay. Is there anything you're particularly worried about?\n\n  Um, well, I've, I've, uh, I've got, um, heart failure.\n\n  Okay.\n\n  Uh, I was told that, uh, a while ago. Um, and I got a bit breathless when I was first diagnosed.\n\n  Right.\n\n  And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n  Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n  No pain in my chest.\n\n  Okay. Have you found yourself coughing, coughing at all?\n\n  Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n  Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n  Um, I'm feeling a little rundown. Um, but otherwise, otherwise pretty normal.\n\n  Okay.\n\n  I've noticed my ankles have got a bit bigger.\n\n  Okay. And what do you mean by that?\n\n  Uh, it's just like they've sort of swollen up a bit.\n\n  Okay. Um, is that is that both.\n\n  Kind of.\n\n  Both ankles?\n\n  Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n  Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n  Um, I kind of noticed it the last few days.\n\n  Last few days. Okay. And is this something that you've had before in the past?\n\n  Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n  Okay. Okay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat?\n\n  No, not really.\n\n  Okay. And any temperatures or fevers?\n\n  Uh, no.\n\n  Okay. And how about your appetite? Are you eating and drinking okay?\n\n  Yeah, I'm, I'm that's fine.\n\n  Okay. And your water work, are you passing urine okay?\n\n  Uh, yeah, that yeah. I usually pee a lot.\n\n  Yeah.\n\n  A little bit since the drugs came out.\n\n  Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n  Uh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to hospital.\n\n  Okay.\n\n  And, um, they, uh but then I just got better.\n\n  Okay.\n\n  Um.\n\n  And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n  Uh, I can't remember. They just called it a s it's something like that, a small heart attack.\n\n  Small heart attack. Okay. Was it something like angina or, um?\n\n  Um, uh, no. They, they said they i-it seemed it was, like, more than angina.\n\n  Okay.\n\n  Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and.\n\n  Okay.\n\n  Uh, and yeah, I've been okay since then.\n\n  You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n  Uh, no, I think I'm otherwise I'm okay.\n\n  Okay.\n\n  Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide.\n\n  Furosemide. And do you know which dose you're taking?\n\n  Uh, I can't remember. I'm sorry, doctor.\n\n  That's okay.\n\n  I'd have to check.\n\n  No problems. Um, any other medications?\n\n  Uh, yeah, I take aspirin.\n\n  Okay.\n\n  And, uh, bisoprolol.\n\n  Is that metoprolol, was this? Or.\n\n  Uh, bisoprolol.\n\n  Sorry, the connection's not very good. Okay, thank you. Yep.\n\n  Great.\n\n  Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n  Uh, no.\n\n  No.\n\n  No, no allergies.\n\n  Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n  Uh, my, my father died of a, uh, of a heart attack.\n\n  I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n  Uh, he was, um, early 60s.\n\n  Early 60s. Okay. Uh, anything else I should be aware of?\n\n  Um, my mother had osteoporosis.\n\n  Okay. Did your mother still with us?\n\n  Uh, yeah, she's still living.\n\n  Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n  Uh, I live on my own. Uh, I've got two cats.\n\n  You've got two cats. Okay, great. Do they have names?\n\n  They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n  Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n  Uh, I work part-time as a, uh, lorry driver.\n\n  Okay. And how is that? Is that quite stressful, long hours?\n\n  Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n  Hmm.\n\n  Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n  Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um.\n\n  Yeah.\n\n  Impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n  Oh, no. I, I, I, I only take shifts.\n\n During the day.\n\n Thank you.\n\n I don't like working at night.\n\n Thank you. All right. And what about smoking and alcohol, though, because it can sometimes be very important when it comes to heart problems. Do you smoke at all?\n\n Not anymore.\n\n So you used to smoke.\n\n Yeah.\n\n And how many do you smoke a day, on average?\n\n Ooh, it was about a pack a day. Back in the day.\n\n And how many years was that for?\n\n Oh, that was.\n\n Oof. Good 25 years.\n\n Okay. Well done for stopping. I'm— I must have been very difficult for you, but well done for stopping. Um, and what about alcohol?\n\n I don't drink alcohol.\n\n Okay. Do you do much in the way of exercise, though?\n\n Uh, I try and walk to the shops at least once a day.\n\n Okay.\n\n Um, but, uh, that's about it. I've— yeah, I don't. I don't go running like I used to when I was young.\n\n Right. Okay. And sessions.\n\n She now, your symptoms— you said you're feeling more breathless even walking to the shop, she said. Right, so based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen, and you know it's.\n\n What's going on?\n\n So it seems like your heart's not pumping as well as it should be, and obviously having diagnosed with heart failure, that's obviously the first thing that comes to mind.\n\n To my mind. Now, there's a couple of options for us to move forward. Given that you're otherwise well at the moment, and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of furosemide. So maybe, rather than 1 tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n\n Okay. I do think that would be best.\n\n I think it's definitely worth treating your symptoms, but.\n\n What we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, to see how well your heart's pumping.\n\n Okay.\n\n Is that something you've had.\n\n I've designed.\n\n Yeah. So, um, an echo scan— it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good.\n\n Oh, yes, I remember now.\n\n Sorry?\n\n Uh, yeah, I remember now.\n\n You remember now, okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized, but I think.\n\n Sir, in the meantime, let's—let's get a blood test done. We can check your, you know, your full blood count and look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your furosemide to, you know, 1 tablet twice a day. But I'd really like—would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n I think that sounds like a good plan.\n\n And of course, in the meantime, if you are getting more unwell—so if you're getting more breathless.\n\n So are you having any other symptoms like chest pain, or palpitations, or dizziness? Then you can say, \"I want you to give me a call sooner than that,\" and we can have a chat on the phone as well.\n\n Okay, I'll see how I get on.\n\n Okay. Do you have any questions for me?\n\n Uh, nothing. That's all pretty clear. Thank you very much, Doctor.\n\n Great. Now I wish you all the best. Have a good day.\n\n Okay, see you soon.\n\n Okay, thank you.","marks":[[118,143,".",false],[156,164,"Nice to see you",false],[171,177,"Oscar.",false],[215,215,"Are you the doctor",false],[459,459,"now",false],[659,663,"really",false],[1188,1199,"you're",false],[1229,1233,"for",false],[1295,1298,"it's",false],[1792,1800,"run-down",false],[1964,1971,"it's",false],[2048,2059,".",false],[2121,2126,"Both ankles OK.",false],[2267,2271,"Past",false],[2497,2500,"you're",false],[2702,2717,"reporting",false],[2777,2777,"any",false],[3015,3018,"I",false],[3055,3065,"waterworks",false],[3143,3164,"ever",false],[3181,3190,". Yeah.",false],[3200,3216,"OK. Alright.",false],[3230,3242,"",false],[3526,3528,"into",false],[3773,3773,"something",false],[3776,3782,"uh",false],[3829,3854,"It's more hard to say. 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OK.",false],[9993,10009,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'Progressive SOB'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","partial","'Progressive SOB x few weeks' - vaguer than the couple of weeks stated."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'markedly worse x few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'Now needs to stop/catch breath walking to shops'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'SOB also around house'."],["The note captures: Concerned that his heart failure is getting worse.","no","Concern that heart failure is worsening not documented."],["The note captures: No chest pain.","yes","'Denies CP'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'Feels mildly run-down'."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'x few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'similar during previous HF deterioration'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'Denies ... palpitations'."],["The note captures: No fevers or temperatures.","yes","'Denies ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Eating/drinking ... normally'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'passing urine normally; reports increased urination since starting medication'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'PMH: HF'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Breathlessness at diagnosis improving with medication not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'\"small heart attack\" ~5 yrs ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'requiring brief admission' but presenting chest pain omitted."],["The note captures: Has been well since the heart attack.","no","Not stated he has been well since."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement of no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'furosemide'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","yes","'dose unknown' and 'from 1 tablet daily'."],["The note captures: Takes aspirin.","yes","'aspirin'."],["The note captures: Takes bisoprolol.","yes","'bisoprolol'."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'father died of MI'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother has osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with 2 cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Worry about ability to work captured; work being exhausting omitted."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'x 25 yrs'."],["The note captures: Does not drink alcohol.","yes","'No alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Usually walks to shops daily'."],["The note captures: Chest examination OK.","yes","'Chest examined; documented as okay'."],["The note captures: Oxygen saturations OK.","yes","'SpO2 ... documented as okay'."],["The note captures: Blood pressure OK.","yes","'BP documented as okay'."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not stated."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Suspected HF exacerbation'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide from 1 tablet daily to 1 tablet BD'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'FBC for anaemia'."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to assess cardiac pumping function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1-2 weeks'."],["The note captures: Follow-up review in about one week.","yes","'Review in ~1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'earlier contact if worsening SOB'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'CP, palpitations or dizziness'."]],"claims":[["Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"Subjective\nProgressive SOB x few weeks; markedly worse x few days.\nNow needs to stop/catch breath walking to shops; SOB also around house.\nDry cough, not troublesome. Feels mildly run-down.\nBilateral ankle swelling x few days; similar during previous HF deterioration.\nDenies CP, palpitations, fever. Eating/drinking and passing urine normally; reports increased urination since starting medication.\nPMH: HF; “small heart attack” ~5 yrs ago requiring brief admission.\nMeds: furosemide (dose unknown), aspirin, bisoprolol, simvastatin. NKDA.\nFHx: father died of MI in early 60s; mother has osteoporosis.\nLives alone with 2 cats. Part-time lorry driver; concerned worsening illness may affect ability to work.\nEx-smoker: ~1 pack/day x 25 yrs. No alcohol. Usually walks to shops daily; activity currently limited by SOB.\nObjective\nChest examined; documented as okay.\nSpO₂ and BP documented as okay; values not recorded.\nAssessment\nSuspected HF exacerbation: progressive exertional SOB, dry cough and recent bilateral ankle oedema, with known HF and similar prior episode.\nNo reported CP, palpitations or fever.\nMild fatigue/run-down feeling.\nPlan\nIncrease furosemide from 1 tablet daily to 1 tablet BD for first few days.\nBlood tests: FBC for anaemia; renal function.\nArrange echocardiogram to assess cardiac pumping function; may take 1–2 weeks.\nReview in ~1 week.\nAdvise earlier contact if worsening SOB, CP, palpitations or dizziness.","review":237.03947368421052,"saved":248.96052631578948,"faster":51.2264457439896,"clean":false,"effort":16.9811320754717,"sig":[["partial","Breathlessness has been gradually worsening over the last couple of weeks.","'Progressive SOB x few weeks' - vaguer than the couple of weeks stated."],["missing","Concerned that his heart failure is getting worse.","Concern that heart failure is worsening not documented."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Breathlessness at diagnosis improving with medication not recorded."],["partial","That episode presented with chest pain and he was admitted to hospital.","'requiring brief admission' but presenting chest pain omitted."],["missing","Has been well since the heart attack.","Not stated he has been well since."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement of no other past medical history."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Worry about ability to work captured; work being exhausting omitted."],["missing","Otherwise well at the moment.","'Otherwise well' not stated."],["fabrication","Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"mb":9.912976,"latency":34.109,"finalised":271.1484736842105},{"label":"Run 3","wer":14.84079870480302,"text":"Hello.\n\n  Hello there.\n\n  Uh, hello, can you hear me okay?\n\n  Yes, I can hear you.\n\n  Okay.\n\n  Great.\n\n  Are you a doctor? Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n  Um, I'm contacting you because I've been quite short of breath lately.\n\n  Okay. Do you want to tell me a bit more about you? When did it all start?\n\n  Uh, well, it seems to have been slowly getting worse over the last couple of weeks, um, and it's become quite troublesome in the last few days.\n\n  Okay.\n\n  Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n  Okay.\n\n  And, uh, it's got me kind of worried. I don't really know what's going on.\n\n  Okay. Okay. Is there anything you're particularly worried about?\n\n  Um, well, I've, I've, uh, I've got, um, heart failure.\n\n  Okay.\n\n  Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed.\n\n  Right.\n\n  And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n  Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days it's got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n  No pain in my chest.\n\n  Okay. Have you found yourself coughing, coughing at all?\n\n  Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n  Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n  Um, I'm feeling a little run down. Um, but otherwise, otherwise pretty normal.\n\n  Okay.\n\n  I've noticed my ankles have got a bit bigger.\n\n  Okay. And what do you mean by that?\n\n  Uh, it's just like they've sort of swollen up a bit.\n\n  Okay. Um, is that, is that both.\n\n  Kind of.\n\n  Both ankles?\n\n  Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n  Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n  Um, I kind of noticed it the last few days.\n\n  Last few days. Okay. And is this something that you've had before in the past?\n\n  Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n  Okay. Okay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat?\n\n  No, not really.\n\n  Okay. And any temperatures or fevers?\n\n  Uh, no.\n\n  Okay. And how about your appetite? Are you eating and drinking okay?\n\n  Yeah, I'm, I'm, that's fine.\n\n  Okay. And your water work, are you passing urine okay?\n\n  Uh, yeah, that, yeah. I usually pee a lot.\n\n  Yeah.\n\n  A little bit since the drugs came out.\n\n  Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n  Uh, well, I was told I had, like, uh, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to the hospital.\n\n  Okay.\n\n  And, um, they, uh, but then I just got better.\n\n  Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n  Uh, I can't remember. They just called it a s-something like that, a small heart attack.\n\n  Small heart attack. Okay. Was it something like angina or, um?\n\n  Um, uh, no. They, they said they i-it seemed it was, like, more than angina.\n\n  Okay.\n\n  Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and.\n\n  Okay.\n\n  Uh, and yeah, I've been okay since then.\n\n  You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n  Uh, no, I think I'm otherwise I'm okay.\n\n  Okay.\n\n  Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide.\n\n  Furosemide. And do you know which dose you're taking?\n\n  Uh, I can't remember. I'm sorry, doctor.\n\n  That's okay.\n\n  I have to check.\n\n  No problems. Um, any other medications?\n\n  Uh, yeah, I take aspirin.\n\n  Okay.\n\n  And, uh, bisoprolol.\n\n  Is that metoprolol, was this? Or.\n\n  Uh, bisoprolol.\n\n  Sorry, the connection's not very good. Okay, thank you. Yep.\n\n  Great.\n\n  Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n  Uh, no, no allergies.\n\n  Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n  Uh, my, my father died of a, uh, of a heart attack.\n\n  I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n  Uh, he was, um, early 60s.\n\n  Early 60s. Okay. Uh, anything else I should be aware of?\n\n  Um, my mother had osteoporosis.\n\n  Okay. Did your mother still with us?\n\n  Uh, yeah, she's still living.\n\n  Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n  Uh, I live on my own. I mean, I've got two cats.\n\n  You've got two cats. Okay, great. Do they have names?\n\n  They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n  Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n  Uh, I work part-time as a, uh, lorry driver.\n\n  Okay. And how is that? Is that quite stressful, long hours?\n\n  Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n  Hmm.\n\n  Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n  Yeah, this is certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n  Oh, no. I, I, I, I only take shifts during the day.\n\n  Okay.\n\n  I don't like working at night.\n\n  Okay. All right. And what about smoking and alcohol, sir? Because it, it can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n  Not anymore.\n\n  So you used to smoke?\n\n  Yeah.\n\n  And how many did you smoke a day, on average?\n\n  Ooh, it was about, about a pack a day. Back in the day.\n\n  Um, and how many, how many years was that for?\n\n  Oh, that was, oof, a good 25 years.\n\n  Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n  I don't drink alcohol.\n\n  Okay. Do you do much in the way of exercise, sir?\n\n  Uh, I try and walk to the shops at least once a day.\n\n  Okay.\n\n  Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young.\n\n  Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless, even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know.\n\n  That's.\n\n  It's.\n\n  What's going on?\n\n  So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\n\n  Okay. If you think that would be best.\n\n  I think, I think it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n  Okay.\n\n  Is that something you've had.\n\n  What does that.\n\n  Yeah. So, um, an echo sca uh, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n  Oh, yes, I remember now.\n\n  Sorry?\n\n  Uh, yeah, I remember now.\n\n  You remember now. Okay, fine. That's something I can organise for you today. And, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day. But I'd really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n  I think that sounds like a good plan.\n\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n  Okay. I'll see how I get on.\n\n  Okay. Do you have any questions for me?\n\n  Uh, nothing. That's all pretty clear. Thank you very much, doctor.\n\n  Great. No, I wish you all the best. Have a good day.\n\n  Okay. See you soon.\n\n  Okay. Thank you.","marks":[[105,125,".",false],[138,146,"Nice to see you",false],[153,159,"Oscar.",false],[197,197,"Are you the doctor",false],[441,444,"now",false],[643,647,"really",false],[1172,1183,"you're",false],[1213,1217,"for",false],[1950,1957,"it's",false],[2035,2046,".",false],[2108,2113,"Both ankles OK.",false],[2254,2258,"Past",false],[2484,2487,"you're",false],[2575,2579,"in",false],[2691,2706,"reporting",false],[2767,2767,"any",false],[3006,3009,"I",false],[3047,3057,"waterworks",false],[3136,3157,"ever",false],[3174,3183,". Yeah.",false],[3193,3209,"OK. Alright.",false],[3223,3235,"",false],[3522,3528,"into",false],[3764,3764,"something",false],[3767,3778,"uh something",false],[3815,3840,"It's more hard to say. OK.",false],[3848,3857,"",false],[3909,3918,"that it uh it",false],[4136,4152,"OK alright.",false],[4487,4502,".",false],[4588,4600,"",false],[4620,4620,"That's OK.",false],[4841,4855,"yeah.",false],[4868,4914,"a thousand OK. 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OK.",false],[10194,10210,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","Note captures gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","Note captures worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","Note captures previously walked to shops, now sits to catch breath."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Note captures breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","yes","Note captures concern HF worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","partial","Records 'Dry cough' but omits that it is mild/not troublesome."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","Records 'mild fatigue/run-down' but not that he otherwise feels normal."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","yes","Note captures ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","Note captures ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","States 'urination unchanged' but omits the frequent urination since starting the diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Note captures known heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Not documented that he was breathless at diagnosis and improved on medication."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","Note captures small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Mentions 'requiring hospital admission' but not the chest pain presentation."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Note does not document previous echo."],["The note captures: No other past medical history apart from the heart problems.","partial","PMH lists only HF and heart attack; absence of other history not explicitly stated."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","yes","Note captures furosemide one tablet daily, mg unknown."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","yes","Note captures bisoprolol."],["The note captures: No known drug allergies.","yes","Note captures NKDA."],["The note captures: Father died of a heart attack.","yes","Note captures father died of heart attack."],["The note captures: Father was in his early sixties when he died.","yes","Note captures father early sixties."],["The note captures: Mother has osteoporosis.","yes","Note captures mother osteoporosis."],["The note captures: Lives alone.","yes","Note captures lives alone."],["The note captures: Works part-time as a lorry driver.","yes","Note captures part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Note only partly captures work exhausting, worried about work."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","Note captures pack a day."],["The note captures: Smoked for about 25 years.","yes","Note captures 25 years."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","Note captures walks to shops daily."],["The note captures: Chest examination OK.","yes","Note captures chest exam OK."],["The note captures: Oxygen saturations OK.","yes","Note captures saturations OK."],["The note captures: Blood pressure OK.","yes","Note captures BP OK."],["The note captures: Otherwise well at the moment.","no","Does not record that the doctor judged him otherwise well at the moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","Note captures for first few days then review."],["The note captures: Blood test: full blood count to look for anaemia.","partial","Lists 'FBC' but not its purpose of checking for anaemia."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","Note captures echo requested, 1-2 weeks."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Meds: ... simvastatin","Simvastatin is never mentioned in the transcript; patient lists furosemide, aspirin and bisoprolol only."]],"note":"Subjective\nProgressive SOB x2 weeks, markedly worse xfew days; now requires rest walking to shops and SOB with activity around home.\nDry cough; mild fatigue/run-down.\nBilateral ankle swelling xfew days; similar during prior HF deterioration.\nDenies CP, palpitations/skipped beats, fever. Appetite/fluid intake and urination unchanged.\nConcerned HF is worsening and may affect ability to work.\nPMH: HF; “small heart attack” requiring hospital admission ~5 yrs ago; exact diagnosis unknown.\nMeds: furosemide (dose unknown), aspirin, bisoprolol, simvastatin. NKDA.\nFHx: father died of heart attack in early 60s; mother has osteoporosis.\nLives alone with 2 cats. Part-time lorry driver, daytime shifts.\nEx-smoker: ~1 pack/day x25 yrs. No alcohol. Usually walks to shops daily.\nObjective\nChest examination, SpO₂ and BP documented as “okay” by clinician.\nAssessment\nSuspected HF exacerbation, supported by progressive exertional → minimal-exertion SOB, dry cough and new bilateral ankle oedema, with similar symptoms during previous HF deterioration.\nNo reported CP, palpitations or fever.\nPlan\nIncrease furosemide from 1 tablet daily to 1 tablet BD for first few days.\nArrange blood tests: FBC and renal function.\nArrange echocardiogram to assess cardiac pumping function; may take 1–2 weeks.\nF/u in ~1 week to assess response.\nAdvise earlier contact if worsening SOB, CP, palpitations or dizziness.","review":246.44736842105263,"saved":239.55263157894737,"faster":49.29066493393979,"clean":false,"effort":16.9811320754717,"sig":[["partial","Has a mild dry cough that is not too troublesome.","Records 'Dry cough' but omits that it is mild/not troublesome."],["partial","Feels a little run-down; otherwise feels generally normal.","Records 'mild fatigue/run-down' but not that he otherwise feels normal."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","States 'urination unchanged' but omits the frequent urination since starting the diuretic."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Not documented that he was breathless at diagnosis and improved on medication."],["partial","That episode presented with chest pain and he was admitted to hospital.","Mentions 'requiring hospital admission' but not the chest pain presentation."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Note does not document previous echo."],["partial","No other past medical history apart from the heart problems.","PMH lists only HF and heart attack; absence of other history not explicitly stated."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Note only partly captures work exhausting, worried about work."],["missing","Otherwise well at the moment.","Does not record that the doctor judged him otherwise well at the moment."],["partial","Blood test: full blood count to look for anaemia.","Lists 'FBC' but not its purpose of checking for anaemia."],["fabrication","Meds: ... simvastatin","Simvastatin is never mentioned in the transcript; patient lists furosemide, aspirin and bisoprolol only."]],"mb":10.05611,"latency":16.497,"finalised":262.9443684210526},{"label":"Run 4","wer":15.380464112250406,"text":"Okay.\n\n  Hello.\n\n  Hello there.\n\n  Uh, hello. Can you hear me okay?\n\n  Yes, I can hear you.\n\n  Okay.\n\n  Great.\n\n  Are you the doctor? Oh, I am, yes. Dr. Sood here, Oskar. Um, how can I help you this afternoon?\n\n  Um, I'm contacting you because I've been quite short of breath lately.\n\n  Okay. Do you want to tell me a bit more about it? So when did it all start?\n\n  Uh, well, it seems to have been slowly getting worse over the last couple of weeks, um, and it's become quite troublesome in the last few days.\n\n  Okay.\n\n  Uh, I kind of normally I can walk to the shop without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n  Okay.\n\n  And, uh, it's got me kind of worried. I don't really know what's going on.\n\n  Okay. Okay. Is there anything you're particularly worried about?\n\n  Um, well, I've, I've, uh, I've got, um, heart failure.\n\n  Okay.\n\n  Uh, I was told that, uh, a while ago.\n\n  Okay.\n\n  Um, and I got a bit breathless when I was first diagnosed.\n\n  Right.\n\n  And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n  Right. Okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n  No pain in my chest.\n\n  Okay. Have you found yourself coughing, coughing at all?\n\n  Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n  Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n  Um, I'm feeling a little run down. Um, but otherwise, otherwise pretty normal.\n\n  Okay.\n\n  I've noticed my ankles have got a bit bigger.\n\n  Okay. And what do you mean by that?\n\n  Uh, it's just like they've sort of swollen up a bit.\n\n  Okay. Um, is that is that both.\n\n  Kind of.\n\n  Both ankles?\n\n  Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n  Okay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\n\n  Um, I kind of noticed it the last few days.\n\n  Last few days. Okay. And is this something that you've had before in the past?\n\n  Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n  Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so you really in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any have you have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n\n  No, not really.\n\n  Okay. And any temperatures or fevers?\n\n  Uh, no.\n\n  Okay. And how about your appetite? Are you eating and drinking okay?\n\n  Yeah, I'm, I'm that's fine.\n\n  Okay. And your water work, are you passing urine okay?\n\n  Uh, yeah, that yeah, I usually pee a lot.\n\n  Yeah.\n\n  A little bit.\n\n  Okay.\n\n  A little bit since the drugs came out.\n\n  Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n  Uh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to the hospital.\n\n  Okay.\n\n  And, um, they, uh but then I just got better.\n\n  Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n  Uh, I can't remember. They just called it a something like that, a small heart attack.\n\n  A small heart attack. Okay. Was it something like angina or, um?\n\n  Um, I know. They, they said they i-it seemed it was, like, more than angina.\n\n  Okay.\n\n  Um, uh, but, um, I didn't but I only had to stay in the hospital for a few days.\n\n  Okay.\n\n  Uh, okay. And yeah, I've been okay since then.\n\n  You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n  Uh, no, I think I'm otherwise I'm okay.\n\n  Okay. Um, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones?\n\n  Uh, yeah, I take something called furosemide.\n\n  Furosemide. And do you know which dose you're taking?\n\n  Uh, I can't remember. I'm sorry, doctor.\n\n  That's okay.\n\n  I'd have to check.\n\n  No problems. Um, any other medications?\n\n  Uh, yeah, I take aspirin.\n\n  Okay.\n\n  And, uh, bisoprolol.\n\n  Is that metoprolol, was it? Or.\n\n  Uh, bisoprolol.\n\n  Sorry, the connection's not very good. Okay, thank you. Yep.\n\n  Great.\n\n  Um, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? To any medications?\n\n  Uh, no.\n\n  No.\n\n  No, no allergies.\n\n  Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n  Uh, my, my father died of a, uh, of a heart attack.\n\n  I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n  Uh, he was, um, early 60s.\n\n  Early 60s. Okay. Uh, anything else I should be aware of?\n\n  Um, my mother had osteoporosis.\n\n  Okay. Is your mother still with us?\n\n  Uh, yeah, she's still living.\n\n  Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n  Uh, I live on my own. I mean, I've got two cats.\n\n  You've got two cats. Okay, great. Do they have names?\n\n  They're my family. Uh, they're, they're called um, they're called Polly and Tim.\n\n  Okay. Um, so this is junior cats. And, um, in terms of day-to-day, are you working at the moment?\n\n  Uh, I work part-time, as a, uh, lorry driver.\n\n  Okay. And how is that? Is that quite stressful, long hours?\n\n  Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n  Hmm.\n\n  Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly.\n\n  Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\n\n  Oh, no, I, I, I I only take shifts during the day.\n\n  Okay.\n\n  I don't like working at night.\n\n  Okay. All right. And what about smoking and alcohol, sir? Because they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n  Not anymore.\n\n  So you used to smoke?\n\n  Yeah.\n\n  And how many did you smoke a day on average?\n\n  Oh, it was about, about a pack a day. Back in the day.\n\n  Um, and how many, how many years was that for?\n\n  Oh, that was oof, a good 25 years.\n\n  Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n  I don't drink alcohol.\n\n  Okay. Do you do much in the way of exercise, sir?\n\n  Uh, I try and walk to the shops, at least once a day.\n\n  Okay.\n\n  Um, but, uh, that's about it. I've yeah, I don't I don't go running like I used to when I was young.\n\n  Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless even walking to the st uh, to the shops, you said. Um, right. So, um, based on your based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know, it's.\n\n  What's going on?\n\n  So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\n\n  Okay, if you think that would be best.\n\n  I think, I think it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n  Okay.\n\n  Is that something you've had. Yeah. So, um, an echo scan it's, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n  Oh, yes, I remember now.\n\n  Sorry?\n\n  Uh, yeah, I remember now.\n\n  You remember now. Okay, fine. That's something I can organize for you today. And, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide to, you know, one tablet twice a day. But I'd really like we'd like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n  I think that sounds like a good plan.\n\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n  Okay. I'll see how I get on.\n\n  Okay. Do you have any questions for me?\n\n  Uh, nothing else. All pretty clear. Thank you very much, doctor.\n\n  Great. No, I wish you all the best.\n\n  Thank you.\n\n  Have a good day.\n\n  See you soon.\n\n  Okay. Thank you.","marks":[[114,136,".",false],[149,157,"Nice to see you",false],[164,170,"Oscar.",false],[208,208,"Are you the doctor",false],[454,457,"now",false],[563,567,"shops",false],[655,659,"really",false],[1196,1207,"you're",false],[1237,1241,"for",false],[1303,1306,"it's",false],[1972,1979,"it's",false],[2056,2067,".",false],[2129,2134,"Both ankles OK.",false],[2275,2279,"Past",false],[2509,2512,"you're",false],[2599,2603,"in",false],[2715,2730,"reporting",false],[2790,2790,"any",false],[3028,3031,"I",false],[3068,3078,"waterworks",false],[3156,3203,"ever",false],[3220,3229,". Yeah.",false],[3239,3255,"OK. Alright.",false],[3269,3281,"",false],[3565,3571,"into",false],[3806,3806,"something",false],[3855,3882,"It's more hard to say. 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OK.",false],[10193,10209,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","partial","'Progressive SOB x several weeks' misstates the couple-of-weeks duration."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'now needs to stop/catch breath walking to shops'; usual daily walks documented."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","yes","'Concerned HF may be worsening'."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not very troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Feels mildly run down' but not that he otherwise feels normal."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'similar during previous HF deterioration'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Eating/drinking ... OK'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'passing urine OK; urinates frequently since starting medication'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'PMH: HF'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Initial breathlessness improving with medication not documented."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'\"small heart attack\" ~5 yrs ago ... more than angina per pt'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Hospital stay recorded but presenting chest pain omitted."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","yes","'dose unknown' and 'from 1 tablet daily'."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","yes","Bisoprolol listed."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'father died of MI'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother has osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with 2 cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","yes","'work exhausting and concerned worsening illness may affect ability to work'."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'x 25 yrs'."],["The note captures: Does not drink alcohol.","yes","'No alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Usually walks to shops daily'."],["The note captures: Chest examination OK.","yes","'chest examination ... OK'."],["The note captures: Oxygen saturations OK.","yes","'SpO2 ... OK'."],["The note captures: Blood pressure OK.","yes","'BP were OK'."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not documented."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'?Acute worsening/flaring HF'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'FBC' planned but anaemia purpose omitted."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","Echo arranged without stating purpose of assessing pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'Arrange echocardiogram; may take 1-2 weeks'."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["Progressive SOB x several weeks","Patient said it has been worsening over the last couple of weeks."],["simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"note":"Subjective\nProgressive SOB x several weeks, markedly worse x few days; now needs to stop/catch breath walking to shops and SOB around house.\nDry cough, not very troublesome. Feels mildly run down.\nBilat ankle swelling x few days; similar during previous HF deterioration.\nDenies CP, palpitations/skipped beats, fever. Eating/drinking and passing urine OK; urinates frequently since starting medication.\nPMH: HF; “small heart attack” ~5 yrs ago requiring several days in hospital, more than angina per pt.\nMeds: furosemide (dose unknown), aspirin, bisoprolol, simvastatin. NKDA.\nFHx: father died of MI in early 60s; mother has osteoporosis.\nLives alone with 2 cats. Part-time lorry driver; work exhausting and concerned worsening illness may affect ability to work.\nEx-smoker: ~1 pack/day x 25 yrs. No alcohol. Usually walks to shops daily; reduced tolerance currently.\nConcerned HF may be worsening; agrees with proposed treatment/investigation plan.\nObjective\nClinician states chest examination, SpO₂ and BP were OK; no values documented.\nAssessment\n?Acute worsening/flaring HF: progressive exertional → household SOB, dry cough and new bilat ankle oedema, with known HF and previous similar oedema.\nNo reported CP, palpitations or fever.\nPlan\nIncrease furosemide from 1 tablet daily to 1 tablet BD for first few days.\nBlood tests: FBC and renal function.\nArrange echocardiogram; may take 1–2 weeks.\nReview in ~1 week.\nAdvise earlier contact if worsening SOB, CP, palpitations or dizziness.","review":254.94736842105263,"saved":231.05263157894737,"faster":47.54169374052415,"clean":false,"effort":18.867924528301888,"sig":[["partial","Breathlessness has been gradually worsening over the last couple of weeks.","'Progressive SOB x several weeks' misstates the couple-of-weeks duration."],["partial","Feels a little run-down; otherwise feels generally normal.","'Feels mildly run down' but not that he otherwise feels normal."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Initial breathlessness improving with medication not documented."],["partial","That episode presented with chest pain and he was admitted to hospital.","Hospital stay recorded but presenting chest pain omitted."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["missing","Otherwise well at the moment.","'Otherwise well' not documented."],["partial","Blood test: full blood count to look for anaemia.","'FBC' planned but anaemia purpose omitted."],["partial","Echocardiogram to assess how well the heart is pumping.","Echo arranged without stating purpose of assessing pumping."],["fabrication","Progressive SOB x several weeks","Patient said it has been worsening over the last couple of weeks."],["fabrication","simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"mb":10.012911,"latency":15.501,"finalised":270.44836842105263},{"label":"Run 5","wer":19.427954668105773,"text":"Normally I can walk to the shops, without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\n\n  Okay.\n\n  And, uh, it's got me kind of worried. I don't really know what's going on.\n\n  Okay, okay. Is there anything you're particularly worried about?\n\n  Um, well, I've, I've, uh, I've got, um, heart failure.\n\n  Okay.\n\n  Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed.\n\n  Right.\n\n  And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse.\n\n  Right, okay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned. Um, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\n\n  No pain in my chest.\n\n  Okay. Have you found yourself coughing, coughing at all?\n\n  Uh, I've got a bit of a dry cough, but it's not too troublesome.\n\n  Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\n  Um, I'm feeling a little rundown. Um, but otherwise, otherwise pretty normal.\n\n  Okay.\n\n  I've noticed my ankles have got a bit bigger.\n\n  Okay. And what do you mean by that?\n\n  Uh, it's just like they've sort of swollen up a bit.\n\n  Okay. Um, is that, is that both.\n\n  Kind of.\n\n  Both ankles?\n\n  Um, yeah, both ankles. Yeah, it's a bit embarrassing.\n\n  Okay. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\n\n  Um, I kind of noticed it the last few days.\n\n  Last few days, okay. And is this something that you've had before in the past?\n\n  Uh, I think my ankles did swell up a bit last time the heart failure was a problem.\n\n  Okay. Okay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough. Um, and some swelling in your ankles. Um, but importantly, no chest pain. Um, and, and, and have you had any, have you, have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n\n  No, not really.\n\n  Okay. And any temperatures or fevers?\n\n  Uh, no.\n\n  Okay. And how about your appetite? Are you eating and drinking okay?\n\n  Yeah, I'm, I'm, that's fine.\n\n  Okay. And your water work, are you passing urine okay?\n\n  Uh, yeah, that, yeah. I usually pee a lot.\n\n  Yeah.\n\n  A little bit since the drugs came out.\n\n  Sure. Okay. All right. Um, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\n\n  Uh, well, I was told I had, like, a, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to hospital.\n\n  Okay.\n\n  And, um, they, uh, but then I just got better.\n\n  Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\n\n  Uh, I can't remember. They just called it a, something like that, a small heart attack.\n\n  Small heart attack, okay. Was it something like angina or, um?\n\n  Um, I know. They, they said they, it seemed it was, like, more than angina.\n\n  Okay.\n\n  Um, uh, but, um, I didn't, but I only had to stay in hospital for a few days and.\n\n  Okay.\n\n  Uh, and yeah, I've been okay since then.\n\n  You've been okay since then, okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\n  Uh, no, I think I'm otherwise I'm okay.\n\n  Okay. Um, do you take any regular medications apart from your, is it diuretics that you're taking? Do you know which ones?\n\n  Uh, yeah, I take something called furosemide.\n\n  Furosemide. And do you know which dose you're taking?\n\n  Uh, I can't remember. I'm sorry, doctor.\n\n  That's okay.\n\n  I'd have to check.\n\n  No problems. Um, any other medications?\n\n  Uh, yeah, I take aspirin.\n\n  Okay.\n\n  And, uh, bisoprolol.\n\n  Is that metoprolol, was this? Or.\n\n  Uh, bisoprolol.\n\n  Sorry, the connection's not very good. Okay, thank you. Yep.\n\n  Great.\n\n  Um, and, uh, simvastatin. Simvastatin, okay. All right. Any allergies at all? To any medications?\n\n  Uh, no, no allergies.\n\n  Okay. And is there anything in the family that's, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\n\n  Uh, my, my father died of a, uh, of a heart attack.\n\n  I'm sorry to hear that. And, um, how old was your father when he passed away?\n\n  Uh, he was, um, early 60s.\n\n  Early 60s, okay. Uh, anything else I should be aware of?\n\n  Um, my mother had osteoporosis.\n\n  Okay. Did your mother still with us?\n\n  Uh, yeah, she's still living.\n\n  Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n\n  Uh, I live on my own. I mean, I've got two cats.\n\n  You've got two cats, okay. Great. Do they have names?\n\n  They're my family. Uh, they're, they're called, um, they're called Polly and Tim.\n\n  Okay. Um, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\n  Uh, I work part-time, as a, uh, lorry driver.\n\n  Okay. And how is that? Is that quite stressful, long hours?\n\n  Uh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting.\n\n  Hmm.\n\n  Um, I guess I'm a bit worried that if I get sick, I won't, if I get more sick, then I won't be able to work properly.\n\n  Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you self, do, do you do a lot of night driving, weekend driving?\n\n  Oh, no, I, I, I only take shifts during the day.\n\n  Okay.\n\n  I don't like working at night.\n\n  Okay. All right. And what about smoking and alcohol, sir? Because they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\n\n  Not anymore.\n\n  So you used to smoke?\n\n  Yeah.\n\n  And how many did you smoke a day on average?\n\n  Ooh, it was about, about a pack a day. Back in the day.\n\n  Um, and how many, how many years was that for?\n\n  Oh, that was, oof, a good 25 years.\n\n  Okay. Well done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\n\n  I don't drink alcohol.\n\n  Okay. Do you do much in the way of exercise, sir?\n\n  Uh, I try and walk to the shops, at least once a day.\n\n  Okay.\n\n  Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young.\n\n  Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a bit of a flare-up of your heart failure, sir. Um, we can sometimes happen. Um, um, and, you know, it's.\n\n  What's going on?\n\n  So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\n\n  Okay, if you think that would be best.\n\n  I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\n  Okay.\n\n  Is that something you've had.\n\n  What does that.\n\n  Yeah. So, um, an echo scan, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good.\n\n  Oh, yes, I remember now.\n\n  Sorry?\n\n  Uh, yeah, I remember now.\n\n  You remember now. Okay, fine. That's something I can organize for you today and, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your furosemide to, you know, one tablet twice a day. But I'd really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n\n  I think that sounds like a good plan.\n\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\n  Okay. I'll see how I get on.\n\n  Okay. Do you have any questions for me?\n\n  Uh, nothing else. All pretty clear. Thank you very much, doctor.\n\n  Great. No, I wish you all the best.\n\n  Thank you.\n\n  Have a good day.\n\n  See you soon.\n\n  Okay. Thank you.","marks":[[0,0,"Hello Hello there. Uh hello. Can you hear me OK Yes I can hear you. OK great. . I am yes. Nice to see you here Oscar. Um how can I help you this afternoon Are you the doctor Um I'm contacting you because I've been quite short of breath lately. OK. Do you want to tell me a bit more about it When did it all start Uh well it seems to have been slowly getting worse over the last couple of weeks. Um now it's become quite troublesome in the last few days. Uh I kind of",true],[121,125,"really",false],[650,661,"you're",false],[691,695,"for",false],[757,760,"it's",false],[1253,1261,"run-down",false],[1425,1432,"it's",false],[1510,1521,".",false],[1583,1588,"Both ankles OK.",false],[1730,1734,"Past",false],[1960,1963,"you're",false],[2051,2055,"in",false],[2167,2182,"reporting",false],[2243,2243,"any",false],[2482,2485,"I",false],[2523,2533,"waterworks",false],[2612,2633,"ever",false],[2650,2659,". Yeah.",false],[2669,2685,"OK. 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OK.",false],[9664,9680,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'DOE ... breathless'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'DOE x 2 wks' with 'progressive DOE' in assessment."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'worse over last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'now needs to sit/rest to catch breath'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'breathless with minimal exertion and around house'."],["The note captures: Concerned that his heart failure is getting worse.","yes","'Concerned HF is worsening'."],["The note captures: No chest pain.","yes","'Denies CP'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Feels mildly run-down' but 'otherwise normal' omitted."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'x few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'similar during previous HF exacerbation'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'Denies ... palpitations/skipped beats'."],["The note captures: No fevers or temperatures.","yes","'Denies ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite and fluid intake maintained'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'passing urine normally, increased since diuretic commenced'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'PMH: HF'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","yes","'previous breathlessness at diagnosis improved with medication'."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'\"small heart attack\" ~5 yrs ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","yes","'hospitalised for a few days following CP'."],["The note captures: Has been well since the heart attack.","no","Wellness since the heart attack not captured."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","yes","'otherwise no reported PMH'."],["The note captures: Takes furosemide (diuretic).","yes","'furosemide'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","yes","'dose unknown' and plan 'from 1 tablet daily'."],["The note captures: Takes aspirin.","yes","'aspirin'."],["The note captures: Takes bisoprolol.","yes","'bisoprolol'."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'father died of MI'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother has osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with 2 cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","'Concerned worsening illness may affect ability to work' but exhaustion omitted."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'x 25 yrs'."],["The note captures: Does not drink alcohol.","yes","'No alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Usually walks to shops daily'."],["The note captures: Chest examination OK.","yes","'chest examination ... \"okay\"'."],["The note captures: Oxygen saturations OK.","yes","'SpO2 ... \"okay\"'."],["The note captures: Blood pressure OK.","yes","'BP ... \"okay\"'."],["The note captures: Otherwise well at the moment.","no","Otherwise well not captured."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'?Acute HF exacerbation' framed as suspected."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'from 1 tablet daily to 1 tablet BD'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for first few days' with review 'to assess response'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'FBC' without anaemia purpose."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to assess cardiac pumping function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1–2 wks to arrange'."],["The note captures: Follow-up review in about one week.","yes","'Review in ~1 wk'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'earlier contact if worsening breathlessness'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'CP, palpitations or dizziness'."]],"claims":[["Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"Subjective\nDOE x 2 wks, worse over last few days; now breathless with minimal exertion and around house. Previously able to walk to shops without difficulty; now needs to sit/rest to catch breath.\nConcerned HF is worsening; previous breathlessness at diagnosis improved with medication.\nDry cough, not troublesome. Feels mildly run-down.\nBilateral ankle swelling x few days; similar during previous HF exacerbation.\nDenies CP, palpitations/skipped beats, fever. Appetite and fluid intake maintained; passing urine normally, increased since diuretic commenced.\nPMH: HF; “small heart attack” ~5 yrs ago, hospitalised for a few days following CP; otherwise no reported PMH.\nMeds: furosemide (dose unknown), aspirin, bisoprolol, simvastatin.\nNKDA.\nFHx: father died of MI in early 60s; mother has osteoporosis.\nLives alone with 2 cats. Part-time lorry driver; daytime shifts only. Concerned worsening illness may affect ability to work.\nEx-smoker: ~1 pack/day x 25 yrs. No alcohol. Usually walks to shops daily; no other regular exercise.\nObjective\nClinician states chest examination, SpO₂ and BP were “okay.”\nAssessment\n?Acute HF exacerbation/fluid overload: progressive DOE, dry cough and recent bilateral ankle oedema in context of known HF; no CP, palpitations or fever reported.\nReduced functional capacity, affecting walking and causing concern re work.\nPlan\nIncrease furosemide from 1 tablet daily to 1 tablet BD for first few days; patient agreed. Dose/strength to be checked.\nArrange blood tests: FBC and renal function.\nOrganise echocardiogram to assess cardiac pumping function; advised this may take 1–2 wks to arrange.\nReview in ~1 wk to assess response.\nAdvise earlier contact if worsening breathlessness, CP, palpitations or dizziness.","review":186.31578947368422,"saved":299.6842105263158,"faster":61.66341780376868,"clean":false,"effort":11.320754716981133,"sig":[["partial","Feels a little run-down; otherwise feels generally normal.","'Feels mildly run-down' but 'otherwise normal' omitted."],["missing","Has been well since the heart attack.","Wellness since the heart attack not captured."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","'Concerned worsening illness may affect ability to work' but exhaustion omitted."],["missing","Otherwise well at the moment.","Otherwise well not captured."],["partial","Blood test: full blood count to look for anaemia.","'FBC' without anaemia purpose."],["fabrication","Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"mb":9.980257,"latency":17.475,"finalised":203.7907894736842}],"heidi":[{"label":"Run 1","wer":14.732865623313545,"text":"Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes, I can hear you. Okay, great. So you're your doctor? I am, yes. Doctor Seed here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, it's become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. The drugs. Sure. Okay. All right. Um, fine, so moving on to your, uh, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh... But then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what had happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or, um. Um. Uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, metoprolol. That metoprolol, was it? Or, uh, metoprolol. Sorry. The connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? So any medications? No. No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nIs your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I've got two cats. You got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. Do you do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and walk to the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you, you said you're feeling more breathless even walking to the stop, uh, to the shop, she said. Um, right. So, um, based on your, based on your history and having listened to all your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know- That's- It's- What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously, having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options- Yeah... to move forward. Um-\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. Do you think that would be better? I think I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan is it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good Oh, yes. Remember that.\n\nSorry? Uh, yeah, I remember now. You remember now? Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like- would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\nOkay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And I wish you all the best. Have a good day. See you soon. Okay. 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OK.",false],[9515,9531,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","partial","'SOB for ~2 weeks' but gradual worsening over that period not stated."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","Walking to shops cited as exertion but not previous normal tolerance or needing to sit down."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","no","Only work concern; worry about worsening heart failure not documented."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'Feeling slightly run down, otherwise well'."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Previous ankle swelling with heart failure not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite ... normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'urination normal' but omits frequent urination since the diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'Heart failure - previously diagnosed'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'managed with medication' but not initial breathlessness that improved."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'MI (\"small heart attack\") ~5 years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","yes","'presented with chest pain, few days hospitalisation'."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose not recalled' but baseline one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","no","Lists metoprolol instead of bisoprolol."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'Father: died ... from MI'."],["The note captures: Father was in his early sixties when he died.","yes","'early 60s'."],["The note captures: Mother has osteoporosis.","yes","'Mother: ... osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Works part-time as lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","yes","'finds work exhausting; concerned re ability to work'."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'Nil alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to shops once daily'."],["The note captures: Chest examination OK.","yes","'Chest: NAD'."],["The note captures: Oxygen saturations OK.","yes","'Saturations: normal'."],["The note captures: Blood pressure OK.","yes","'BP: normal'."],["The note captures: Otherwise well at the moment.","yes","'otherwise well'."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Likely flare-up of heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","partial","Increase stated but not limited to the first few days."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'FBC' planned but anaemia purpose omitted."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'Echocardiogram to assess cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo planned but 1-2 week timing not stated."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["Metoprolol","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["Simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"note":"Subjective\n\n- SOB for ~2 weeks, worsening over last few days\n\n- Breathlessness on minimal exertion - walking to shops and around house\n\n- Dry cough, not troublesome\n\n- Bilateral ankle swelling over last few days\n\n- Feeling slightly run down, otherwise well\n\n- Denies chest pain, palpitations, skipped beats, fevers\n\n- Appetite and urination normal\n\n\n\n\nPast Medical History\n\n- Heart failure - previously diagnosed, managed with medication\n\n- MI (\"small heart attack\") ~5 years ago, presented with chest pain, few days hospitalisation\n\n\n\n\nMedications\n\n- Furosemide (dose not recalled)\n\n- Aspirin\n\n- Metoprolol\n\n- Simvastatin\n\n\n\n\nAllergies\n\n- NKDA\n\n\n\n\nFamily History\n\n- Father: died early 60s from MI\n\n- Mother: alive, osteoporosis\n\n\n\n\nSocial History\n\n- Lives alone with two cats\n\n- Works part-time as lorry driver, day shifts; finds work exhausting; concerned re ability to work if health deteriorates\n\n- Ex-smoker: ~1 pack/day for 25 years, stopped\n\n- Nil alcohol\n\n- Walks to shops once daily\n\n\n\n\nObjective\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment\n\n- Likely flare-up of heart failure\n\n\n\n\nPlan\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC, renal function\n\n- Echocardiogram to assess cardiac function\n\n- Review in 1 week\n\n- Safety netting: advised to call sooner if worsening SOB, chest pain, palpitations or dizziness","review":308.10526315789474,"saved":177.89473684210526,"faster":36.60385531730561,"clean":false,"effort":23.58490566037736,"sig":[["partial","Breathlessness has been gradually worsening over the last couple of weeks.","'SOB for ~2 weeks' but gradual worsening over that period not stated."],["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","Walking to shops cited as exertion but not previous normal tolerance or needing to sit down."],["missing","Concerned that his heart failure is getting worse.","Only work concern; worry about worsening heart failure not documented."],["missing","Ankles also swelled previously when his heart failure was a problem.","Previous ankle swelling with heart failure not mentioned."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'urination normal' but omits frequent urination since the diuretic."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'managed with medication' but not initial breathlessness that improved."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose not recalled' but baseline one tablet daily not stated."],["missing","Takes bisoprolol.","Lists metoprolol instead of bisoprolol."],["partial","Increased furosemide dose for the first few days, then see how he gets on.","Increase stated but not limited to the first few days."],["partial","Blood test: full blood count to look for anaemia.","'FBC' planned but anaemia purpose omitted."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo planned but 1-2 week timing not stated."],["fabrication","Metoprolol","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["fabrication","Simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"mb":41.47627,"latency":28.689,"finalised":336.79426315789476},{"label":"Run 2","wer":14.894765245547761,"text":"Hello? Hello there. Hello. Can you hear me? Okay.\n\nYeah. Okay. Great. Are you a doctor? Oh, I am. Yes. Doctor Seed here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, it's become quite troublesome in the last few days. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh-\n\nA while ago, and I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that, is that both ankle? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. With the drugs. Sure. Okay. All right. Um, fine, so moving on to your, uh, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh... But then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or, um. Um, uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, zoprolol. That metoprolol, was it? Or Loprolol. Sorry. The connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? Take any medications? No. No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of?\n\nUm, my mother had osteoporosis. Okay. Is your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment?\n\nUh, I work part-time as a, uh, lorry driver. Okay, and how is that? Is that quite stressful, long hours? Uh, it's okay. Um, I, uh... Yeah, like, when I'm working, it's pretty exhausting. Mm-hmm. Um, I guess I'm a bit worried that if I get sick, I won't-- if I get more sick, then I won't be able to work properly. Yeah, there's certainly a consideration, isn't there? So let's, let's try and get you better soon so it doesn't have any, um- Yeah... impact on your, on your job. And, and do you find yourself doing a lot of antisocial hours? Do you sort of, do, do you do a lot of night driving, weekend driving?\n\nOh, no. I I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. So do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you, but well done for stopping.\n\nUm, and what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? Uh, I try and walk to the shops at least once a day. Okay. Um, okay. But, uh, that's about it. I've... Yeah, I don't, I don't go running like I used to when I was young. Right, okay. And certainly now with your symptoms, y- you, you said you're feeling more breathless even walking to the stop, uh, to the shop, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know-\n\nIt's What's going on? So I seem like your heart's not pumping as well as it should be. And, obviously, having diagnosed with heart failure, there's obviously it's the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of fruit. So maybe rather than a one tablet a day, we can give you two tablets a day for the first few days and see and see how you're getting on. Okay. Do you think that would be better? I I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n\nOkay. Is that something you've had? Yeah. So, um, an echo scan. It's a it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good Oh, yes, I remember now. Sorry? Uh, yeah, I remember now. Remember now? Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day.\n\nI really like, would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And then I wish you all the best. Have a good day. See you soon. Okay. Thank you.","marks":[[44,73,"OK Yes I can hear",false],[78,90,"OK great. .",false],[103,114,"Nice to see you",false],[161,161,"Are you the doctor Um",false],[390,390,"now",false],[578,582,"really",false],[1070,1081,"you're",false],[1171,1174,"it's",false],[1443,1443,"coughing",false],[1786,1793,"it's",false],[1852,1870,"Kind of .",false],[1926,1930,"Both ankles OK.",false],[2067,2071,"Past",false],[2296,2296,"you're",false],[2494,2509,"reporting",false],[2556,2556,"any",false],[2566,2566,"any",false],[2827,2838,"waterworks",false],[2911,2921,"ever since",false],[2932,2932,". Yeah.",false],[2939,2955,"OK. Alright.",false],[2969,2981,"",false],[3273,3275,"into",false],[3342,3347,"OK. And when",false],[3489,3489,"something",false],[3535,3560,"It's more hard to say. OK.",false],[3827,3843,"OK alright.",false],[4161,4176,".",false],[4256,4259,"I",false],[4274,4274,"That's OK.",false],[4356,4370,"Bisoprolol. 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OK.",false],[9510,9526,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'Increasing dyspnoea'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'over last couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'significantly worse in last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","'walking to shops' breathlessness noted, but prior ability and needing to sit down omitted."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'Breathlessness on minimal exertion - ... around house'."],["The note captures: Concerned that his heart failure is getting worse.","no","Concern about heart failure worsening not documented."],["The note captures: No chest pain.","yes","'No chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'Feeling slightly run down, otherwise well'."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'over last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Previous ankle swelling with heart failure not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'No palpitations or skipped heartbeats'."],["The note captures: No fevers or temperatures.","yes","'No fevers'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'Urinary output normal' but increased urination since medication omitted."],["The note captures: Known heart failure, diagnosed some time ago.","partial","Only implied by 'exacerbation of heart failure'; known history not stated."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Previous heart attack not mentioned."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Not mentioned."],["The note captures: Has been well since the heart attack.","no","Not mentioned."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","yes","'previously performed at diagnosis'."],["The note captures: No other past medical history apart from the heart problems.","no","No past medical history section."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide implied as current medication ('Increase Furosemide')."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","no","Current dose not recorded."],["The note captures: Takes aspirin.","no","Aspirin not mentioned."],["The note captures: Takes bisoprolol.","no","Bisoprolol not mentioned."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","no","Family history not documented."],["The note captures: Father was in his early sixties when he died.","no","Not documented."],["The note captures: Mother has osteoporosis.","no","Not documented."],["The note captures: Lives alone.","no","Social history not documented."],["The note captures: Works part-time as a lorry driver.","no","Occupation not documented."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Not documented."],["The note captures: Ex-smoker.","no","Smoking history not documented."],["The note captures: Smoked about a pack a day.","no","Not documented."],["The note captures: Smoked for about 25 years.","no","Not documented."],["The note captures: Does not drink alcohol.","no","Alcohol not documented."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual exercise not documented."],["The note captures: Chest examination OK.","yes","'Chest: NAD'."],["The note captures: Oxygen saturations OK.","yes","'Saturations: normal'."],["The note captures: Blood pressure OK.","yes","'BP: normal'."],["The note captures: Otherwise well at the moment.","yes","'otherwise well'."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Possible exacerbation of heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase Furosemide to one tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for a few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'FBC ... check for anaemia'."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'Echocardiogram to assess cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo planned but 'today' and 1-2 week timeframe omitted."],["The note captures: Follow-up review in about one week.","yes","'Review in one week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'contact sooner if symptoms worsen (increased breathlessness'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations, dizziness'."]],"claims":[["Urinary output normal","Patient said he passes urine OK but pees a lot since starting his medication; output was not described as normal."]],"note":"Subjective\n\n- Increasing dyspnoea over last couple of weeks, significantly worse in last few days\n\n- Breathlessness on minimal exertion - walking to shops and around house\n\n- Dry cough, not troublesome\n\n- Bilateral ankle swelling over last few days\n\n- No chest pain\n\n- No palpitations or skipped heartbeats\n\n- No fevers\n\n- Appetite normal\n\n- Urinary output normal\n\n- Feeling slightly run down, otherwise well\n\n\n\n\nObjective\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment\n\n- Possible exacerbation of heart failure\n\n\n\n\nPlan\n\n- Increase Furosemide to one tablet twice daily for a few days\n\n- Bloods: FBC, renal function (check for anaemia and kidney function)\n\n- Echocardiogram to assess cardiac function (previously performed at diagnosis)\n\n- Review in one week\n\n- Advised to contact sooner if symptoms worsen (increased breathlessness, chest pain, palpitations, dizziness)","review":478.9473684210526,"saved":7.052631578947398,"faster":1.4511587611002879,"clean":false,"effort":47.16981132075472,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","'walking to shops' breathlessness noted, but prior ability and needing to sit down omitted."],["missing","Concerned that his heart failure is getting worse.","Concern about heart failure worsening not documented."],["missing","Ankles also swelled previously when his heart failure was a problem.","Previous ankle swelling with heart failure not mentioned."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'Urinary output normal' but increased urination since medication omitted."],["partial","Known heart failure, diagnosed some time ago.","Only implied by 'exacerbation of heart failure'; known history not stated."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Not recorded."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Previous heart attack not mentioned."],["missing","That episode presented with chest pain and he was admitted to hospital.","Not mentioned."],["missing","Has been well since the heart attack.","Not mentioned."],["missing","No other past medical history apart from the heart problems.","No past medical history section."],["missing","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Current dose not recorded."],["missing","Takes aspirin.","Aspirin not mentioned."],["missing","Takes bisoprolol.","Bisoprolol not mentioned."],["missing","No known drug allergies.","Allergies not documented."],["missing","Father died of a heart attack.","Family history not documented."],["missing","Father was in his early sixties when he died.","Not documented."],["missing","Mother has osteoporosis.","Not documented."],["missing","Lives alone.","Social history not documented."],["missing","Works part-time as a lorry driver.","Occupation not documented."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Not documented."],["missing","Ex-smoker.","Smoking history not documented."],["missing","Smoked about a pack a day.","Not documented."],["missing","Smoked for about 25 years.","Not documented."],["missing","Does not drink alcohol.","Alcohol not documented."],["missing","Usual exercise is walking to the shops at least once a day.","Usual exercise not documented."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo planned but 'today' and 1-2 week timeframe omitted."],["fabrication","Urinary output normal","Patient said he passes urine OK but pees a lot since starting his medication; output was not described as normal."]],"mb":42.291885,"latency":25.396,"finalised":504.3433684210526},{"label":"Run 3","wer":15.326497571505667,"text":"Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes. I can do you. Okay. Great. So you're your doctor. I am. Yes. Doctor. Seod here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Can you tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, and it's become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that, is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay, and how about your appetite? Are you eating and drinking okay?\n\nYeah, I'm, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. The, the, the drugs that I've done. Sure. Okay. All right. Um, fine, so moving on to your, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh, but then I just got better.\n\nOkay. Um, when you say small heart attack, did they give you a name for what happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or, um. Um, uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't. But I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, um, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, metoprolol. That metoprolol, was it? Or, uh, metoprolol. Sorry. The connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? So any medications? No. No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nIs your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I've got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. I kinda like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. So do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you that well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and walk to the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay, and certainly now with your symptoms, y- you, you said you're feeling more breathless even walking to the stop- uh, to the shop, she said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know- That's- It's- What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously, having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options- Yeah... to move forward. Um-\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. If you think that would be better. I I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan is it's a jelly scan of your heart. You may have had this done before when you were diagnosed, and it's just to get a good Oh, yes. I remember now.\n\nSorry? Uh, yeah, I remember now. You remember now? Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like- would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\nOkay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. Now I wish you all the best. Have a good day. See you soon. Okay. Thank you.","marks":[[62,64,"hear",false],[83,105,".",false],[117,129,"Nice to see you",false],[176,176,"Are you the doctor Um",false],[245,254,"OK. 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OK.",false],[9509,9525,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'Increasing dyspnoea over past 2 weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","'Difficulty walking to shops' but not that he previously managed fine and now must sit down."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","yes","'Worried about worsening heart failure'."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Mild dry cough'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'Feeling slightly run down, otherwise well'."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Previous ankle swelling with heart failure not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'Urination normal' but omits frequent urination since the diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Heart failure listed in PMH."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'previously managed with medication' but not initial breathlessness that improved."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'Small heart attack ~5 years ago... diagnosis more than angina'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","yes","'presented with chest pain, brief hospitalisation'."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose not recalled' but baseline of one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","no","Lists metoprolol instead of bisoprolol."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'Father died of heart attack'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'Mother has osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Works part-time as lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","'finds work exhausting' but worry about being unable to work omitted."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'Non-drinker'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to shops daily'."],["The note captures: Chest examination OK.","yes","'Chest: NAD'."],["The note captures: Oxygen saturations OK.","yes","'Saturations: normal'."],["The note captures: Blood pressure OK.","yes","'BP: normal'."],["The note captures: Otherwise well at the moment.","yes","'otherwise well'."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Possible flare-up of heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","partial","Increase stated but not that it is for the first few days."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'FBC' planned but anaemia purpose omitted."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","'Organise echocardiogram' without purpose of assessing pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo organised but timing (1-2 weeks) not stated."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["Metoprolol","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["Simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"note":"Subjective:\n\n- Increasing dyspnoea over past 2 weeks, significantly worse in last few days\n\n- Difficulty walking to shops; now breathless with minimal exertion around house\n\n- Mild dry cough\n\n- Bilateral ankle swelling, noticed over last few days\n\n- No chest pain\n\n- No palpitations or skipped heartbeats\n\n- No temperatures/fevers\n\n- Appetite normal\n\n- Urination normal\n\n- Feeling slightly run down, otherwise well\n\n- Worried about worsening heart failure\n\n\n\n\nPast Medical History:\n\n- Heart failure, previously managed with medication\n\n- Small heart attack ~5 years ago; presented with chest pain, brief hospitalisation, diagnosis more than angina\n\n\n\n\nMedications:\n\n- Furosemide (dose not recalled)\n\n- Aspirin\n\n- Metoprolol\n\n- Simvastatin\n\n\n\n\nAllergies:\n\n- NKDA\n\n\n\n\nFamily History:\n\n- Father died of heart attack in early 60s\n\n- Mother has osteoporosis, still living\n\n\n\n\nSocial History:\n\n- Lives alone with two cats\n\n- Works part-time as lorry driver, day shifts only; finds work exhausting\n\n- Ex-smoker, ~1 pack/day for 25 years\n\n- Non-drinker\n\n- Walks to shops daily; current symptoms limiting this\n\n\n\n\nObjective:\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment:\n\n- Possible flare-up of heart failure\n\n\n\n\nPlan:\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC, renal function\n\n- Organise echocardiogram\n\n- Review in 1 week\n\n- Advised to contact sooner if dyspnoea worsens or new symptoms develop (chest pain, palpitations, dizziness)","review":308.57894736842104,"saved":177.42105263157896,"faster":36.50638943036604,"clean":false,"effort":22.641509433962266,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","'Difficulty walking to shops' but not that he previously managed fine and now must sit down."],["missing","Ankles also swelled previously when his heart failure was a problem.","Previous ankle swelling with heart failure not mentioned."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'Urination normal' but omits frequent urination since the diuretic."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'previously managed with medication' but not initial breathlessness that improved."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose not recalled' but baseline of one tablet daily not stated."],["missing","Takes bisoprolol.","Lists metoprolol instead of bisoprolol."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","'finds work exhausting' but worry about being unable to work omitted."],["partial","Increased furosemide dose for the first few days, then see how he gets on.","Increase stated but not that it is for the first few days."],["partial","Blood test: full blood count to look for anaemia.","'FBC' planned but anaemia purpose omitted."],["partial","Echocardiogram to assess how well the heart is pumping.","'Organise echocardiogram' without purpose of assessing pumping."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo organised but timing (1-2 weeks) not stated."],["fabrication","Metoprolol","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["fabrication","Simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"mb":42.740674,"latency":24.914,"finalised":333.492947368421},{"label":"Run 4","wer":15.86616297895305,"text":"Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes. I can hear you. Okay. Great. Are you Doctor? Oh, I am. Yes. Doctor Seoud here, Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Can you tell me a bit more about it? When did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, I've become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. I don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nUm, I'm feeling a little run down, um, but otherwise, otherwise pretty normal. Okay. I've noticed my ankles have gotten a bit bigger. Okay. And what do you mean by that? Uh, it's just like they've sort of swollen up a bit. Okay. Um, is that, is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing. Okay, uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for? Um, I kind of noticed it the last few days. Last few days, okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles. Um, but reporting no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I, I'm, that's fine. Okay, and your water works, are you passing urine okay? Uh, yeah, that, yeah. I usually pee a lot. Yeah. The drugs. Sure. Okay. All right. Um, fine, so moving on to your, your past medical history, you mentioned heart failure. Any, any other medical history I should be aware of? Uh, well, I was told I had, like, a... They called it, like, a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh... But then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what had happened? A name of a diagnosis? Uh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um. Um, uh, no, they they said they it seemed it was, like, more than angina. Okay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, okay. And yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I'd have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, Loprolol. That metoprolol, was it? Or Loprolol. Sorry, the connection is not very good. Okay, thank you. Yep.\n\nUm, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all to any medications? No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s. Okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nIs your mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. Okay. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. Do do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. It must have been very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and watch the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've yeah, I don't I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you you said you're feeling more breathless even walking to the stop to the shops, you said. Um, right. So, um, based on your based on your history and having listened to all your story, I wonder whether you've had a bit of a flare up of your heart failure, sir. Um, which can sometimes happen. Um, um, and, you know, it's what's going on. So I seem like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now there's a couple of options to move forward. Um.\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. If you think that would be best. I think I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan is it's a jelly scan of your heart. You may have had it done before when you were diagnosed, and it's just to get a good Oh, yes.\n\nSorry? Uh, yeah, I remember now. Okay, fine. That's something I can organize for you today, and they may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like- we'd like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that- Okay.-and we can have a chat on the phone as well.\n\nOkay, I'll see how I get on. Okay. Do you have any questions for me? Uh, I think that's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best. Have a good day. See you soon. Okay. Thank you.","marks":[[85,103,".",false],[116,128,"Nice to see you",false],[175,175,"Are you the doctor Um",false],[244,253,"OK. 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OK.",false],[9430,9446,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'Worsening SOB'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'Worsening SOB over last 2 weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'significantly worse in last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","Previously walked to shops without issue captured, but needing to sit down to catch breath is not."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'Now breathless on minimal exertion'."],["The note captures: Concerned that his heart failure is getting worse.","partial","'Worried about symptoms' - does not specify concern that heart failure is worsening."],["The note captures: No chest pain.","yes","'Denies: chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'Mild lethargy, feeling \"run down\"'."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'over last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'similar to previous heart failure flare'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'Denies ... palpitations, skipped heartbeats'."],["The note captures: No fevers or temperatures.","yes","'Denies ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Denies ... reduced appetite'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'Denies ... urinary issues' but increased urination since medication omitted."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'heart failure (previously diagnosed...)'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'improved with medication' captured but not that he was breathless at diagnosis."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","partial","'small heart attack ~5 years ago' but '(query angina)' contradicts patient's 'more than angina'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'brief hospitalisation' captured; presenting chest pain omitted."],["The note captures: Has been well since the heart attack.","no","Not stated he has been well since."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement of no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'furosemide'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unknown' captured but current one tablet a day not recorded."],["The note captures: Takes aspirin.","yes","'aspirin'."],["The note captures: Takes bisoprolol.","no","Lists 'metoprolol' instead of bisoprolol - wrong medication."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'father died of MI'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother osteoporosis'."],["The note captures: Lives alone.","yes","'lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'works part-time as lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Concern re impact on work captured; work being exhausting omitted."],["The note captures: Ex-smoker.","yes","'ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'x25 years'."],["The note captures: Does not drink alcohol.","yes","'non-drinker'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'walks to shops once daily'."],["The note captures: Chest examination OK.","yes","'Chest examination: NAD'."],["The note captures: Oxygen saturations OK.","yes","'Saturations: within normal limits'."],["The note captures: Blood pressure OK.","yes","'BP: within normal limits'."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not stated."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Suspected flare-up of heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to one tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","no","No mention of the increase being for the first few days then reassessing."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'FBC (anaemia)'."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to assess cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","'Organise echocardiogram' but the 1-2 week timeframe is omitted."],["The note captures: Follow-up review in about one week.","yes","'Review in 1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'contact sooner if increased breathlessness'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations or dizziness'."]],"claims":[["\"small heart attack\" ~5 years ago ... (query angina)","Patient said he was told it was more than angina, not angina."],["Meds: ... metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"Subjective\n\n\n\n\n- Worsening SOB over last 2 weeks, significantly worse in last few days\n\n- Now breathless on minimal exertion; previously able to walk to shops without issue\n\n- Worried about symptoms\n\n- Dry cough, not troublesome\n\n- Mild lethargy, feeling \"run down\"\n\n- Bilateral ankle swelling over last few days (similar to previous heart failure flare)\n\n- Denies: chest pain, palpitations, skipped heartbeats, fever, reduced appetite, urinary issues\n\n- PMHx: heart failure (previously diagnosed, improved with medication); \"small heart attack\" ~5 years ago with brief hospitalisation (query angina)\n\n- Meds: furosemide (dose unknown), aspirin, metoprolol, simvastatin\n\n- Allergies: NKDA\n\n- FHx: father died of MI in early 60s; mother osteoporosis (alive)\n\n- Social: lives alone with two cats; works part-time as lorry driver (day shifts), concerned re impact of worsening health on work; ex-smoker (~1 pack/day x25 years); non-drinker; walks to shops once daily\n\n\n\n\nObjective\n\n\n\n\n- Chest examination: NAD\n\n- Saturations: within normal limits\n\n- BP: within normal limits\n\n\n\n\nAssessment\n\n\n\n\n- Suspected flare-up of heart failure\n\n\n\n\nPlan\n\n\n\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC (anaemia), renal function\n\n- Organise echocardiogram to assess cardiac function\n\n- Review in 1 week\n\n- Safety netting: advised to contact sooner if increased breathlessness, chest pain, palpitations or dizziness","review":342.1973684210526,"saved":143.8026315789474,"faster":29.589018843404812,"clean":false,"effort":26.41509433962264,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","Previously walked to shops without issue captured, but needing to sit down to catch breath is not."],["partial","Concerned that his heart failure is getting worse.","'Worried about symptoms' - does not specify concern that heart failure is worsening."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'Denies ... urinary issues' but increased urination since medication omitted."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'improved with medication' captured but not that he was breathless at diagnosis."],["partial","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","'small heart attack ~5 years ago' but '(query angina)' contradicts patient's 'more than angina'."],["partial","That episode presented with chest pain and he was admitted to hospital.","'brief hospitalisation' captured; presenting chest pain omitted."],["missing","Has been well since the heart attack.","Not stated he has been well since."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement of no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unknown' captured but current one tablet a day not recorded."],["missing","Takes bisoprolol.","Lists 'metoprolol' instead of bisoprolol - wrong medication."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Concern re impact on work captured; work being exhausting omitted."],["missing","Otherwise well at the moment.","'Otherwise well' not stated."],["missing","Increased furosemide dose for the first few days, then see how he gets on.","No mention of the increase being for the first few days then reassessing."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","'Organise echocardiogram' but the 1-2 week timeframe is omitted."],["fabrication","\"small heart attack\" ~5 years ago ... (query angina)","Patient said he was told it was more than angina, not angina."],["fabrication","Meds: ... metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["fabrication","Meds: ... simvastatin","Simvastatin is never mentioned in the transcript."]],"mb":40.684546,"latency":28.91,"finalised":371.1073684210526},{"label":"Run 5","wer":15.758229897463572,"text":"Hello? Hello there. Hello. Can you hear me? Okay.\n\nYes, I can hear you. Okay, great. So you're your doctor, right? I am, yes. Doctor Seod here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately. Okay. Do you want to tell me a bit more about it? So when did it all start?\n\nUh, well, it seems to have been slowly getting worse over the last couple of weeks. Um, and it's become quite troublesome in the last few days. Uh, I kind of- normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And, uh, it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about? Um, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that-\n\nA while ago. And I got a bit breathless when I was first diagnosed Right. And put on some medicine that that that helped, but I'm a bit worried it's just getting worse. Right. Okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling\n\nWeak, lethargic? I'm feeling a little run down, but otherwise otherwise pretty normal. Okay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that? It's just like they've sort of swollen up a bit. Okay. Is that is that both ankles? Both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this for? I kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past?\n\nUh, I think my ankles did swell up a bit last time. The heart failure was a problem. Okay. Okay. Um, fine. Okay. So, um, just to really recap, uh, so really the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough, um, and some swelling in your ankles, um, but importantly, no chest pain. Um, and, and, and have you had, have you, have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers? Uh, no. Okay. And how about your appetite? Are you eating and drinking okay?\n\nYeah, I'm I'm that's fine. Okay. And your water works, are you passing urine okay? Uh, yeah, that yeah. I usually pee a lot. Yeah. The drugs. Sure. Okay. All right. Um, fine. So moving on to your your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Uh, well, I was told I had, like, a they called it, like, a small heart attack about five years ago. Um, I, uh, I had I I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh, but then I just got better.\n\nOkay. When you say small heart attack, did they give you a name for what happened? A name of a diagnosis? I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it like angina or no? They they said they it seemed it was, like, more than angina. Okay. But I didn't but I only had to stay in hospital for a few days. Okay. Okay. And, yeah, I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of?\n\nUh, no, I think I'm otherwise I'm okay. Okay. Um, do you take any regular medications apart from your diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. I have to check. No problems. Um, any other medications? Uh, yeah, I take aspirin. Okay. And, uh, zoprolol. That metoprolol, was it? Or metoprolol. Sorry. The connection is not very good. Okay. Thank you. Yep.\n\nUm, and, uh, simvastatin. Simvastatin. Okay. All right. Any allergies at all? Take medications? No, no allergies. Okay. And is there anything in the family that's that that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems? Uh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away? Uh, he was, um, early 60s. Early 60s, okay. Uh, anything else I should be aware of? Um, my mother had osteoporosis. Okay.\n\nYour mother still with us? Uh, yes, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. Oh, I've got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay. Um, so it's just you and your cats. And, um, in terms of day-to-day, are you working at the moment? Uh, I work part-time as-\n\nA lorry driver. Okay. And how is that? Is that quite stressful? Long hours? It's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. This is certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving? No. I I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? So because they can sometimes be very important when it comes to heart problems. So do you smoke at all?\n\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many years was that for? Oh, that was a good twenty five years. Okay. Well done for stopping. That must have been very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in the way of exercise, sir? I try and walk to the shops at least once a day. Okay.\n\nOkay. But, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you, you said you're feeling more breathless, even walking to the stop- uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to all your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir, um, which can sometimes happen. Um, um, and, you know- That's- It's- What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options- Yeah... to move forward. Um-\n\nGiven that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure are all okay, I'm quite happy to increase your dose of fruit. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days, and see and see how you're getting on. Okay. Do you think that would be better? I think I think it's it's it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan it's it's a jelly scan of your heart. You may have had this done before when you were diagnosed, and it's just to get a good Oh, yes.\n\nSorry? Uh, yeah, I remember now. I remember now. Okay, fine. That's something I can organize for you today, and it may take a week or two weeks for that to be organized. But I think certainly in the meantime, let's, um, let's let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, um, and we can definitely increase your, um, your fruit, uh, to, you know, one tablet twice a day. But I really like, would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\n\nOkay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. No. Well, I wish you all the best. Have a good day. See you soon. Okay. Thank you.","marks":[[85,113,".",false],[126,137,"Nice to see you",false],[188,188,"Are you the doctor",false],[426,429,"now",false],[617,621,"really",false],[897,902,"that uh",false],[1103,1114,"you're",false],[1204,1207,"it's",false],[1476,1476,"coughing",false],[1654,1662,"run-down um",false],[1806,1813,"it's",false],[1867,1886,"Kind of . Um",false],[1938,1943,"Both ankles OK. 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OK.",false],[9418,9434,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'SOB'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","partial","'SOB over last couple of weeks' without stating gradual worsening over that period."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'worse in last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'now requires sitting to catch breath'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'breathless even around the house'."],["The note captures: Concerned that his heart failure is getting worse.","partial","'Worried about symptoms' without specifying worry about worsening heart failure."],["The note captures: No chest pain.","yes","'Denies chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Feeling a little run down' but 'otherwise normal' omitted."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'over last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Previous ankle swelling with heart failure not captured."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'Denies ... palpitations, skipped heartbeats'."],["The note captures: No fevers or temperatures.","yes","'Denies ... temperatures, fevers'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite ... normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'urination normal' omits increased urination since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'Heart failure, diagnosed some time ago'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","yes","'previously caused breathlessness, managed with medication'."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'Small heart attack ~5 years ago... \"more than angina\"'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","yes","'presented with chest pain, brief hospitalisation'."],["The note captures: Has been well since the heart attack.","no","Wellness since the heart attack not captured."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement of no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'Furosemide'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose not recalled' but current one tablet daily not stated."],["The note captures: Takes aspirin.","yes","'Aspirin'."],["The note captures: Takes bisoprolol.","no","Lists 'Metoprolol' instead of bisoprolol."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'Father: died ... from heart attack'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'Mother: living, osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Works part-time as lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","'Concerns re impact of worsening health on ability to work' but exhaustion omitted."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'~1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'Non-drinker'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to shops once daily'."],["The note captures: Chest examination OK.","yes","'Chest: NAD'."],["The note captures: Oxygen saturations OK.","yes","'Saturations: normal'."],["The note captures: Blood pressure OK.","yes","'BP: normal'."],["The note captures: Otherwise well at the moment.","no","Otherwise well not captured."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Possible flare-up of heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to one tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","no","'First few days' duration not captured."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'FBC ... check for anaemia'."],["The note captures: Blood test: kidney function.","yes","'U&E'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'Echocardiogram to assess cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","no","Echo timing not captured."],["The note captures: Follow-up review in about one week.","yes","'Review in 1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'call sooner if increased breathlessness'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations or dizziness'."]],"claims":[["Medications: Metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["Medications: Simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"Subjective\n\n- SOB over last couple of weeks, worse in last few days\n\n- Normally walks to shops without issue, now requires sitting to catch breath; breathless even around the house\n\n- Worried about symptoms\n\n- Bilateral ankle swelling over last few days\n\n- Dry cough, not troublesome\n\n- Feeling a little run down\n\n- Denies chest pain, palpitations, skipped heartbeats, temperatures, fevers\n\n- Appetite and urination normal\n\n\n\n\nPast Medical History\n\n- Heart failure, diagnosed some time ago, previously caused breathlessness, managed with medication\n\n- Small heart attack ~5 years ago, presented with chest pain, brief hospitalisation, described as \"more than angina\"\n\n\n\n\nMedications\n\n- Furosemide (dose not recalled, requires checking)\n\n- Aspirin\n\n- Metoprolol\n\n- Simvastatin\n\n\n\n\nAllergies\n\n- NKDA\n\n\n\n\nFamily History\n\n- Father: died in early 60s from heart attack\n\n- Mother: living, osteoporosis\n\n\n\n\nSocial History\n\n- Lives alone with two cats\n\n- Works part-time as lorry driver, daytime shifts only\n\n- Concerns re impact of worsening health on ability to work\n\n- Ex-smoker: ~1 pack/day for 25 years, stopped\n\n- Non-drinker\n\n- Walks to shops once daily\n\n\n\n\nObjective\n\n- Chest: NAD\n\n- Saturations: normal\n\n- BP: normal\n\n\n\n\nAssessment\n\n- Possible flare-up of heart failure\n\n\n\n\nPlan\n\n- Increase furosemide to one tablet twice daily\n\n- Bloods: FBC, U&E, check for anaemia\n\n- Echocardiogram to assess cardiac function\n\n- Review in 1 week\n\n- Safety netting: advised to call sooner if increased breathlessness, chest pain, palpitations or dizziness","review":325.63157894736844,"saved":160.36842105263156,"faster":32.99761750054147,"clean":false,"effort":25.471698113207548,"sig":[["partial","Breathlessness has been gradually worsening over the last couple of weeks.","'SOB over last couple of weeks' without stating gradual worsening over that period."],["partial","Concerned that his heart failure is getting worse.","'Worried about symptoms' without specifying worry about worsening heart failure."],["partial","Feels a little run-down; otherwise feels generally normal.","'Feeling a little run down' but 'otherwise normal' omitted."],["missing","Ankles also swelled previously when his heart failure was a problem.","Previous ankle swelling with heart failure not captured."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'urination normal' omits increased urination since diuretic."],["missing","Has been well since the heart attack.","Wellness since the heart attack not captured."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement of no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose not recalled' but current one tablet daily not stated."],["missing","Takes bisoprolol.","Lists 'Metoprolol' instead of bisoprolol."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","'Concerns re impact of worsening health on ability to work' but exhaustion omitted."],["missing","Otherwise well at the moment.","Otherwise well not captured."],["missing","Increased furosemide dose for the first few days, then see how he gets on.","'First few days' duration not captured."],["missing","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo timing not captured."],["fabrication","Medications: Metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["fabrication","Medications: Simvastatin","Simvastatin is never mentioned in the transcript."]],"mb":41.443116,"latency":27.769,"finalised":353.40057894736844}],"freed":[{"label":"Run 1","wer":25.41824069077172,"text":"Unknown: Hello?\n  Hello there.\n  Hello, can you hear me okay?\n  Yes, I can hear you.\n  Okay, great.\n  Are you a doctor?\n  I am, yes. Doctor Seward here, Oscar. How can I help you this afternoon?\n  I'm contacting you because I've been quite short of breath lately.\n  Okay. Do you want to tell me a bit more about it? When did it all start?\n  Well it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome in the last few days. Normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath and I'm even starting to get a bit breathless just about the house and it's got me kind of worried. I don't really know what's going on.\n  Is there anything you're particularly worried about?\n  Um, well, I've, I've, I've got heart failure.\n  Okay.\n  I was told that a while ago. And I got a bit breathless when I was 1st diagnosed, and put on some medicines that helped, but I'm a bit worried it's getting worse.\n  Right, okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse, and you're now feeling more breathless or kind of minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\n  No pain in my chest.\n  Okay. Have you found yourself coughing at all?\n  I've got a bit of a dry cough, but it's not too troublesome.\n  Okay, okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n  I'm feeling a little run down, but otherwise pretty normal. I've noticed my ankles have got a bit bigger.\n  Okay, and what do you mean by that?\n  It's just like, they've sort of swollen up a bit.\n  Okay, is that both ankles?\n  Yeah, both ankles. Yeah, it's a bit embarrassing.\n  Okay, I can imagine, yeah. And again, over how long have you noticed this for?\n  I kind of noticed it the last few days.\n  Last few days, okay. And is this something that you've had before in the past?\n  I think my ankles did swell up a bit last time the heart failure was a problem.\n  Okay, okay. Fine, okay. So just to really recap, so really the last couple of weeks you've been feeling breathless but worse over the last couple of days. You mentioned you had a bit of a dry cough and some swelling in your ankles, but importantly, no chest pain. And have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n  No, not really.\n  Okay, and any temperatures or fevers?\n  No.\n  Okay, and how about your appetite? Are you eating and drinking okay?\n  Yeah, that's fine.\n  Okay, and your water works? Are you passing urine okay?\n  Yeah, I usually pee a lot, besides the drugs.\n  Sure, okay, all right. Fine, so moving on to your past medical history, you mentioned heart failure. Any other medical history I should be aware of?\n  Well, I was told I had like, they called it like a small heart attack about 5 years ago. I had like chest pain and they took me to hospital.\n  Okay.\n  And they, but then I just got better.\n  Okay. When you say small heart attack, did they give you a name for what happened, a name of a diagnosis?\n  I can't remember. They just called it something like that, a small heart attack.\n  Small heart attack, okay. Was it something like angina or...\n  No, they said it seemed like it was more than angina.\n  Okay.\n  But... I didn't, but I only had to stay in hospital for a few days. Okay. And yeah, I've been okay since then.\n  You've been okay since then? Okay, all right. So apart from the heart problems, the heart failure, any other problems I should be aware of?\n  No, I think otherwise I'm okay.\n Unknown: Okay.\n  Do you take any regular medications apart from your diuretics that you're taking? Do you know which ones?\n  Yeah, I take something called ferrosamide.\n  Ferrosamide, and do you know which dose you're taking?\n  I can't remember, I'm sorry doctor, I have to check.\n  No problems. Any other medications?\n  Yeah, I take aspirin and bisoprolol.\n  Is that metoprolol?\n  Bisoprolol.\n  Sorry, the connection is not very good. Okay, thank you, yeah. Simvastatin. Simvastatin, okay, all right. Any allergies at all to any medications? That's important for me to know. Any family history of medical problems, heart problems, lung problems?\n  My father died of a heart attack.\n  I'm sorry to hear that. How old was your father when he passed away? He was early sixties. Early sixties, okay. Anything else I should be aware of?\n  My mother had osteoporosis.\n  Is your mother still with us?\n  Yeah, she's still living.\n  Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n  I live on my own. I've got 2 cats. You've got 2 cats?\n  Okay, great.\n  Do you have names? They're my family. They're called Polly and Tim.\n  So this is Junior Katz, and in terms of day-to-day, are you working at the moment?\n  I work part-time as a lorry driver.\n  Okay, and how is that? Is that quite stressful, long hours?\n  It's okay. Yeah, like when I'm working it's pretty exhausting. I guess I'm a bit worried that if I get more sick then I won't be able to work properly.\n  Yeah, and it's certainly a consideration, isn't it? So let's try and get you better soon so it doesn't have any impact on your job. Do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\n  No, I only take shifts during the day. I don't like working at night.\n  Okay, all right. And what about smoking and alcohol? Because it can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day, back in the day. And how many years was that for? Oh, that was a good 25 years.\n Unknown: Okay.\n  Well done for stopping. It must have been very difficult for you, well done for stopping. And what about alcohol?\n  I don't drink alcohol. Okay.\n  Do you do much exercise, sir?\n  I try and walk to the shops at least once a day. Okay. But that's about it. Yeah, I don't get running like I used to when I was young.\n  Right, okay, and certainly now with your symptoms, you said you're feeling more breathless even walking to the shop, she said. Right, based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen. What's going on? It seems like your heart's not pumping as well as it should be. And obviously having diagnosed heart failure is obviously the 1st thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruzemide. Maybe rather than one tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n  Okay, if you think that would be best.\n  I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n  Okay, good design.\n  Yeah, so an echocardiogram is a jelly scan of your heart. You may have had this done before when you were diagnosed and it's just to get a good- Oh, yes, I remember now.\n  Yeah, I remember now.\n  Okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's get a blood test done. We can check your full blood count, look for signs of anemia, we can have a check of your kidney function, and we can definitely increase your fruizomide to one tablet twice a day. But I really would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n  I think that sounds like a good plan.\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then you know, certainly I want you to give me a call sooner than that and we can have a chat on the phone as well.\n  Okay, I'll see how I get on.\n  Okay, do you have any questions for me?\n  Nothing at all, pretty clear. Thank you very much, Doctor.\n  Great, now I wish you all the best. Have a good day.\n  You soon.\n  Okay, thank you.","marks":[[0,7,"",false],[102,118,".",false],[133,146,"Nice to see you",false],[193,193,"Are you the doctor Um",false],[419,419,"Um now",false],[471,471,"Uh I kind of",false],[590,594,"really",false],[899,902,"first",false],[930,939,"medicine that that um",false],[1027,1038,"you're",false],[1189,1191,"on",false],[1199,1199,"minimal",false],[1397,1397,"coughing",false],[1580,1588,"run-down um",false],[1593,1593,"otherwise",false],[1721,1728,"it's",false],[1776,1782,"Kind of . Um",false],[1838,1842,"Both ankles OK. Uh",false],[1889,1889,"has this",false],[1961,1965,"Past",false],[2175,2175,"you're",false],[2249,2253,"in",false],[2356,2371,"Um reporting",false],[2391,2391,"and have you had any have you any",false],[2618,2618,"I I'm",false],[2650,2661,"waterworks",false],[2720,2727,"ever since",false],[2738,2738,". Yeah.",false],[2747,2763,"OK. Alright. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'progressive shortness of breath'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'over the past couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'worsening significantly in the last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'Previously able to walk to the shops without difficulty, ... now having to sit down and catch their breath'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'breathlessness with minimal exertion around the house'."],["The note captures: Concerned that his heart failure is getting worse.","yes","'concern that the heart failure may be worsening'."],["The note captures: No chest pain.","yes","'denies chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'dry cough that is not too troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'feeling a little run down'."],["The note captures: Swelling of both ankles.","yes","'bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noticed over the last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'ankle swelling was also present when the heart failure was previously problematic'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'denies ... palpitations'."],["The note captures: No fevers or temperatures.","yes","ROS 'denies fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'denies ... changes in appetite'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'Urination is reported as normal, with frequent urination attributed to diuretic use'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'history of heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Breathlessness at diagnosis improving with medication not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'Myocardial infarction (approximately 5 years ago)'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Chest pain and hospital admission not mentioned."],["The note captures: Has been well since the heart attack.","no","Not mentioned."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Not stated."],["The note captures: Takes furosemide (diuretic).","yes","'Furosemide PO daily'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'Furosemide PO daily' implies once daily but tablet count and unknown mg dose not stated."],["The note captures: Takes aspirin.","yes","'Aspirin'."],["The note captures: Takes bisoprolol.","yes","'Bisoprolol'."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","yes","'Father: MI in early sixties, deceased'."],["The note captures: Father was in his early sixties when he died.","yes","'early sixties'."],["The note captures: Mother has osteoporosis.","yes","'Mother: Osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Worry about work captured; exhaustion omitted."],["The note captures: Ex-smoker.","yes","'Former smoker'."],["The note captures: Smoked about a pack a day.","yes","'25 pack-year history' accepted as equivalent."],["The note captures: Smoked for about 25 years.","yes","'25 pack-year history' accepted as equivalent."],["The note captures: Does not drink alcohol.","yes","'Alcohol: Denies use'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to the shops at least once daily'."],["The note captures: Chest examination OK.","no","Objective 'N/A'; chest examination not recorded."],["The note captures: Oxygen saturations OK.","no","Saturations not recorded."],["The note captures: Blood pressure OK.","no","Blood pressure not recorded."],["The note captures: Otherwise well at the moment.","partial","Only 'denies ... significant systemic symptoms'; otherwise well not clearly stated."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'this represents likely acute decompensation'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to 1 tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'full blood count to assess for anemia'."],["The note captures: Blood test: kidney function.","yes","'and kidney function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to evaluate cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1-2 weeks to schedule'."],["The note captures: Follow-up review in about one week.","yes","'Follow-up appointment in approximately 1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'contact clinic sooner if experiencing worsening dyspnea'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations, or dizziness'."]],"claims":[["Simvastatin PO daily","Simvastatin is never mentioned in the transcript."],["Aspirin PO daily","Aspirin frequency was never stated."],["Bisoprolol PO daily","Bisoprolol frequency was never stated."],["Respiratory: Denies wheezing","Wheezing was never discussed."],["now occurring with minimal exertion and at rest","Patient described breathlessness moving about the house; breathlessness at rest was never stated."]],"note":"Subjective\nCliniTech Benchmark 54904fad, with a history of heart failure and myocardial infarction, presents with progressive shortness of breath over the past couple of weeks, worsening significantly in the last few days. Previously able to walk to the shops without difficulty, the patient is now having to sit down and catch their breath during such activities and is experiencing breathlessness with minimal exertion around the house. The patient also reports a dry cough that is not too troublesome, bilateral ankle swelling noticed over the last few days, and feeling a little run down. The patient notes that the ankle swelling was also present when the heart failure was previously problematic. The patient expresses concern that the heart failure may be worsening and is worried about the impact on their ability to work as a part-time lorry driver.\n\nThe patient denies chest pain, palpitations, or changes in appetite. Urination is reported as normal, with frequent urination attributed to diuretic use.\n\nMedical History  \n- Heart failure  \n- Myocardial infarction (approximately 5 years ago)\n\nMedications and Supplements  \n- Furosemide PO daily  \n- Aspirin PO daily  \n- Bisoprolol PO daily  \n- Simvastatin PO daily\n\nFamily History  \n- Father: MI in early sixties, deceased  \n- Mother: Osteoporosis, living\n\nSocial History  \n- Tobacco: Former smoker, quit, 25 pack-year history  \n- Alcohol: Denies use  \n- Occupation: Part-time lorry driver, daytime shifts only  \n- Living Situation: Lives alone with two cats  \n- Exercise: Walks to the shops at least once daily; otherwise limited physical activity\n\nReview of Systems  \n- General: Positive for fatigue, denies fever  \n- Cardiovascular: Shortness of breath with minimal exertion, bilateral ankle swelling, dry cough, denies chest pain, palpitations  \n- Respiratory: Denies wheezing  \n- Gastrointestinal: Denies appetite changes  \n- Genitourinary: Denies urinary difficulties\n\nObjective\nN/A\n\nAssessment & Plan\nPatient with known heart failure presenting with worsening shortness of breath over 2 weeks, particularly severe in recent days.\n\nHeart failure exacerbation  \nAssessment: Patient presents with progressive dyspnea over 2 weeks, significantly worsening in recent days, now occurring with minimal exertion and at rest. Associated symptoms include bilateral ankle swelling and mild dry cough. Given known history of heart failure and previous similar presentation with ankle swelling during prior heart failure exacerbation, this represents likely acute decompensation. Patient denies chest pain, palpitations, fever, or significant systemic symptoms. History of prior small heart attack 5 years ago and family history of paternal myocardial infarction in early sixties support cardiac etiology. Current medication regimen includes furosemide, aspirin, bisoprolol, and simvastatin.  \nPlan:  \n- Increase furosemide to 1 tablet twice daily for first few days  \n- Order blood tests including full blood count to assess for anemia and kidney function  \n- Arrange echocardiogram to evaluate cardiac function, which may take 1-2 weeks to schedule  \n- Follow-up appointment in approximately 1 week to reassess symptoms  \n- Patient advised to contact clinic sooner if experiencing worsening dyspnea, chest pain, palpitations, or dizziness\n","review":392.32894736842104,"saved":93.67105263157896,"faster":19.2738791423002,"clean":false,"effort":33.9622641509434,"sig":[["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Breathlessness at diagnosis improving with medication not recorded."],["missing","That episode presented with chest pain and he was admitted to hospital.","Chest pain and hospital admission not mentioned."],["missing","Has been well since the heart attack.","Not mentioned."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Not mentioned."],["missing","No other past medical history apart from the heart problems.","Not stated."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'Furosemide PO daily' implies once daily but tablet count and unknown mg dose not stated."],["missing","No known drug allergies.","Allergies not documented."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Worry about work captured; exhaustion omitted."],["missing","Chest examination OK.","Objective 'N/A'; chest examination not recorded."],["missing","Oxygen saturations OK.","Saturations not recorded."],["missing","Blood pressure OK.","Blood pressure not recorded."],["partial","Otherwise well at the moment.","Only 'denies ... significant systemic symptoms'; otherwise well not clearly stated."],["fabrication","Simvastatin PO daily","Simvastatin is never mentioned in the transcript."],["fabrication","Aspirin PO daily","Aspirin frequency was never stated."],["fabrication","Bisoprolol PO daily","Bisoprolol frequency was never stated."],["fabrication","Respiratory: Denies wheezing","Wheezing was never discussed."],["fabrication","now occurring with minimal exertion and at rest","Patient described breathlessness moving about the house; breathlessness at rest was never stated."]],"mb":15.012226,"latency":51.51,"finalised":431.61994736842104},{"label":"Run 2","wer":25.41824069077172,"text":"Unknown: Hello?\n  Hello there.\n  Hello, can you hear me okay?\n  Yes, I can hear you.\n  Okay, great.\n  Are you a doctor?\n  I am, yes. Doctor Seward here, Oscar. How can I help you this afternoon?\n  I'm contacting you because I've been quite short of breath lately.\n  Okay. Do you want to tell me a bit more about it? When did it all start?\n  Well it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome in the last few days. Normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath and I'm even starting to get a bit breathless just about the house and it's got me kind of worried. I don't really know what's going on.\n  Is there anything you're particularly worried about?\n  Um, well, I've, I've, I've got heart failure.\n  Okay.\n  I was told that a while ago. And I got a bit breathless when I was 1st diagnosed, and put on some medicines that helped, but I'm a bit worried it's getting worse.\n  Right, okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse, and you're now feeling more breathless or kind of minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\n  No pain in my chest.\n  Okay. Have you found yourself coughing at all?\n  I've got a bit of a dry cough, but it's not too troublesome.\n  Okay, okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n  I'm feeling a little run down, but otherwise pretty normal. I've noticed my ankles have got a bit bigger.\n  Okay, and what do you mean by that?\n  It's just like, they've sort of swollen up a bit.\n  Okay, is that both ankles?\n  Yeah, both ankles. Yeah, it's a bit embarrassing.\n  Okay, I can imagine, yeah. And again, over how long have you noticed this for?\n  I kind of noticed it the last few days.\n  Last few days, okay. And is this something that you've had before in the past?\n  I think my ankles did swell up a bit last time the heart failure was a problem.\n  Okay, okay. Fine, okay. So just to really recap, so really the last couple of weeks you've been feeling breathless but worse over the last couple of days. You mentioned you had a bit of a dry cough and some swelling in your ankles, but importantly, no chest pain. And have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n  No, not really.\n  Okay, and any temperatures or fevers?\n  No.\n  Okay, and how about your appetite? Are you eating and drinking okay?\n  Yeah, that's fine.\n  Okay, and your water works? Are you passing urine okay?\n  Yeah, I usually pee a lot, besides the drugs.\n  Sure, okay, all right. Fine, so moving on to your past medical history, you mentioned heart failure. Any other medical history I should be aware of?\n  Well, I was told I had like, they called it like a small heart attack about 5 years ago. I had like chest pain and they took me to hospital.\n  Okay.\n  And they, but then I just got better.\n  Okay. When you say small heart attack, did they give you a name for what happened, a name of a diagnosis?\n  I can't remember. They just called it something like that, a small heart attack.\n  Small heart attack, okay. Was it something like angina or...\n  No, they said it seemed like it was more than angina.\n  Okay.\n  But... I didn't, but I only had to stay in hospital for a few days. Okay. And yeah, I've been okay since then.\n  You've been okay since then? Okay, all right. So apart from the heart problems, the heart failure, any other problems I should be aware of?\n  No, I think otherwise I'm okay.\n Unknown: Okay.\n  Do you take any regular medications apart from your diuretics that you're taking? Do you know which ones?\n  Yeah, I take something called ferrosamide.\n  Ferrosamide, and do you know which dose you're taking?\n  I can't remember, I'm sorry doctor, I have to check.\n  No problems. Any other medications?\n  Yeah, I take aspirin and bisoprolol.\n  Is that metoprolol?\n  Bisoprolol.\n  Sorry, the connection is not very good. Okay, thank you, yeah. Simvastatin. Simvastatin, okay, all right. Any allergies at all to any medications? That's important for me to know. Any family history of medical problems, heart problems, lung problems?\n  My father died of a heart attack.\n  I'm sorry to hear that. How old was your father when he passed away? He was early sixties. Early sixties, okay. Anything else I should be aware of?\n  My mother had osteoporosis.\n  Is your mother still with us?\n  Yeah, she's still living.\n  Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n  I live on my own. I've got 2 cats. You've got 2 cats?\n  Okay, great.\n  Do you have names? They're my family. They're called Polly and Tim.\n  So this is Junior Katz, and in terms of day-to-day, are you working at the moment?\n  I work part-time as a lorry driver.\n  Okay, and how is that? Is that quite stressful, long hours?\n  It's okay. Yeah, like when I'm working it's pretty exhausting. I guess I'm a bit worried that if I get more sick then I won't be able to work properly.\n  Yeah, and it's certainly a consideration, isn't it? So let's try and get you better soon so it doesn't have any impact on your job. Do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\n  No, I only take shifts during the day. I don't like working at night.\n  Okay, all right. And what about smoking and alcohol? Because it can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day, back in the day. And how many years was that for? Oh, that was a good 25 years.\n Unknown: Okay.\n  Well done for stopping. It must have been very difficult for you, well done for stopping. And what about alcohol?\n  I don't drink alcohol. Okay.\n  Do you do much exercise, sir?\n  I try and walk to the shops at least once a day. Okay. But that's about it. Yeah, I don't get running like I used to when I was young.\n  Right, okay, and certainly now with your symptoms, you said you're feeling more breathless even walking to the shop, she said. Right, based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen. What's going on? It seems like your heart's not pumping as well as it should be. And obviously having diagnosed heart failure is obviously the 1st thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruzemide. Maybe rather than one tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n  Okay, if you think that would be best.\n  I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n  Okay, good design.\n  Yeah, so an echocardiogram is a jelly scan of your heart. You may have had this done before when you were diagnosed and it's just to get a good- Oh, yes, I remember now.\n  Yeah, I remember now.\n  Okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's get a blood test done. We can check your full blood count, look for signs of anemia, we can have a check of your kidney function, and we can definitely increase your fruizomide to one tablet twice a day. But I really would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n  I think that sounds like a good plan.\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then you know, certainly I want you to give me a call sooner than that and we can have a chat on the phone as well.\n  Okay, I'll see how I get on.\n  Okay, do you have any questions for me?\n  Nothing at all, pretty clear. Thank you very much, Doctor.\n  Great, now I wish you all the best. Have a good day.\n  You soon.\n  Okay, thank you.","marks":[[0,7,"",false],[102,118,".",false],[133,146,"Nice to see you",false],[193,193,"Are you the doctor Um",false],[419,419,"Um now",false],[471,471,"Uh I kind of",false],[590,594,"really",false],[899,902,"first",false],[930,939,"medicine that that um",false],[1027,1038,"you're",false],[1189,1191,"on",false],[1199,1199,"minimal",false],[1397,1397,"coughing",false],[1580,1588,"run-down um",false],[1593,1593,"otherwise",false],[1721,1728,"it's",false],[1776,1782,"Kind of . Um",false],[1838,1842,"Both ankles OK. Uh",false],[1889,1889,"has this",false],[1961,1965,"Past",false],[2175,2175,"you're",false],[2249,2253,"in",false],[2356,2371,"Um reporting",false],[2391,2391,"and have you had any have you any",false],[2618,2618,"I I'm",false],[2650,2661,"waterworks",false],[2720,2727,"ever since",false],[2738,2738,". Yeah.",false],[2747,2763,"OK. Alright. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","Note captures gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","Note captures worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","Note captures previously walked to shops, now sits to catch breath."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Note captures breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","yes","Note captures concern HF worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","Note captures mild dry cough."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'feeling a little run down' captured without the otherwise-normal element."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","yes","Note captures ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","Note captures ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","Note captures urine OK, frequent since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Note captures known heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'previously treated with diuretics with good response' but not breathlessness at original diagnosis."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","Note captures small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'requiring hospitalization for a few days' but no chest pain presentation."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Note does not document previous echo."],["The note captures: No other past medical history apart from the heart problems.","partial","PMH lists only HF and small heart attack; no explicit statement of no other history."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'Furosemide PO daily' without one-tablet dose or that mg dose is unknown."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","yes","Note captures bisoprolol."],["The note captures: No known drug allergies.","no","No allergy status documented."],["The note captures: Father died of a heart attack.","yes","Note captures father died of heart attack."],["The note captures: Father was in his early sixties when he died.","yes","Note captures father early sixties."],["The note captures: Mother has osteoporosis.","yes","Note captures mother osteoporosis."],["The note captures: Lives alone.","no","Social history omits that he lives alone."],["The note captures: Works part-time as a lorry driver.","yes","Note captures part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","yes","Note captures work exhausting, worried about work."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","'25 pack-year history' is an accepted equivalent."],["The note captures: Smoked for about 25 years.","yes","'25 pack-year history' is an accepted equivalent."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","Note captures walks to shops daily."],["The note captures: Chest examination OK.","no","Objective recorded as 'N/A'; chest exam not documented."],["The note captures: Oxygen saturations OK.","no","Objective 'N/A'; saturations not documented."],["The note captures: Blood pressure OK.","no","Objective 'N/A'; blood pressure not documented."],["The note captures: Otherwise well at the moment.","no","Doctor's statement that he is otherwise well not recorded."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","Note captures for first few days then review."],["The note captures: Blood test: full blood count to look for anaemia.","yes","Note captures FBC for anaemia."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","Note captures echo requested, 1-2 weeks."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Aspirin PO daily","Aspirin frequency was never stated in the transcript."],["Bisoprolol PO daily","Bisoprolol frequency was never stated in the transcript."],["Simvastatin PO daily","Simvastatin is never mentioned in the transcript."],["now occurring with minimal exertion and at rest","Breathlessness at rest was never reported; patient described it walking to the shops and about the house."],["Current presentation is highly suggestive of heart failure exacerbation","Clinician only said he wondered whether it was a flare-up; 'highly suggestive' overstates the certainty."]],"note":"Subjective\nCliniTech Benchmark 94af0978, a patient with a history of heart failure and history of a \"small heart attack\" approximately 5 years ago, presents with progressive shortness of breath over the past couple of weeks, worsening significantly over the last few days. Previously able to walk to the shops without difficulty, the patient is now having to sit down and catch their breath during such activities and is experiencing breathlessness with minimal exertion around the house. The patient also reports a dry cough that is not too troublesome, bilateral ankle swelling noticed over the last few days, and feeling a little run down. The patient notes that the ankle swelling is similar to what occurred previously when the heart failure was problematic. The patient denies chest pain, palpitations, fever, and reports a normal appetite. Urination is reported as normal, noting frequent urination attributed to diuretic use. The patient expresses concern that the heart failure may be worsening and is worried about the impact on their ability to work as a part-time lorry driver.\n\nMedical History  \n- Heart failure  \n- History of a \"small heart attack\" approximately 5 years ago, requiring hospitalization for a few days\n\nMedications and Supplements  \n- Furosemide PO daily  \n- Aspirin PO daily  \n- Bisoprolol PO daily  \n- Simvastatin PO daily\n\nFamily History  \n- Father: Heart attack in early sixties, deceased  \n- Mother: Osteoporosis, living\n\nSocial History  \n- Tobacco: Former smoker, quit, 25 pack-year history  \n- Alcohol: Denies alcohol use  \n- Exercise: Walks to the shops at least once daily; otherwise limited physical activity  \n- Occupation: Works part-time as a lorry driver, daytime shifts only\n\nReview of Systems  \n- General: Positive for fatigue, denies fever  \n- Cardiovascular: Denies chest pain, palpitations  \n- Respiratory: Dry cough  \n- Gastrointestinal: Denies decreased appetite  \n- Genitourinary: Denies urinary difficulties\n\nObjective\nN/A\n\nAssessment & Plan\nPatient with known heart failure presenting with progressive dyspnea over 2 weeks, worsening in recent days, concerning for heart failure exacerbation.\n\nHeart failure exacerbation  \nAssessment: Patient presents with progressive dyspnea over 2 weeks, significantly worsening in recent days, now occurring with minimal exertion and at rest. Associated symptoms include bilateral ankle swelling, consistent with fluid retention, and mild dry cough. Patient has known heart failure previously treated with diuretics with good response. History of small heart attack approximately 5 years ago requiring brief hospitalization. Current presentation is highly suggestive of heart failure exacerbation given the constellation of worsening dyspnea, bilateral lower extremity edema, and known cardiac history. Patient denies chest pain, palpitations, fever, or other concerning symptoms.  \nPlan:  \n- Increase furosemide to 1 tablet twice daily for first few days  \n- Order blood tests including full blood count to assess for anemia and kidney function  \n- Arrange echocardiogram to evaluate cardiac function, which may take 1-2 weeks to schedule  \n- Follow-up appointment in approximately 1 week to reassess symptoms and response to treatment  \n- Patient advised to contact clinic sooner if experiencing worsening dyspnea, chest pain, palpitations, or dizziness\n","review":378.5,"saved":107.5,"faster":22.11934156378601,"clean":false,"effort":33.9622641509434,"sig":[["partial","Feels a little run-down; otherwise feels generally normal.","'feeling a little run down' captured without the otherwise-normal element."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'previously treated with diuretics with good response' but not breathlessness at original diagnosis."],["partial","That episode presented with chest pain and he was admitted to hospital.","'requiring hospitalization for a few days' but no chest pain presentation."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Note does not document previous echo."],["partial","No other past medical history apart from the heart problems.","PMH lists only HF and small heart attack; no explicit statement of no other history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'Furosemide PO daily' without one-tablet dose or that mg dose is unknown."],["missing","No known drug allergies.","No allergy status documented."],["missing","Lives alone.","Social history omits that he lives alone."],["missing","Chest examination OK.","Objective recorded as 'N/A'; chest exam not documented."],["missing","Oxygen saturations OK.","Objective 'N/A'; saturations not documented."],["missing","Blood pressure OK.","Objective 'N/A'; blood pressure not documented."],["missing","Otherwise well at the moment.","Doctor's statement that he is otherwise well not recorded."],["fabrication","Aspirin PO daily","Aspirin frequency was never stated in the transcript."],["fabrication","Bisoprolol PO daily","Bisoprolol frequency was never stated in the transcript."],["fabrication","Simvastatin PO daily","Simvastatin is never mentioned in the transcript."],["fabrication","now occurring with minimal exertion and at rest","Breathlessness at rest was never reported; patient described it walking to the shops and about the house."],["fabrication","Current presentation is highly suggestive of heart failure exacerbation","Clinician only said he wondered whether it was a flare-up; 'highly suggestive' overstates the certainty."]],"mb":14.75223,"latency":48.991,"finalised":415.978},{"label":"Run 3","wer":25.41824069077172,"text":"Unknown: Hello?\n  Hello there.\n  Hello, can you hear me okay?\n  Yes, I can hear you.\n  Okay, great.\n  Are you a doctor?\n  I am, yes. Doctor Seward here, Oscar. How can I help you this afternoon?\n  I'm contacting you because I've been quite short of breath lately.\n  Okay. Do you want to tell me a bit more about it? When did it all start?\n  Well it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome in the last few days. Normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath and I'm even starting to get a bit breathless just about the house and it's got me kind of worried. I don't really know what's going on.\n  Is there anything you're particularly worried about?\n  Um, well, I've, I've, I've got heart failure.\n  Okay.\n  I was told that a while ago. And I got a bit breathless when I was 1st diagnosed, and put on some medicines that helped, but I'm a bit worried it's getting worse.\n  Right, okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse, and you're now feeling more breathless or kind of minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\n  No pain in my chest.\n  Okay. Have you found yourself coughing at all?\n  I've got a bit of a dry cough, but it's not too troublesome.\n  Okay, okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n  I'm feeling a little run down, but otherwise pretty normal. I've noticed my ankles have got a bit bigger.\n  Okay, and what do you mean by that?\n  It's just like, they've sort of swollen up a bit.\n  Okay, is that both ankles?\n  Yeah, both ankles. Yeah, it's a bit embarrassing.\n  Okay, I can imagine, yeah. And again, over how long have you noticed this for?\n  I kind of noticed it the last few days.\n  Last few days, okay. And is this something that you've had before in the past?\n  I think my ankles did swell up a bit last time the heart failure was a problem.\n  Okay, okay. Fine, okay. So just to really recap, so really the last couple of weeks you've been feeling breathless but worse over the last couple of days. You mentioned you had a bit of a dry cough and some swelling in your ankles, but importantly, no chest pain. And have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n  No, not really.\n  Okay, and any temperatures or fevers?\n  No.\n  Okay, and how about your appetite? Are you eating and drinking okay?\n  Yeah, that's fine.\n  Okay, and your water works? Are you passing urine okay?\n  Yeah, I usually pee a lot, besides the drugs.\n  Sure, okay, all right. Fine, so moving on to your past medical history, you mentioned heart failure. Any other medical history I should be aware of?\n  Well, I was told I had like, they called it like a small heart attack about 5 years ago. I had like chest pain and they took me to hospital.\n  Okay.\n  And they, but then I just got better.\n  Okay. When you say small heart attack, did they give you a name for what happened, a name of a diagnosis?\n  I can't remember. They just called it something like that, a small heart attack.\n  Small heart attack, okay. Was it something like angina or...\n  No, they said it seemed like it was more than angina.\n  Okay.\n  But... I didn't, but I only had to stay in hospital for a few days. Okay. And yeah, I've been okay since then.\n  You've been okay since then? Okay, all right. So apart from the heart problems, the heart failure, any other problems I should be aware of?\n  No, I think otherwise I'm okay.\n Unknown: Okay.\n  Do you take any regular medications apart from your diuretics that you're taking? Do you know which ones?\n  Yeah, I take something called ferrosamide.\n  Ferrosamide, and do you know which dose you're taking?\n  I can't remember, I'm sorry doctor, I have to check.\n  No problems. Any other medications?\n  Yeah, I take aspirin and bisoprolol.\n  Is that metoprolol?\n  Bisoprolol.\n  Sorry, the connection is not very good. Okay, thank you, yeah. Simvastatin. Simvastatin, okay, all right. Any allergies at all to any medications? That's important for me to know. Any family history of medical problems, heart problems, lung problems?\n  My father died of a heart attack.\n  I'm sorry to hear that. How old was your father when he passed away? He was early sixties. Early sixties, okay. Anything else I should be aware of?\n  My mother had osteoporosis.\n  Is your mother still with us?\n  Yeah, she's still living.\n  Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n  I live on my own. I've got 2 cats. You've got 2 cats?\n  Okay, great.\n  Do you have names? They're my family. They're called Polly and Tim.\n  So this is Junior Katz, and in terms of day-to-day, are you working at the moment?\n  I work part-time as a lorry driver.\n  Okay, and how is that? Is that quite stressful, long hours?\n  It's okay. Yeah, like when I'm working it's pretty exhausting. I guess I'm a bit worried that if I get more sick then I won't be able to work properly.\n  Yeah, and it's certainly a consideration, isn't it? So let's try and get you better soon so it doesn't have any impact on your job. Do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\n  No, I only take shifts during the day. I don't like working at night.\n  Okay, all right. And what about smoking and alcohol? Because it can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day, back in the day. And how many years was that for? Oh, that was a good 25 years.\n Unknown: Okay.\n  Well done for stopping. It must have been very difficult for you, well done for stopping. And what about alcohol?\n  I don't drink alcohol. Okay.\n  Do you do much exercise, sir?\n  I try and walk to the shops at least once a day. Okay. But that's about it. Yeah, I don't get running like I used to when I was young.\n  Right, okay, and certainly now with your symptoms, you said you're feeling more breathless even walking to the shop, she said. Right, based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen. What's going on? It seems like your heart's not pumping as well as it should be. And obviously having diagnosed heart failure is obviously the 1st thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruzemide. Maybe rather than one tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n  Okay, if you think that would be best.\n  I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n  Okay, good design.\n  Yeah, so an echocardiogram is a jelly scan of your heart. You may have had this done before when you were diagnosed and it's just to get a good- Oh, yes, I remember now.\n  Yeah, I remember now.\n  Okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's get a blood test done. We can check your full blood count, look for signs of anemia, we can have a check of your kidney function, and we can definitely increase your fruizomide to one tablet twice a day. But I really would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n  I think that sounds like a good plan.\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then you know, certainly I want you to give me a call sooner than that and we can have a chat on the phone as well.\n  Okay, I'll see how I get on.\n  Okay, do you have any questions for me?\n  Nothing at all, pretty clear. Thank you very much, Doctor.\n  Great, now I wish you all the best. Have a good day.\n  You soon.\n  Okay, thank you.","marks":[[0,7,"",false],[102,118,".",false],[133,146,"Nice to see you",false],[193,193,"Are you the doctor Um",false],[419,419,"Um now",false],[471,471,"Uh I kind of",false],[590,594,"really",false],[899,902,"first",false],[930,939,"medicine that that um",false],[1027,1038,"you're",false],[1189,1191,"on",false],[1199,1199,"minimal",false],[1397,1397,"coughing",false],[1580,1588,"run-down um",false],[1593,1593,"otherwise",false],[1721,1728,"it's",false],[1776,1782,"Kind of . Um",false],[1838,1842,"Both ankles OK. Uh",false],[1889,1889,"has this",false],[1961,1965,"Past",false],[2175,2175,"you're",false],[2249,2253,"in",false],[2356,2371,"Um reporting",false],[2391,2391,"and have you had any have you any",false],[2618,2618,"I I'm",false],[2650,2661,"waterworks",false],[2720,2727,"ever since",false],[2738,2738,". Yeah.",false],[2747,2763,"OK. Alright. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'progressive shortness of breath over the past two weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'Previously able to walk to the shops without difficulty... now needs to sit down and catch their breath'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","yes","'concern that the heart failure may be worsening'."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'mild dry cough'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'feeling a little run down' but not that he otherwise feels normal."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'ankle swelling is similar to what occurred during a previous episode of worsening heart failure'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'denies ... changes in appetite'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'Urination is reported as normal, with frequent urination attributed to diuretic use'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Heart failure in medical history."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","yes","'known heart failure with previous similar presentation that responded to diuretic therapy'."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'small heart attack approximately 5 years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Hospital admission recorded but presenting chest pain omitted."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","no","Neither baseline one tablet daily nor unknown mg dose documented."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","yes","Bisoprolol listed."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","yes","'Father: Heart attack in early sixties, deceased'."],["The note captures: Father was in his early sixties when he died.","yes","'early sixties'."],["The note captures: Mother has osteoporosis.","yes","'Mother: Osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Works part-time as a lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Worry about ability to work captured; work being exhausting omitted."],["The note captures: Ex-smoker.","yes","'Former smoker'."],["The note captures: Smoked about a pack a day.","yes","'1 pack per day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'Alcohol: Denies'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to the shops at least once daily'."],["The note captures: Chest examination OK.","no","Objective 'N/A'; chest exam not recorded."],["The note captures: Oxygen saturations OK.","no","Saturations not recorded."],["The note captures: Blood pressure OK.","no","Blood pressure not recorded."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not documented."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'acute exacerbation of chronic heart failure... decreased cardiac output'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'full blood count to assess for anemia'."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to evaluate current cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1-2 weeks to schedule'."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["Simvastatin PO","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."],["breathlessness with minimal exertion and at rest around the house","Patient described breathlessness moving about the house (minimal exertion); breathlessness at rest was never reported."],["acute exacerbation of chronic heart failure, likely due to fluid retention and decreased cardiac output","Clinician said only a possible flare-up with the heart not pumping as well; fluid retention as the cause was not stated."]],"note":"Subjective\nCliniTech Benchmark 2f2040d6 presents with progressive shortness of breath over the past two weeks, worsening significantly in the last few days. Previously able to walk to the shops without difficulty, the patient now needs to sit down and catch their breath during such walks and is becoming breathless with minimal exertion around the house. The patient also reports a mild dry cough, bilateral ankle swelling noticed over the last few days, and feeling a little run down. The patient notes that the ankle swelling is similar to what occurred during a previous episode of worsening heart failure. The patient denies chest pain, palpitations, fever, or changes in appetite. Urination is reported as normal, with frequent urination attributed to diuretic use. The patient expresses concern that the heart failure may be worsening and is worried about the impact on their ability to work as a part-time lorry driver.\n\nMedical History  \n- Heart failure  \n- History of a \"small heart attack\" approximately 5 years ago, requiring hospitalization for a few days\n\nMedications and Supplements  \n- Furosemide PO  \n- Aspirin PO  \n- Bisoprolol PO  \n- Simvastatin PO\n\nFamily History  \n- Father: Heart attack in early sixties, deceased  \n- Mother: Osteoporosis, living\n\nSocial History  \n- Tobacco: Former smoker, 1 pack per day for 25 years, quit  \n- Alcohol: Denies  \n- Occupation: Works part-time as a lorry driver, daytime shifts only  \n- Living Situation: Lives alone with two cats  \n- Exercise: Walks to the shops at least once daily; otherwise limited physical activity\n\nReview of Systems  \n- General: Positive for fatigue, denies fever  \n- Cardiovascular: Denies chest pain, palpitations  \n- Respiratory: Mild dry cough  \n- Gastrointestinal: Denies appetite changes  \n- Genitourinary: Denies urinary difficulties\n\nObjective\nN/A\n\nAssessment & Plan\nPatient with known heart failure presenting with worsening shortness of breath over 2 weeks, particularly severe in recent days, accompanied by bilateral ankle swelling and dry cough.\n\nHeart failure exacerbation  \nAssessment: Patient presents with worsening dyspnea over 2 weeks, now experiencing breathlessness with minimal exertion and at rest around the house. Previously could walk to shops without difficulty but now requires frequent rest breaks. Associated symptoms include bilateral ankle swelling noted over the past few days and mild dry cough. No chest pain, palpitations, fever, or other concerning symptoms. Patient has known heart failure with previous similar presentation that responded to diuretic therapy. History of small heart attack approximately 5 years ago requiring brief hospitalization. Currently on frusemide, aspirin, bisoprolol, and simvastatin. Clinical presentation is consistent with acute exacerbation of chronic heart failure, likely due to fluid retention and decreased cardiac output.  \nPlan:  \n- Increase frusemide to 1 tablet twice daily for the first few days  \n- Order blood tests including full blood count to assess for anemia and kidney function  \n- Arrange echocardiogram to evaluate current cardiac function, which may take 1-2 weeks to schedule  \n- Follow-up appointment in approximately 1 week to reassess symptoms and response to treatment  \n- Patient advised to contact clinic sooner if experiencing worsening breathlessness, chest pain, palpitations, or dizziness\n","review":368.9605263157895,"saved":117.03947368421052,"faster":24.082196231319035,"clean":false,"effort":28.30188679245283,"sig":[["partial","Feels a little run-down; otherwise feels generally normal.","'feeling a little run down' but not that he otherwise feels normal."],["partial","That episode presented with chest pain and he was admitted to hospital.","Hospital admission recorded but presenting chest pain omitted."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["missing","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Neither baseline one tablet daily nor unknown mg dose documented."],["missing","No known drug allergies.","Allergies not documented."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Worry about ability to work captured; work being exhausting omitted."],["missing","Chest examination OK.","Objective 'N/A'; chest exam not recorded."],["missing","Oxygen saturations OK.","Saturations not recorded."],["missing","Blood pressure OK.","Blood pressure not recorded."],["missing","Otherwise well at the moment.","'Otherwise well' not documented."],["fabrication","Simvastatin PO","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."],["fabrication","breathlessness with minimal exertion and at rest around the house","Patient described breathlessness moving about the house (minimal exertion); breathlessness at rest was never reported."],["fabrication","acute exacerbation of chronic heart failure, likely due to fluid retention and decreased cardiac output","Clinician said only a possible flare-up with the heart not pumping as well; fluid retention as the cause was not stated."]],"mb":15.637547,"latency":55.702,"finalised":412.3765263157895},{"label":"Run 4","wer":25.41824069077172,"text":"Unknown: Hello?\n  Hello there.\n  Hello, can you hear me okay?\n  Yes, I can hear you.\n  Okay, great.\n  Are you a doctor?\n  I am, yes. Doctor Seward here, Oscar. How can I help you this afternoon?\n  I'm contacting you because I've been quite short of breath lately.\n  Okay. Do you want to tell me a bit more about it? When did it all start?\n  Well it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome in the last few days. Normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath and I'm even starting to get a bit breathless just about the house and it's got me kind of worried. I don't really know what's going on.\n  Is there anything you're particularly worried about?\n  Um, well, I've, I've, I've got heart failure.\n  Okay.\n  I was told that a while ago. And I got a bit breathless when I was 1st diagnosed, and put on some medicines that helped, but I'm a bit worried it's getting worse.\n  Right, okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse, and you're now feeling more breathless or kind of minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\n  No pain in my chest.\n  Okay. Have you found yourself coughing at all?\n  I've got a bit of a dry cough, but it's not too troublesome.\n  Okay, okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n  I'm feeling a little run down, but otherwise pretty normal. I've noticed my ankles have got a bit bigger.\n  Okay, and what do you mean by that?\n  It's just like, they've sort of swollen up a bit.\n  Okay, is that both ankles?\n  Yeah, both ankles. Yeah, it's a bit embarrassing.\n  Okay, I can imagine, yeah. And again, over how long have you noticed this for?\n  I kind of noticed it the last few days.\n  Last few days, okay. And is this something that you've had before in the past?\n  I think my ankles did swell up a bit last time the heart failure was a problem.\n  Okay, okay. Fine, okay. So just to really recap, so really the last couple of weeks you've been feeling breathless but worse over the last couple of days. You mentioned you had a bit of a dry cough and some swelling in your ankles, but importantly, no chest pain. And have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n  No, not really.\n  Okay, and any temperatures or fevers?\n  No.\n  Okay, and how about your appetite? Are you eating and drinking okay?\n  Yeah, that's fine.\n  Okay, and your water works? Are you passing urine okay?\n  Yeah, I usually pee a lot, besides the drugs.\n  Sure, okay, all right. Fine, so moving on to your past medical history, you mentioned heart failure. Any other medical history I should be aware of?\n  Well, I was told I had like, they called it like a small heart attack about 5 years ago. I had like chest pain and they took me to hospital.\n  Okay.\n  And they, but then I just got better.\n  Okay. When you say small heart attack, did they give you a name for what happened, a name of a diagnosis?\n  I can't remember. They just called it something like that, a small heart attack.\n  Small heart attack, okay. Was it something like angina or...\n  No, they said it seemed like it was more than angina.\n  Okay.\n  But... I didn't, but I only had to stay in hospital for a few days. Okay. And yeah, I've been okay since then.\n  You've been okay since then? Okay, all right. So apart from the heart problems, the heart failure, any other problems I should be aware of?\n  No, I think otherwise I'm okay.\n Unknown: Okay.\n  Do you take any regular medications apart from your diuretics that you're taking? Do you know which ones?\n  Yeah, I take something called ferrosamide.\n  Ferrosamide, and do you know which dose you're taking?\n  I can't remember, I'm sorry doctor, I have to check.\n  No problems. Any other medications?\n  Yeah, I take aspirin and bisoprolol.\n  Is that metoprolol?\n  Bisoprolol.\n  Sorry, the connection is not very good. Okay, thank you, yeah. Simvastatin. Simvastatin, okay, all right. Any allergies at all to any medications? That's important for me to know. Any family history of medical problems, heart problems, lung problems?\n  My father died of a heart attack.\n  I'm sorry to hear that. How old was your father when he passed away? He was early sixties. Early sixties, okay. Anything else I should be aware of?\n  My mother had osteoporosis.\n  Is your mother still with us?\n  Yeah, she's still living.\n  Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n  I live on my own. I've got 2 cats. You've got 2 cats?\n  Okay, great.\n  Do you have names? They're my family. They're called Polly and Tim.\n  So this is Junior Katz, and in terms of day-to-day, are you working at the moment?\n  I work part-time as a lorry driver.\n  Okay, and how is that? Is that quite stressful, long hours?\n  It's okay. Yeah, like when I'm working it's pretty exhausting. I guess I'm a bit worried that if I get more sick then I won't be able to work properly.\n  Yeah, and it's certainly a consideration, isn't it? So let's try and get you better soon so it doesn't have any impact on your job. Do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\n  No, I only take shifts during the day. I don't like working at night.\n  Okay, all right. And what about smoking and alcohol? Because it can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day, back in the day. And how many years was that for? Oh, that was a good 25 years.\n Unknown: Okay.\n  Well done for stopping. It must have been very difficult for you, well done for stopping. And what about alcohol?\n  I don't drink alcohol. Okay.\n  Do you do much exercise, sir?\n  I try and walk to the shops at least once a day. Okay. But that's about it. Yeah, I don't get running like I used to when I was young.\n  Right, okay, and certainly now with your symptoms, you said you're feeling more breathless even walking to the shop, she said. Right, based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen. What's going on? It seems like your heart's not pumping as well as it should be. And obviously having diagnosed heart failure is obviously the 1st thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruzemide. Maybe rather than one tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n  Okay, if you think that would be best.\n  I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n  Okay, good design.\n  Yeah, so an echocardiogram is a jelly scan of your heart. You may have had this done before when you were diagnosed and it's just to get a good- Oh, yes, I remember now.\n  Yeah, I remember now.\n  Okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's get a blood test done. We can check your full blood count, look for signs of anemia, we can have a check of your kidney function, and we can definitely increase your fruizomide to one tablet twice a day. But I really would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\n  I think that sounds like a good plan.\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then you know, certainly I want you to give me a call sooner than that and we can have a chat on the phone as well.\n  Okay, I'll see how I get on.\n  Okay, do you have any questions for me?\n  Nothing at all, pretty clear. Thank you very much, Doctor.\n  Great, now I wish you all the best. Have a good day.\n  You soon.\n  Okay, thank you.","marks":[[0,7,"",false],[102,118,".",false],[133,146,"Nice to see you",false],[193,193,"Are you the doctor Um",false],[419,419,"Um now",false],[471,471,"Uh I kind of",false],[590,594,"really",false],[899,902,"first",false],[930,939,"medicine that that um",false],[1027,1038,"you're",false],[1189,1191,"on",false],[1199,1199,"minimal",false],[1397,1397,"coughing",false],[1580,1588,"run-down um",false],[1593,1593,"otherwise",false],[1721,1728,"it's",false],[1776,1782,"Kind of . Um",false],[1838,1842,"Both ankles OK. Uh",false],[1889,1889,"has this",false],[1961,1965,"Past",false],[2175,2175,"you're",false],[2249,2253,"in",false],[2356,2371,"Um reporting",false],[2391,2391,"and have you had any have you any",false],[2618,2618,"I I'm",false],[2650,2661,"waterworks",false],[2720,2727,"ever since",false],[2738,2738,". Yeah.",false],[2747,2763,"OK. Alright. 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And um",false],[5144,5144,"if I get sick I won't",false],[5211,5219,"that's",false],[5259,5259,"let's",false],[5331,5331,"on your",false],[5336,5336,"No. Uh and",false],[5373,5383,"anti-social",false],[5389,5389,"Do you",false],[5440,5440,"Ohh",false],[5516,5532,"OK. OK alright.",false],[5569,5579,"So 'cause that",false],[5651,5651,"do you",false],[5670,5678,"any more.",false],[5748,5750,"Ooh",false],[5758,5758,"about",false],[5799,5799,"how many",false],[5829,5831,"Ohh",false],[5842,5843,"oof",false],[5860,5890,"OK. And what about the",false],[5919,5923,"",false],[5943,5956,"",false],[5970,5970,"what",false],[6038,6038,"in the way of",false],[6131,6131,"I've.",false],[6146,6149,"I don't go",false],[6242,6242,"you you're",false],[6325,6325,"Ohh um",false],[6340,6340,"based on you",false],[6479,6494,"Um um and uh Mmm. That. It's . So",false],[6605,6607,"there's",false],[6617,6617,"What's going on. Um that's",false],[6622,6625,"first",false],[6703,6703,"Um Mmm.",false],[6873,6883,"Furosemide.",false],[6927,6935,"do",false],[6974,6974,"Um and see",false],[7027,7037,"that'll",false],[7041,7046,"better. Uh",false],[7056,7056,"I think it's it's",false],[7278,7296,"OK. Is that something you've had before",false],[7311,7328,"it's",false],[7331,7336,"it's a general",false],[7361,7364,"might",false],[7438,7446,"good What does that Ohh",false],[7468,7468,"Sorry Uh",false],[7495,7499,". You remember that. OK",false],[7558,7564,"and that might",false],[7658,7658,"um Let's let's",false],[7694,7694,"your um you know",false],[7825,7835,"um your Furosemide uh",false],[7838,7838,"you know",false],[7968,7972,"",false],[8102,8107,"feel like",false],[8236,8245,"",false],[8412,8422,"Uh I think that's",false],[8480,8483,"and then well",false],[8528,8544,"OK.",false],[8556,8556,"OK. See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'progressive shortness of breath' captured."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'progressive shortness of breath over the past couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'worsening significantly over the last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'Previously able to walk to the shops without difficulty, the patient now needs to sit down and catch their breath'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'breathless with minimal exertion around the house'."],["The note captures: Concerned that his heart failure is getting worse.","yes","'expresses concern that the heart failure may be worsening'."],["The note captures: No chest pain.","yes","'denies chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'mild dry cough that is not too troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'feeling a little run down' captured."],["The note captures: Swelling of both ankles.","yes","'bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noticed over the last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'similar to what occurred previously when the heart failure was exacerbating'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'denies ... palpitations'."],["The note captures: No fevers or temperatures.","yes","'denies ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'denies changes in appetite'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'Urination is reported as normal, with frequent urination attributed to diuretic use'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'history of heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","yes","'previous episode of breathlessness at diagnosis that responded to medications'."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'small heart attack approximately 5 years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Hospitalisation for a few days captured but the presenting chest pain is not."],["The note captures: Has been well since the heart attack.","no","Not stated that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement that there is no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'Furosemide PO' listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","no","Current dose (one tablet a day) and unknown mg dose not recorded."],["The note captures: Takes aspirin.","yes","'Aspirin PO'."],["The note captures: Takes bisoprolol.","yes","'Bisoprolol PO'."],["The note captures: No known drug allergies.","no","Allergy status not documented."],["The note captures: Father died of a heart attack.","yes","'Father: Died of a heart attack'."],["The note captures: Father was in his early sixties when he died.","yes","'in his early sixties'."],["The note captures: Mother has osteoporosis.","yes","'Mother: Osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Works part-time as a lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Worry about ability to work captured, but that work is exhausting is not."],["The note captures: Ex-smoker.","yes","'Former smoker'."],["The note captures: Smoked about a pack a day.","yes","'approximately 1 pack per day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'Denies alcohol use'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to the shops at least once daily'."],["The note captures: Chest examination OK.","no","Objective 'N/A'; chest examination not recorded."],["The note captures: Oxygen saturations OK.","no","Oxygen saturations not recorded."],["The note captures: Blood pressure OK.","no","Blood pressure not recorded."],["The note captures: Otherwise well at the moment.","partial","Only 'No ... other concerning symptoms reported'; 'otherwise well' not clearly stated."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'concerning for heart failure exacerbation' framed as suspected."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase frusemide to one tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'full blood count to assess for anemia'."],["The note captures: Blood test: kidney function.","yes","'and kidney function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to evaluate cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1-2 weeks to organize'."],["The note captures: Follow-up review in about one week.","yes","'Follow-up appointment in approximately one week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'contact clinic sooner if experiencing worsening breathlessness'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations, or dizziness'."]],"claims":[["Simvastatin PO","Simvastatin is never mentioned; patient named only furosemide, aspirin and bisoprolol."],["breathlessness with minimal exertion and at rest around the house","Patient described breathlessness moving about the house; breathlessness at rest was never stated."]],"note":"Subjective\nCliniTech Benchmark 21c959b0 presents with a history of heart failure and a history of a small heart attack approximately 5 years ago. The patient reports progressive shortness of breath over the past couple of weeks, worsening significantly over the last few days. Previously able to walk to the shops without difficulty, the patient now needs to sit down and catch their breath during such walks and is becoming breathless with minimal exertion around the house. The patient also reports bilateral ankle swelling noticed over the last few days, similar to what occurred previously when the heart failure was exacerbating, and feeling a little run down.\n\nThe patient denies chest pain, palpitations, or fever. The patient reports a mild dry cough that is not too troublesome. Urination is reported as normal, with frequent urination attributed to diuretic use. The patient denies changes in appetite. The patient expresses concern that the heart failure may be worsening and is worried about the impact on their ability to work as a part-time lorry driver.\n\nMedical History  \n- Heart failure  \n- History of a small heart attack approximately 5 years ago, requiring hospitalization for a few days\n\nMedications and Supplements  \n- Furosemide PO  \n- Aspirin PO  \n- Bisoprolol PO  \n- Simvastatin PO\n\nFamily History  \n- Father: Died of a heart attack in his early sixties  \n- Mother: Osteoporosis, living\n\nSocial History  \n- Tobacco: Former smoker, approximately 1 pack per day for 25 years, quit  \n- Alcohol: Denies alcohol use  \n- Exercise: Walks to the shops at least once daily; otherwise limited physical activity  \n- Occupation: Works part-time as a lorry driver with daytime shifts only  \n- Living Situation: Lives alone with two cats\n\nReview of Systems  \n- General: Positive for fatigue, denies fever  \n- Cardiovascular: Denies chest pain, palpitations  \n- Respiratory: Mild dry cough  \n- Gastrointestinal: Denies appetite changes  \n- Genitourinary: Denies urinary difficulties\n\nObjective\nN/A\n\nAssessment & Plan\nPatient with known heart failure presenting with worsening shortness of breath over 2 weeks, particularly severe in recent days, accompanied by bilateral ankle swelling and dry cough.\n\nHeart failure exacerbation  \nAssessment: Patient presents with worsening dyspnea over 2 weeks, now experiencing breathlessness with minimal exertion and at rest around the house. Previously could walk to shops without difficulty but now requires frequent rest breaks. Associated symptoms include bilateral ankle swelling noted over the past few days and mild dry cough. Patient has known heart failure with previous episode of breathlessness at diagnosis that responded to medications. History of small heart attack approximately 5 years ago requiring brief hospitalization. Current presentation is concerning for heart failure exacerbation given the constellation of symptoms including progressive dyspnea, bilateral lower extremity edema, and dry cough in the setting of known heart failure. No chest pain, palpitations, fever, or other concerning symptoms reported.  \nPlan:  \n- Increase frusemide to one tablet twice daily for the first few days  \n- Order blood tests including full blood count to assess for anemia and kidney function  \n- Arrange echocardiogram to evaluate cardiac function, which may take 1-2 weeks to organize  \n- Follow-up appointment in approximately one week to reassess symptoms and response to treatment  \n- Patient advised to contact clinic sooner if experiencing worsening breathlessness, chest pain, palpitations, or dizziness\n","review":352.5131578947368,"saved":133.48684210526318,"faster":27.466428416720817,"clean":false,"effort":23.58490566037736,"sig":[["partial","That episode presented with chest pain and he was admitted to hospital.","Hospitalisation for a few days captured but the presenting chest pain is not."],["missing","Has been well since the heart attack.","Not stated that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement that there is no other past medical history."],["missing","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Current dose (one tablet a day) and unknown mg dose not recorded."],["missing","No known drug allergies.","Allergy status not documented."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Worry about ability to work captured, but that work is exhausting is not."],["missing","Chest examination OK.","Objective 'N/A'; chest examination not recorded."],["missing","Oxygen saturations OK.","Oxygen saturations not recorded."],["missing","Blood pressure OK.","Blood pressure not recorded."],["partial","Otherwise well at the moment.","Only 'No ... other concerning symptoms reported'; 'otherwise well' not clearly stated."],["fabrication","Simvastatin PO","Simvastatin is never mentioned; patient named only furosemide, aspirin and bisoprolol."],["fabrication","breathlessness with minimal exertion and at rest around the house","Patient described breathlessness moving about the house; breathlessness at rest was never stated."]],"mb":14.957368,"latency":81.331,"finalised":421.8951578947368},{"label":"Run 5","wer":24.824608742579603,"text":"Hello?\n  Hello there.\n  Hello, can you hear me okay?\n  Yes, I can hear you. Okay, great. Are you a doctor?\n  I am, yes. Doctor Seward here, Oscar. How can I help you this afternoon?\n  I'm contacting you because I've been quite short of breath lately.\n  Okay. Do you want to tell me a bit more about it? When did it all start?\n  Well it seems to have been slowly getting worse over the last couple of weeks and it's become quite troublesome in the last few days. Normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath and I'm even starting to get a bit breathless just about the house and it's got me kind of worried. I don't really know what's going on.\n  Is there anything you're particularly worried about?\n  Well, I've got heart failure, I was told that a while ago. And I got a bit breathless when I was 1st diagnosed, and put on some medicine that helped, but I'm a bit worried it's getting worse.\n  Right, okay. So you mentioned you've been feeling short of breath for the last couple of weeks, but mainly the last couple of days it's got a bit worse, and you're now feeling more breathless or kind of minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\n  No pain in my chest.\n  Okay. Have you found yourself coughing at all?\n  I've got a bit of a dry cough, but it's not too troublesome.\n  Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n  I'm feeling a little run down, but otherwise pretty normal. I've noticed my ankles have got a bit bigger.\n  Okay. And what do you mean by that?\n  It's like, it's sort of swollen up a bit.\n  Okay, is that both ankles?\n  Yeah, both ankles. Yeah, it's a bit embarrassing.\n  Okay, I can imagine, yeah. And again, over how long have you noticed this for?\n  I kind of noticed it the last few days.\n  Last few days, okay. And is this something that you've had before in the past?\n  I think my ankles did swell up a bit last time the heart failure was a problem.\n  Okay. Fine. Okay. So just to really recap, so really in the last couple of weeks you've been feeling breathless but worse over the last couple of days. You mentioned you had a bit of a dry cough and some swelling in your ankles, but importantly, no chest pain. And have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat?\n  No not really.\n  Okay and any temperatures or fevers?\n  Uh no.\n  Okay and how about your appetite? Are you eating and drinking okay?\n  Yeah I'm that's fine.\n  Okay and your water works? Are you passing urine okay?\n  Uh yeah that yeah I usually pee a lot.\n  Yeah.\n  The drugs.\n  Sure, okay, all right. Fine, so moving on to your past medical history, you mentioned heart failure. Any other medical history I should be aware of?\n  Well, I was told I had like, they called it like a small heart attack about five years ago. I had like chest pain and they took me to hospital.\n  Okay.\n  And they, but then I just got better.\n  Okay. When you say small heart attack, did they give you a name for what happened, a name of a diagnosis?\n  I can't remember. They just called it something like that, a small heart attack.\n  Small heart attack, okay. Was it something like angina or...\n  No, they said it seemed like it was more than angina.\n  Okay.\n  But... I didn't, but I only had to stay in hospital for a few days. Okay. And yeah, I've been okay since then.\n  You've been okay since then. Okay. All right. So apart from the heart problems, the heart failure, any other problems I should be aware of?\n  No, I think otherwise I'm okay.\n Unknown: Okay.\n  Do you take any regular medications apart from your diuretics that you're taking? Do you know which ones?\n  Yeah, I take something called furosemide.\n  Furosemide. And do you know which dose you're taking?\n  I can't remember, I'm sorry doctor, I have to check.\n  No problems. Any other medications?\n  Yeah, I take aspirin and bisoprolol.\n  Is that metoprolol, what is it?\n  Bisoprolol.\n  Sorry, the connection is not very good. Okay, thank you, yeah.\n  Simvastatin.\n  Simvastatin, okay, all right. Any allergies at all to any medications? That's important for me to know. Any family history of medical problems, heart problems, lung problems?\n  My father died of a heart attack.\n  I'm sorry to hear that. How old was your father when he passed away? He was early sixties. Early sixties, okay. Anything else I should be aware of?\n  My mother had osteoporosis.\n  Is your mother still with us?\n  Uh, yeah, she's still living. Okay.\n  All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\n  Uh, I live on my own. I've got 2 cats. You've got 2 cats? Okay, great. Do you have names? They're my family. Uh, they're called, um, they're called Holly and Tim.\n  Okay. So this is Junior Katz, and in terms of day-to-day, are you working at the moment?\n  I work part-time as a lorry driver.\n  Okay, and how is that? Is that quite stressful, long hours?\n  It's okay. Yeah, like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get more sick, then I won't be able to work properly.\n  Yeah, and it's certainly a consideration, isn't it? So let's try and get you better soon, so it doesn't have any impact on your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\n  No, I only take shifts during the day. I don't like working at night.\n  Okay, all right. And what about smoking and alcohol? Because it can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day, back in the day. And how many years was that for? Oh, that was a good 25 years.\n Unknown: Okay.\n  Well done for stopping. It must have been very difficult for you, well done for stopping. And what about alcohol?\n  I don't drink alcohol.\n  Okay. Do you do much exercise, sir?\n  I try and walk to the shops at least once a day. Okay. But that's about it. Yeah, I don't go running like I used to when I was young.\n  Right, okay, and certainly now with your symptoms, you said you're feeling more breathless even walking to the shops, you said. Right, based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir, which can sometimes happen. What's going on? It seems like your heart's not pumping as well as it should be. And obviously having diagnosed heart failure is obviously the 1st thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of fruzemide. Maybe rather than one tablet a day, we can give you 2 tablets a day for the first few days and see how you're getting on.\n  Okay, if you think that would be best.\n  I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\n  Okay, good design.\n  Yeah, so an echocardiogram is a jelly scan of your heart. You may have had this done before when you were diagnosed and it's just to get a good- Oh, yes, I remember now.\n  Yeah, I remember now.\n  Okay, fine. That's something I can organize for you today, and it may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's get a blood test done. We can check your full blood count, look for signs of anemia, we can have a check of your kidney function, and we can definitely increase your fruzomide to one tablet twice a day. But I really would like you to come back and see me in about a week's time, see how you're getting on. Does that sound reasonable?\n  I think that sounds like a good plan.\n  And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then you know, certainly I want you to give me a call sooner than that and we can have a chat on the phone as well.\n  Okay, I'll see how I get on.\n  Okay, do you have any questions for me?\n  Nothing at all, pretty clear. Thank you very much, Doctor.\n  Great, now I wish you all the best. Have a good day.\n  See you soon.\n  Thank you.","marks":[[89,105,".",false],[120,133,"Nice to see you",false],[180,180,"Are you the doctor Um",false],[406,409,"Um now",false],[461,461,"Uh I kind of",false],[580,584,"really",false],[776,776,"I've uh I've",false],[863,866,"first",false],[990,1001,"you're",false],[1152,1154,"on",false],[1162,1162,"minimal",false],[1360,1360,"coughing",false],[1543,1551,"run-down um",false],[1556,1556,"otherwise",false],[1731,1737,"Kind of . Um",false],[1793,1797,"Both ankles OK. Uh",false],[1844,1844,"has this",false],[1916,1920,"Past",false],[2124,2124,"you're",false],[2201,2205,"in",false],[2308,2323,"Um reporting",false],[2343,2343,"and have you had any have you any",false],[2604,2615,"waterworks",false],[2688,2693,"ever since",false],[2706,2706,". Yeah.",false],[2715,2731,"OK. Alright. 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OK.",false],[8580,8590,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'progressive shortness of breath over the past couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'can normally walk to the shops without difficulty, but now has to sit down and catch his breath'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","yes","'concern that his heart failure may be worsening'."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'mild dry cough that is not too troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'feeling a little run down but otherwise normal'."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'recalls also occurred when his heart failure was previously symptomatic'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'appetite is fine and he is eating and drinking well'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'frequent urination, which he attributes to his medications'; denies difficulty urinating."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Heart failure in medical history."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","Symptoms similar to when first diagnosed and treated with diuretics, but improvement with medication not stated."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'Myocardial infarction (approximately five years ago)'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Chest pain presentation and hospital admission not documented."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","no","Neither baseline one tablet daily nor unknown mg dose documented."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","yes","Bisoprolol listed."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","yes","'Father: MI in early sixties, deceased'."],["The note captures: Father was in his early sixties when he died.","yes","'early sixties'."],["The note captures: Mother has osteoporosis.","yes","'Mother: Osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Works part-time as a lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Worry about not working properly captured; work being exhausting omitted."],["The note captures: Ex-smoker.","yes","'Former smoker, quit'."],["The note captures: Smoked about a pack a day.","yes","'25 pack-year history' accepted equivalent."],["The note captures: Smoked for about 25 years.","yes","'25 pack-year history' accepted equivalent."],["The note captures: Does not drink alcohol.","yes","'Alcohol: Denies'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'Walks to the shops at least once daily'."],["The note captures: Chest examination OK.","no","Objective 'N/A'; chest exam not recorded."],["The note captures: Oxygen saturations OK.","no","Saturations not recorded."],["The note captures: Blood pressure OK.","no","Blood pressure not recorded."],["The note captures: Otherwise well at the moment.","yes","'otherwise normal'."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'consistent with acute exacerbation of heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'full blood count to assess for anemia'."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to evaluate heart function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1-2 weeks to organize'."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["Simvastatin PO","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."],["now occurring with minimal exertion and at rest","Patient described breathlessness moving about the house (minimal exertion); breathlessness at rest was never reported."],["acute exacerbation of heart failure with likely fluid overload","Clinician said only a possible flare-up with the heart not pumping as well; fluid overload was not stated."]],"note":"Subjective\nCliniTech Benchmark 45d4cdff, a patient with a history of heart failure and prior myocardial infarction, presents with progressive shortness of breath over the past couple of weeks, worsening significantly over the last few days. He reports that he can normally walk to the shops without difficulty, but now has to sit down and catch his breath along the way. He is also becoming breathless with minimal exertion around the house. He notes a mild dry cough that is not too troublesome. He denies chest pain, palpitations, or fevers. He reports feeling a little run down but otherwise normal.\n\nHe has noticed bilateral ankle swelling over the last few days, which he recalls also occurred when his heart failure was previously symptomatic. He reports frequent urination, which he attributes to his medications. He states his appetite is fine and he is eating and drinking well.\n\nHe expresses concern that his heart failure may be worsening, as his current symptoms are similar to those he experienced when first diagnosed. He works part-time as a lorry driver and is worried that if his symptoms worsen, he may not be able to work properly.\n\nMedical History  \n- Heart failure  \n- Myocardial infarction (approximately five years ago)\n\nMedications and Supplements  \n- Aspirin PO  \n- Bisoprolol PO  \n- Furosemide PO  \n- Simvastatin PO\n\nFamily History  \n- Father: MI in early sixties, deceased  \n- Mother: Osteoporosis, living\n\nSocial History  \n- Tobacco: Former smoker, quit, 25 pack-year history  \n- Alcohol: Denies  \n- Exercise: Walks to the shops at least once daily  \n- Occupation: Works part-time as a lorry driver, daytime shifts only  \n- Living Situation: Lives alone with two cats\n\nReview of Systems  \n- General: Mild fatigue, denies fever  \n- Cardiovascular: Shortness of breath with exertion, bilateral ankle swelling, denies chest pain, palpitations  \n- Respiratory: Mild dry cough  \n- Genitourinary: Frequent urination, denies difficulty urinating\n\nObjective\nN/A\n\nAssessment & Plan\nPatient with known heart failure presenting with worsening shortness of breath over the past couple of weeks, particularly severe in the last few days.\n\nHeart failure exacerbation  \nAssessment: Patient presents with progressive dyspnea over 2 weeks, significantly worsening in the last few days, now occurring with minimal exertion and at rest. Associated symptoms include bilateral ankle swelling noted in the past few days and mild dry cough. Patient has known heart failure previously treated with diuretics, and recalls similar ankle swelling during previous heart failure exacerbation. No chest pain, palpitations, fever, or other concerning symptoms. Given the constellation of symptoms including worsening dyspnea, bilateral lower extremity edema, and history of heart failure, this presentation is consistent with acute exacerbation of heart failure with likely fluid overload.  \nPlan:  \n- Increase furosemide to 1 tablet twice daily for the first few days  \n- Order blood tests including full blood count to assess for anemia and kidney function  \n- Arrange echocardiogram to evaluate heart function, which may take 1-2 weeks to organize  \n- Follow-up appointment in approximately 1 week to reassess symptoms  \n- Patient advised to contact clinic sooner if experiencing worsening breathlessness, chest pain, palpitations, or dizziness\n","review":371.3026315789474,"saved":114.6973684210526,"faster":23.600281568117822,"clean":false,"effort":27.358490566037734,"sig":[["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","Symptoms similar to when first diagnosed and treated with diuretics, but improvement with medication not stated."],["missing","That episode presented with chest pain and he was admitted to hospital.","Chest pain presentation and hospital admission not documented."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["missing","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Neither baseline one tablet daily nor unknown mg dose documented."],["missing","No known drug allergies.","Allergies not documented."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Worry about not working properly captured; work being exhausting omitted."],["missing","Chest examination OK.","Objective 'N/A'; chest exam not recorded."],["missing","Oxygen saturations OK.","Saturations not recorded."],["missing","Blood pressure OK.","Blood pressure not recorded."],["fabrication","Simvastatin PO","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."],["fabrication","now occurring with minimal exertion and at rest","Patient described breathlessness moving about the house (minimal exertion); breathlessness at rest was never reported."],["fabrication","acute exacerbation of heart failure with likely fluid overload","Clinician said only a possible flare-up with the heart not pumping as well; fluid overload was not stated."]],"mb":15.132811,"latency":53.358,"finalised":412.5986315789474}],"cliniscripts":[{"label":"Run 1","wer":14.786832164058284,"text":"Okay. Hello.\nHello there.\nUh, hello. Can you hear me okay?\nYes, I can hear you. Okay, great. Are you the doctor? Oh, I am, yes. Dr. Sood here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about you? When did it all start?\nUh, well, it seems to have been slowly getting worse over the last couple of weeks.\nUm, it's become quite troublesome in the last few days.\nOkay. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\nOkay. And, uh, it's got me kind of worried.\nI don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\nUm, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse. Right.\nOkay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned.\nUm, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing, coughing at all?\nUh, I've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\nUm, I'm feeling a little rundown.\nUm, but otherwise, otherwise pretty normal.\nOkay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that?\nUh, it's just like they've sort of swollen up a bit.\nOkay. Um, is that, is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing.\nOkay. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\nUm, I kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nUh, I think my ankles did swell up a bit last time the heart failure was a problem. Okay.\nOkay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse in the last couple of days. You mentioned you had a bit of a dry cough.\nUm, and some swelling in your ankles.\nUm, but importantly, no chest pain. Um, and, and have you had, have you, have you noticed your heartbeat racing at all?\nSo palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers?\nUh, no. Okay. And how about your appetite? Are you eating and drinking okay? Yeah, I'm, I'm, that's fine. Okay. And your water work, are you passing urine okay?\nUh, yeah, that, yeah. I usually pee a lot. Yeah.\nA little bit since the drugs came out. Sure. Okay. All right.\nUm, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\nUh, well, I was told I had, like, a, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to hospital. Okay. And, um, they, uh, but then I just got better. Okay. And when, when you say small heart attack, did they give you a name for what happened?\nA, a name of a diagnosis?\nUh, I can't remember. They just called it a, something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um?\nUm, uh, no, they, they said that it seemed it was like more than angina.\nOkay. Um, uh, but, um, I didn't, but I only had to stay in hospital for a few days and. Okay. Uh, and yeah, I've been okay since then. You've been okay since then.\nOkay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\nUh, no, I think I'm otherwise I'm okay. Okay.\nUm, do you take any regular medications apart from your is it diuretics that you're taking? And do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor.\nThat's okay. I'd have to check. No problems. Um, any other medications?\nUh, yeah, I take aspirin. Okay.\nAnd, uh, bisoprolol.\nIs that metoprolol, was it?\nOr? Uh, bisoprolol. Sorry, the connection's not very good. Okay, thank you. Yep.\nGreat. Um, and, uh, simvastatin. Simvastatin.\nOkay. All right. Any allergies at all to any medications?\nUh, no. No. No, no allergies. Okay. And is there anything in the family that's, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\nUh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away?\nUh, he was, um, early 60s. Early 60s.\nOkay. Uh, anything else I should be aware of?\nUm, my mother had osteoporosis. Okay.\nIs your mother still with us?\nUh, yeah, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. Uh, I've got two cats. You've got two cats. Okay, great. Do they have names?\nThey're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay.\nUm, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\nUh, I work part-time as a, uh, lorry driver.\nOkay. And how is that? Is that quite stressful, long hours?\nUh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting. Mm-hmm. Um, I guess I'm a bit worried that if I get sick, I won't, if I get more sick, then I won't be able to work properly. Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Do you s do, do you do a lot of night driving, weekend driving?\nOh, no, I, I, I, I only take shifts during the day. Okay.\nI don't like working at night. Okay. All right. And what about smoking and alcohol, sir? Because it, it can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\nNot anymore. So you used to smoke?\nYeah.\nAnd how many did you smoke a day on average?\nOh, it was about, about a pack a day back in the day. Um, and how many, how many years was that for?\nOh, that was, oof, a good 25 years. Okay.\nWell done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\nI don't drink alcohol. Okay. Do you do much in the way of exercise, sir?\nUh, I try and walk to the shops at least once a day. Okay. Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless, even walking to the st uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um,\num, and, you know, it's. What's going on? So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind.\nUm, now, there's a couple of options to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide.\nSo maybe rather than one tablet a day, we can give you two tablets a day for the first few days.\nUm, and see, and see how you're getting on.\nOkay. Okay. If you think that would be best. I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\nOkay.\nIs that something you've had. What does that? Yeah. So, um, an echo scan, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good. Oh, yes, I remember now.\nSorry?\nUh, yeah, I remember now. You remember now. Okay, fine. That's something I can organise for you today and, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function.\nUm, and we can definitely increase your, um, your furosemide to, you know, one tablet twice a day. But I'd really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call\nsooner than that and we can have a chat on the phone as well. Okay. I'll see how I get on.\nOkay. Do you have any questions for me?\nUh, nothing else. All pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day. Okay. See you soon. Okay. Thank you.","marks":[[93,115,".",false],[128,136,"Nice to see you",false],[187,187,"Are you the doctor",false],[420,420,"now",false],[614,618,"really",false],[1116,1127,"you're",false],[1157,1161,"for",false],[1223,1226,"it's",false],[1705,1713,"run-down",false],[1865,1872,"it's",false],[1931,1950,"Kind of .",false],[2006,2011,"Both ankles OK.",false],[2147,2151,"Past",false],[2371,2374,"you're",false],[2576,2591,"reporting",false],[2633,2633,"any",false],[2643,2643,"any",false],[2867,2870,"I",false],[2905,2915,"waterworks",false],[2988,3006,"ever",false],[3023,3032,". Yeah.",false],[3039,3055,"OK. Alright.",false],[3069,3081,"",false],[3364,3366,"into",false],[3590,3590,"something",false],[3637,3662,"It's more hard to say. 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OK.",false],[9746,9762,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'worsening shortness of breath'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'worsening shortness of breath over the last two weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'becoming more troublesome in the last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'requiring them to sit down while walking to shops'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'minimal exertion... even around the house'."],["The note captures: Concerned that his heart failure is getting worse.","no","Patient's concern about worsening heart failure not captured."],["The note captures: No chest pain.","yes","'denies chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","partial","'a dry cough' without noting it is mild/not troublesome."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'a little rundown but otherwise normal'."],["The note captures: Swelling of both ankles.","yes","'bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noticed over the last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'which they recall occurred during a previous heart failure episode'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'denies ... palpitations'."],["The note captures: No fevers or temperatures.","yes","'denies ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'appetite ... reported as fine'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'urination reported as fine' omits increased urination since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'heart failure, diagnosed previously'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'managed with medication' but prior breathlessness at diagnosis not stated."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'a \"small heart attack\" five years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'short hospital stay' but chest pain presentation omitted."],["The note captures: Has been well since the heart attack.","no","Wellness since the heart attack not captured."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement of no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'furosemide (dose unknown)'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unknown' but current one tablet daily not stated."],["The note captures: Takes aspirin.","yes","'aspirin'."],["The note captures: Takes bisoprolol.","yes","'bisoprolol'."],["The note captures: No known drug allergies.","yes","'no known allergies'."],["The note captures: Father died of a heart attack.","yes","'father who died of a heart attack'."],["The note captures: Father was in his early sixties when he died.","yes","'in his early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother with osteoporosis'."],["The note captures: Lives alone.","no","Living situation not captured."],["The note captures: Works part-time as a lorry driver.","yes","'works part-time as a lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Work exhaustion and worry not captured."],["The note captures: Ex-smoker.","yes","'former smoker'."],["The note captures: Smoked about a pack a day.","yes","'one pack/day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'does not drink alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual exercise not captured."],["The note captures: Chest examination OK.","yes","'chest ... within normal limits'."],["The note captures: Oxygen saturations OK.","yes","'oxygen saturations ... within normal limits'."],["The note captures: Blood pressure OK.","yes","'blood pressure ... within normal limits'."],["The note captures: Otherwise well at the moment.","partial","Only patient's 'otherwise normal'; doctor's judgement that he is otherwise well not explicit."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'primary impression is a flare-up of the patient's pre-existing heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide dosage to two tablets per day'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the initial few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'full blood count to check for anemia'."],["The note captures: Blood test: kidney function.","yes","'kidney function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to assess cardiac pumping function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","no","Echo timing (requested today, 1-2 weeks) not captured."],["The note captures: Follow-up review in about one week.","yes","'follow-up appointment in one week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'if symptoms worsen, including increased breathlessness'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations, or dizziness'."]],"claims":[["The patient denies ... chills","Chills were never discussed; only temperatures/fevers were asked about."],["currently on ... simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"S - Subjective\n- The patient presents with worsening shortness of breath over the last two weeks, becoming more troublesome in the last few days.\n- They report increased breathlessness with minimal exertion, now requiring them to sit down while walking to shops and experiencing it even around the house.\n- Associated symptoms include a dry cough and bilateral ankle swelling, noticed over the last few days, which they recall occurred during a previous heart failure episode.\n- The patient denies chest pain, palpitations, fever, or chills. They feel a little rundown but otherwise normal, with appetite and urination reported as fine.\n- Their past medical history includes heart failure, diagnosed previously and managed with medication, and a \"small heart attack\" five years ago requiring a short hospital stay. They are currently on furosemide (dose unknown), aspirin, bisoprolol, and simvastatin, with no known allergies.\n- Family history includes a father who died of a heart attack in his early 60s and a mother with osteoporosis. The patient is a former smoker (one pack/day for 25 years, now stopped), does not drink alcohol, and works part-time as a lorry driver.\n\nO - Objective\n- The physician performed a physical examination, noting the patient's chest, oxygen saturations, and blood pressure were all within normal limits.\n- Insufficient information documented regarding specific vital signs or other objective measurements.\n\nA - Assessment\n- The physician's primary impression is a flare-up of the patient's pre-existing heart failure.\n- This assessment is based on the patient's presenting symptoms of progressively worsening dyspnea and bilateral ankle edema, in the context of their known heart failure and absence of other acute symptoms like chest pain or fever.\n\nP - Plan\n- Increase furosemide dosage to two tablets per day for the initial few days.\n- Order blood tests including a full blood count to check for anemia and kidney function.\n- Arrange for an echocardiogram to assess cardiac pumping function.\n- Schedule a follow-up appointment in one week to review the patient's progress.\n- Advised the patient to contact the physician sooner if symptoms worsen, including increased breathlessness, chest pain, palpitations, or dizziness.\n","review":372.7631578947369,"saved":113.23684210526312,"faster":23.29976175005414,"clean":false,"effort":26.41509433962264,"sig":[["missing","Concerned that his heart failure is getting worse.","Patient's concern about worsening heart failure not captured."],["partial","Has a mild dry cough that is not too troublesome.","'a dry cough' without noting it is mild/not troublesome."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'urination reported as fine' omits increased urination since diuretic."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'managed with medication' but prior breathlessness at diagnosis not stated."],["partial","That episode presented with chest pain and he was admitted to hospital.","'short hospital stay' but chest pain presentation omitted."],["missing","Has been well since the heart attack.","Wellness since the heart attack not captured."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement of no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unknown' but current one tablet daily not stated."],["missing","Lives alone.","Living situation not captured."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Work exhaustion and worry not captured."],["missing","Usual exercise is walking to the shops at least once a day.","Usual exercise not captured."],["partial","Otherwise well at the moment.","Only patient's 'otherwise normal'; doctor's judgement that he is otherwise well not explicit."],["missing","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo timing (requested today, 1-2 weeks) not captured."],["fabrication","The patient denies ... chills","Chills were never discussed; only temperatures/fevers were asked about."],["fabrication","currently on ... simvastatin","Simvastatin is never mentioned in the transcript."]],"mb":31.649586,"latency":30.72,"finalised":388.75915789473686},{"label":"Run 2","wer":16.45979492714517,"text":"Okay. Hello.\nHello there.\nUh, hello. Can you hear me okay?\nYes, I can hear you. Okay, great. Are you the doctor? Oh, I am, yes. Dr. Sood here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about you? When did it all start?\nUh, well, it seems to have been slowly getting worse over the last couple of weeks.\nUm, it's become quite troublesome in the last few days.\nOkay. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\nOkay. And, uh, it's got me kind of worried.\nI don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\nUm, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that, that, um, that helped, but I'm a bit worried it's just getting worse. Right.\nOkay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion you mentioned.\nUm, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing, coughing at all?\nUh, I've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\nUm, I'm feeling a little rundown.\nUm, but otherwise, otherwise pretty normal.\nOkay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that?\nUh, it's just like they've sort of swollen up a bit.\nOkay. Um, is that is that both. Kind of. Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing.\nOkay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\nUm, I kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nUh, I think my ankles did swell up a bit last time the heart failure was a problem. Okay.\nOkay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough.\nUm, and some swelling in your ankles.\nUm, but importantly, no chest pain.\nUm, and, and have you had have you have you noticed your heartbeat racing at all?\nSo palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers?\nUh, no. Okay. And how about your appetite? Are you eating and drinking okay? Yeah, I'm, I'm that's fine. Okay. And your water work, are you passing urine okay?\nUh, yeah, that yeah. I usually pee a lot. Yeah.\nWithin the drugs.\nSure. Okay. All right.\nUm, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\nUh, well, I was told I had, like, a they called it like a small heart attack about five years ago. Um, I, uh, I had I, I had, like, some chest pain and they took me to hospital. Okay. And, um, they, uh but then I just got better. Okay. And when, when you say small heart attack, did they give you a name for what happened?\nA, a name of a diagnosis?\nUh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um?\nUm, uh, no. They, they said they i-it seemed it was, like, more than angina.\nOkay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days and. Okay. Uh, and yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\nUh, no. I think I'm otherwise I'm okay. Okay.\nUm, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor. That's okay. I have to check. No problems. Um, any other medications?\nUh, yeah, I take aspirin. Okay.\nAnd, uh, bisoprolol.\nIs that metoprolol, was this? Or.\nUh, bisoprolol. Sorry, the connection's not very good. Okay, thank you. Yep.\nGreat.\nUm, and, uh, simvastatin.\nSimvastatin. Okay. All right.\nAny allergies at all? To any medications? Uh, no. No.\nNo, no allergies. Okay. And is there anything in the family that's, that, that's, uh, that's important for me to know? Any family history or medical problems, heart problems, lung problems?\nUh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away?\nUh, he was, um, early 60s.\nEarly 60s. Okay.\nUh, anything else I should be aware of?\nUm, my mother had osteoporosis.\nOkay.\nHas your mother still with us?\nUh, yeah, she's still living. Okay. All right.\nUm, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you?\nUh, I live on my own. Uh, I've got two cats. You've got two cats. Okay, great.\nDo they have names?\nThey're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay.\nUm, so this is you and your cats.\nOkay, and how is that by strength? Long hours?\nUh, it's okay.\nUm, I, uh, yeah, like, when I'm working it's pretty exhausting. Mm-hmm. Um, I guess I'm a bit worried that if I get sick I won't— if I get more sick then I won't be able to work properly.\nYeah, and it's certainly a consideration, isn't it?\nSo let's, let's try and get you better soon so it doesn't have any, um, impact on your— on your job.\nAnd do you find yourself doing a lot of anti-social hours, or do you— do you do a lot of night driving, weekend driving? Uh, no. I, I, I only take shifts during the day. Okay. I don't like working at night. Okay. All right. And what about smoking and alcohol though? Because they can sometimes be very important when it comes to heart problems. Do you— do you smoke at all?\nNot anymore. So you used to smoke?\nYeah. And how many did you smoke a day, on average?\nOoh, it was about— about a pack a day. Back in the day.\nUm, and how many— how many years was that for?\nOh, that was— oof, a good 25 years.\nOkay. Well done for stopping. I'm— I must be very difficult for you, but well done for stopping. Um, and what— and what about alcohol?\nI don't drink alcohol. Okay.\nDo you do much in the way of exercise though?\nUh, I try and walk to the shops at least once a day. Okay.\nUm, but, uh, that's about it. I've— yeah, I don't— I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you— you said you're feeling more breathless, even walking to the st— uh, to the shops you said.\nUm, right. So, um, based on your— based on your history and having listened to your story, I wonder whether you've had a flare-up of your heart failure, sir.\nUm, we can sometimes happen.\nUm, um, and, you know. That's. It's. What's going on? So, it seems like your heart's not pumping as well as it should be.\nUm, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now there's a couple of options to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of Furosemide. So maybe rather than one tablet a day, we can give you two tablets a day for the first few days. Um, and see— and see how you're getting on\n. Okay. Yeah. If you think that would be best. I think— I think it's— it's— it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\nOkay. Is that something you've had. What does that mean? Yeah. So, um, an echo scan— it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good. Oh, we still remember it now. Sorry? Uh, yeah, I remember now. You remember now. Okay, fine. That's something I can organise for you today, and it may take a week or two weeks for that to be organised.\nBut I think certainly in the meantime, let's, um, let's— let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function. Um, and we can definitely increase your, um, your Furosemide to, you know, one tablet twice a day. But I'd really like— would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable?\nI think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that, and we can have a chat on the phone as well.\nOkay. I'll see how I get on. Okay. Do you have any questions for me?\nUh, nothing. That's all pretty clear. Thank you very much, doctor. Great. No worries. I wish you all the best. Have a good day. Okay. See you soon. Okay. Thank you.","marks":[[93,115,".",false],[128,136,"Nice to see you",false],[187,187,"Are you the doctor",false],[420,420,"now",false],[614,618,"really",false],[1116,1127,"you're",false],[1157,1161,"for",false],[1223,1226,"it's",false],[1704,1712,"run-down",false],[1864,1871,"it's",false],[1939,1950,".",false],[2006,2011,"Both ankles OK.",false],[2146,2150,"Past",false],[2370,2373,"you're",false],[2461,2465,"in",false],[2577,2592,"reporting",false],[2634,2634,"any",false],[2643,2643,"any",false],[2866,2869,"I",false],[2903,2913,"waterworks",false],[2985,2997,"ever since",false],[3008,3008,". Yeah.",false],[3015,3031,"OK. Alright.",false],[3045,3057,"",false],[3338,3340,"into",false],[3563,3563,"something",false],[3609,3634,"It's more hard to say. 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OK.",false],[9597,9613,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","no","Note does not document gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","no","Note does not document worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","Notes breathlessness 'even during short walks to the shops' but not needing to sit down or prior normal tolerance."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","no","Note does not document breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","no","Note does not document concern HF worsening."],["The note captures: No chest pain.","no","Note does not document no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","no","Note does not document mild dry cough."],["The note captures: Feels a little run-down; otherwise feels generally normal.","no","Note does not document run-down, otherwise normal."],["The note captures: Swelling of both ankles.","no","Note does not document bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","no","Note does not document ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Note does not document ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","no","Note does not document no palpitations."],["The note captures: No fevers or temperatures.","no","Note does not document no fever."],["The note captures: Eating and drinking normally (appetite fine).","no","Note does not document appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","no","Note does not document urine OK, frequent since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Assessment references 'previously diagnosed heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Note does not document breathless at HF diagnosis, improved with meds."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Note does not document small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Note does not document presented with chest pain, admitted."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Note does not document previous echo."],["The note captures: No other past medical history apart from the heart problems.","no","Note does not document no other PMH."],["The note captures: Takes furosemide (diuretic).","yes","Plan implies current furosemide ('will be increased from one tablet daily')."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","Gives current dose as one tablet daily but not that the mg dose is unknown."],["The note captures: Takes aspirin.","no","Note does not document aspirin."],["The note captures: Takes bisoprolol.","no","Note does not document bisoprolol."],["The note captures: No known drug allergies.","no","Note does not document NKDA."],["The note captures: Father died of a heart attack.","no","Note does not document father died of heart attack."],["The note captures: Father was in his early sixties when he died.","no","Note does not document father early sixties."],["The note captures: Mother has osteoporosis.","no","Note does not document mother osteoporosis."],["The note captures: Lives alone.","no","Note does not document lives alone."],["The note captures: Works part-time as a lorry driver.","partial","Mentions day shifts and driving duties but not part-time lorry driver role."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","yes","Note captures work exhausting, worried about work."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","Note captures pack a day."],["The note captures: Smoked for about 25 years.","yes","Note captures 25 years."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'attempts to walk to the shops daily for exercise'."],["The note captures: Chest examination OK.","yes","Note captures chest exam OK."],["The note captures: Oxygen saturations OK.","yes","Note captures saturations OK."],["The note captures: Blood pressure OK.","yes","Note captures BP OK."],["The note captures: Otherwise well at the moment.","no","Note does not document otherwise well at moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","Note captures for first few days then review."],["The note captures: Blood test: full blood count to look for anaemia.","yes","Note captures FBC for anaemia."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","Note captures echo requested, 1-2 weeks."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["do not take on night or weekend driving duties","Patient said he only takes day shifts and dislikes nights; weekend work was never answered."],["no longer run as they did when younger, attributing this to current symptoms","Patient did not attribute stopping running to his current symptoms; he simply said he doesn't run like when he was young."],["This assessment integrates the patient's known history of heart failure and their significant past smoking history.","Clinician based the impression on history and the story; he did not cite smoking history as part of the assessment."]],"note":"S - Subjective\n- Patient reports experiencing exhaustion during work, expressing concern that any further decline in health would impede their ability to work effectively.\n- They describe increased breathlessness, noting its occurrence even during short walks to the shops.\n- Patient states they exclusively work day shifts and do not take on night or weekend driving duties.\n- Reports a past history of smoking approximately one pack of cigarettes per day for 25 years, but confirms they have successfully stopped.\n- Denies alcohol consumption and attempts to walk to the shops daily for exercise, though they no longer run as they did when younger, attributing this to current symptoms.\n\nO - Objective\n- Physical examination was performed, with the physician noting that the patient’s chest, oxygen saturations, and blood pressure were all within normal parameters.\n\nA - Assessment\n- Clinical impression is a flare-up of the patient's previously diagnosed heart failure.\n- The physician assesses that the patient's heart is not pumping as efficiently as it should be.\n- This assessment integrates the patient’s known history of heart failure and their significant past smoking history.\n\nP - Plan\n- Medication adjustment: The dose of Furosemide will be increased from one tablet daily to two tablets daily for the initial few days.\n- Investigations to include blood tests, specifically a full blood count to check for anaemia and an assessment of kidney function.\n- An echocardiogram (echo scan) of the heart will be organized to evaluate the heart's pumping function, with an estimated wait time of one to two weeks for scheduling.\n- A follow-up appointment is scheduled for the patient to return in approximately one week to review their progress and symptom improvement.\n- Patient advised to contact the clinic sooner than the scheduled follow-up if they experience worsening symptoms such as increased breathlessness, chest pain, palpitations, or dizziness.\n","review":647.2368421052631,"saved":-161.23684210526312,"faster":-33.17630495993068,"clean":false,"effort":63.20754716981132,"sig":[["missing","Breathlessness has been gradually worsening over the last couple of weeks.","Note does not document gradual worsening over couple of weeks."],["missing","Breathlessness has become much more troublesome in the last few days.","Note does not document worse in last few days."],["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","Notes breathlessness 'even during short walks to the shops' but not needing to sit down or prior normal tolerance."],["missing","Now breathless just moving about the house (breathless on minimal exertion).","Note does not document breathless around the house."],["missing","Concerned that his heart failure is getting worse.","Note does not document concern HF worsening."],["missing","No chest pain.","Note does not document no chest pain."],["missing","Has a mild dry cough that is not too troublesome.","Note does not document mild dry cough."],["missing","Feels a little run-down; otherwise feels generally normal.","Note does not document run-down, otherwise normal."],["missing","Swelling of both ankles.","Note does not document bilateral ankle swelling."],["missing","Ankle swelling noticed over the last few days.","Note does not document ankle swelling last few days."],["missing","Ankles also swelled previously when his heart failure was a problem.","Note does not document ankles swelled in previous HF episode."],["missing","No palpitations or racing/skipped heartbeat.","Note does not document no palpitations."],["missing","No fevers or temperatures.","Note does not document no fever."],["missing","Eating and drinking normally (appetite fine).","Note does not document appetite normal."],["missing","Passing urine OK, but urinates a lot since starting his medication (diuretic).","Note does not document urine OK, frequent since diuretic."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Note does not document breathless at HF diagnosis, improved with meds."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Note does not document small heart attack ~5 years ago."],["missing","That episode presented with chest pain and he was admitted to hospital.","Note does not document presented with chest pain, admitted."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Note does not document previous echo."],["missing","No other past medical history apart from the heart problems.","Note does not document no other PMH."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Gives current dose as one tablet daily but not that the mg dose is unknown."],["missing","Takes aspirin.","Note does not document aspirin."],["missing","Takes bisoprolol.","Note does not document bisoprolol."],["missing","No known drug allergies.","Note does not document NKDA."],["missing","Father died of a heart attack.","Note does not document father died of heart attack."],["missing","Father was in his early sixties when he died.","Note does not document father early sixties."],["missing","Mother has osteoporosis.","Note does not document mother osteoporosis."],["missing","Lives alone.","Note does not document lives alone."],["partial","Works part-time as a lorry driver.","Mentions day shifts and driving duties but not part-time lorry driver role."],["missing","Otherwise well at the moment.","Note does not document otherwise well at moment."],["fabrication","do not take on night or weekend driving duties","Patient said he only takes day shifts and dislikes nights; weekend work was never answered."],["fabrication","no longer run as they did when younger, attributing this to current symptoms","Patient did not attribute stopping running to his current symptoms; he simply said he doesn't run like when he was young."],["fabrication","This assessment integrates the patient's known history of heart failure and their significant past smoking history.","Clinician based the impression on history and the story; he did not cite smoking history as part of the assessment."]],"mb":31.348868,"latency":34.188,"finalised":668.2638421052632},{"label":"Run 3","wer":15.272531030760927,"text":"Okay. Hello.\nHello there.\nUh, hello. Can you hear me okay?\nYes, I can hear you. Okay, great. Are you the doctor? Oh, I am, yes. Dr. Sood here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about you? When did it all start?\nUh, well, it seems to have been slowly getting worse over the last couple of weeks.\nUm, it's become quite troublesome in the last few days.\nOkay. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\nOkay. And, uh, it's got me kind of worried.\nI don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\nUm, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that, that, um, that helped, but I'm a bit worried it's, it's getting worse. Right.\nOkay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned.\nUm, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\nNo pain in my chest. Okay. Have you found yourself coughing, coughing at all?\nUh, I've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\nUm, I'm feeling a little rundown.\nUm, but otherwise, otherwise pretty normal.\nOkay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that?\nUh, it's just like they've sort of swollen up a bit.\nOkay. Um, is that, is that both? Kind of. Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing.\nOkay. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\nUm, I kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nUh, I think my ankles did swell up a bit last time the heart failure was a problem. Okay.\nOkay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough.\nUm, and some swelling in your ankles.\nUm, but importantly, no chest pain.\nUm, and, and, and have you had, have you, have you noticed your heartbeat racing at all, so palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers?\nUh, no. Okay. And how about your appetite? Are you eating and drinking okay? Yeah, I'm, I'm, that's fine. Okay. And your water work, are you passing urine okay?\nUh, yeah, that, yeah. I usually pee a lot. Yeah.\nA little bit since the drugs came out. Sure. Okay. All right.\nUm, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\nUh, well, I was told I had, like, uh, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to the hospital. Okay. And, um, they, uh, but then I just got better. Okay. And when, when you say small heart attack, did they give you a name for what happened? A, a name of a diagnosis?\nUh, I can't remember.\nThey just called it a s-something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um,?\nUm, uh, no, they, they said they, it seemed it was, like, more than angina.\nOkay. Um, uh, but, um, I didn't, but I only had to stay in hospital for a few days and. Okay. Uh, and yeah, I've been okay since then. You've been okay since then.\nOkay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\nUh, no, I think I'm otherwise, I'm okay. Okay.\nUm, do you take any regular medications apart from your, your diuretics that you're taking? And do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking? Uh, I can't remember. I'm sorry, doctor.\nThat's okay. I have to check. No problems. Um, any other medications?\nUh, yeah, I take aspirin and, uh, bisoprolol. Okay. Is that metoprolol, was this?\nOr? Uh, bisoprolol. Sorry, the connection's not very good. Okay, thank you. Yep.\nGreat. Um, and, uh, simvastatin. Simvastatin.\nOkay. All right. Any allergies at all? To any medications?\nUh, no. No. No, no allergies. Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\nUh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away?\nUh, he was, um, early 60s. Early 60s.\nOkay. Uh, anything else I should be aware of?\nUm, my mother had osteoporosis. Okay.\nDid your mother still live with us?\nUh, yeah, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. I mean, I've got two cats. You've got two cats. Okay, great. Do they have names?\nThey're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay.\nUm, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\nUh, I work part-time as a, uh, lorry driver.\nOkay. And how is that? Is that quite stressful, long hours?\nUh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting. Mm-hmm. Um, I guess I'm a bit worried that if I get sick, I won't, if I get more sick, then I won't be able to work properly. Yeah, it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of antisocial hours? Or do you self, do, do you do a lot of night driving, weekend driving?\nUh, no, I, I, I, I only take shifts during the day. Okay. I don't like working at night. Okay. All right. And what about smoking and alcohol, sir? 'Cause they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\nNot anymore. So you used to smoke?\nYeah.\nAnd how many did you smoke a day on average?\nOh, it was about, about a pack a day back in the day. Um, and how many, how many years was that for?\nOh, that was, oof, a good 25 years. Okay.\nWell done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\nI don't drink alcohol. Okay. Do you do much in the way of exercise, sir?\nUh, I try and walk to the shops, at least once a day. Okay. Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um,\num, and, you know. That's. It's. What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can\ngive you two tablets a day for the first few days.\nUm, and see, and see how you're getting on.\nOkay. Okay. If you think that would be best. I think, I think it's, it's, it's definitely worth treating your symptoms. But what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping.\nOkay.\nIs that something you've had. What does that?\nYeah. So, um, an echo scan, uh, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good. Oh, we still remember now.\nSorry?\nUh, yeah, I remember now. You remember now. Okay, fine. That's something I can organise for you today. And, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function.\nUm, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day. But I'd really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a\ncall sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on.\nOkay. Do you have any questions for me?\nUh, nothing else. All pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day. Okay. See you soon. Okay. Thank you.","marks":[[93,115,".",false],[128,136,"Nice to see you",false],[187,187,"Are you the doctor",false],[420,420,"now",false],[614,618,"really",false],[1067,1071,"just",false],[1117,1128,"you're",false],[1158,1162,"for",false],[1224,1227,"it's",false],[1706,1714,"run-down",false],[1866,1873,"it's",false],[1942,1953,".",false],[2009,2014,"Both ankles OK.",false],[2150,2154,"Past",false],[2374,2377,"you're",false],[2465,2469,"in",false],[2581,2596,"reporting",false],[2643,2643,"any",false],[2653,2653,"any",false],[2877,2880,"I",false],[2915,2925,"waterworks",false],[2998,3016,"ever",false],[3033,3042,". Yeah.",false],[3049,3065,"OK. Alright.",false],[3079,3091,"",false],[3375,3381,"into",false],[3605,3605,"something",false],[3608,3619,"uh something",false],[3653,3678,"It's more hard to say. 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OK.",false],[9801,9817,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'increasing shortness of breath over the last couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","'difficulty walking to the shops' but not previous normal tolerance or needing to sit down."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","partial","Breathlessness is 'causing worry' but concern specifically about worsening heart failure not stated."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'dry cough (not troublesome)'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","no","Feeling run down not documented."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'which they have experienced previously when heart failure was an issue'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'denies ... changes in appetite'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'normal urination, noting they \"usually pee a lot\" since starting diuretics'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'history of heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Initial breathlessness improving with medication not documented."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'\"small heart attack\" approximately five years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Hospitalisation recorded but presenting chest pain omitted."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","yes","'patient recalls having this done previously'."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unknown' but baseline one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","yes","Bisoprolol listed."],["The note captures: No known drug allergies.","yes","'no known drug allergies'."],["The note captures: Father died of a heart attack.","yes","'father who died of a heart attack'."],["The note captures: Father was in his early sixties when he died.","yes","'in his early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother with osteoporosis'."],["The note captures: Lives alone.","yes","'lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'works part-time as a lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Concern about ability to work captured; work being exhausting omitted."],["The note captures: Ex-smoker.","yes","'past smoking history ... (quit)'."],["The note captures: Smoked about a pack a day.","yes","'a pack a day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'no alcohol consumption'."],["The note captures: Usual exercise is walking to the shops at least once a day.","partial","'walking to the shops' mentioned without the daily frequency."],["The note captures: Chest examination OK.","no","Objective 'Insufficient information'; chest exam not recorded."],["The note captures: Oxygen saturations OK.","no","Saturations not recorded."],["The note captures: Blood pressure OK.","no","Blood pressure not recorded."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not documented."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Suspected flare-up of chronic heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the initial few days'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","Full blood count ordered but anaemia purpose omitted."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram ... to evaluate cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo arranged but 1-2 week timing not stated."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["simvastatin (current medications)","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."],["significant family history of premature cardiac death (father in early 60s)","Transcript only says father died of a heart attack in his early sixties; it was not characterised as premature cardiac death or a risk factor."]],"note":"S - Subjective\n- Patient presents with increasing shortness of breath over the last couple of weeks, worsening significantly in the last few days.\n- They report difficulty walking to the shops and experiencing breathlessness even around the house, causing worry.\n- Patient has a history of heart failure and a \"small heart attack\" approximately five years ago, for which they were hospitalized for a few days.\n- Associated symptoms include a dry cough (not troublesome) and bilateral ankle swelling noticed in the last few days, which they have experienced previously when heart failure was an issue.\n- Patient denies chest pain, palpitations, fevers, or changes in appetite; reports normal urination, noting they \"usually pee a lot\" since starting diuretics.\n- Current medications include furosemide (dose unknown), aspirin, bisoprolol, and simvastatin. Patient reports no known drug allergies.\n- Family history is significant for father who died of a heart attack in his early 60s and mother with osteoporosis (still living).\n- Patient lives alone with two cats (Polly and Tim), works part-time as a lorry driver during day shifts, and is concerned about the impact of illness on their ability to work.\n- Social history includes a past smoking history of a pack a day for 25 years (quit), no alcohol consumption, and limited exercise beyond walking to the shops.\n\nO - Objective\n- Insufficient information documented.\n\nA - Assessment\n- Suspected flare-up of chronic heart failure, presenting with worsening dyspnea on exertion and bilateral ankle edema.\n- Patient's history of heart failure and prior episodes of ankle swelling are consistent with this presentation.\n- Risk factors include a history of a \"small heart attack\" and a significant family history of premature cardiac death (father in early 60s).\n\nP - Plan\n- Increase furosemide dosage to one tablet twice a day for the initial few days to address current symptoms.\n- Order a blood test to assess full blood count and kidney function.\n- Arrange for an echocardiogram (echo scan) to evaluate cardiac function; patient recalls having this done previously.\n- Schedule a follow-up appointment in approximately one week to reassess symptoms and treatment effectiveness.\n- Patient advised to contact the clinic sooner if symptoms worsen, including increased breathlessness, chest pain, palpitations, or dizziness.\n","review":373.92105263157896,"saved":112.07894736842104,"faster":23.06151180420186,"clean":false,"effort":28.30188679245283,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","'difficulty walking to the shops' but not previous normal tolerance or needing to sit down."],["partial","Concerned that his heart failure is getting worse.","Breathlessness is 'causing worry' but concern specifically about worsening heart failure not stated."],["missing","Feels a little run-down; otherwise feels generally normal.","Feeling run down not documented."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Initial breathlessness improving with medication not documented."],["partial","That episode presented with chest pain and he was admitted to hospital.","Hospitalisation recorded but presenting chest pain omitted."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unknown' but baseline one tablet daily not stated."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Concern about ability to work captured; work being exhausting omitted."],["partial","Usual exercise is walking to the shops at least once a day.","'walking to the shops' mentioned without the daily frequency."],["missing","Chest examination OK.","Objective 'Insufficient information'; chest exam not recorded."],["missing","Oxygen saturations OK.","Saturations not recorded."],["missing","Blood pressure OK.","Blood pressure not recorded."],["missing","Otherwise well at the moment.","'Otherwise well' not documented."],["partial","Blood test: full blood count to look for anaemia.","Full blood count ordered but anaemia purpose omitted."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo arranged but 1-2 week timing not stated."],["fabrication","simvastatin (current medications)","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."],["fabrication","significant family history of premature cardiac death (father in early 60s)","Transcript only says father died of a heart attack in his early sixties; it was not characterised as premature cardiac death or a risk factor."]],"mb":31.770423,"latency":24.737,"finalised":383.90505263157894},{"label":"Run 4","wer":15.21856449001619,"text":"Okay. Hello.\nHello there.\nUh, hello. Can you hear me okay?\nYes, I can hear you. Okay, great. Are you the doctor? Oh, I am, yes. Dr. Sood here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about you? When did it all start?\nUh, well, it seems to have been slowly getting worse over the last couple of weeks.\nUm, it's become quite troublesome in the last few days.\nOkay. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\nOkay. And, uh, it's got me kind of worried.\nI don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\nUm, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed. Right.\nAnd put on some medicine that, that, um, that helped, but I'm a bit worried it's, it's getting worse. Right.\nOkay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned.\nUm, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing, coughing at all?\nUh, I've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\nUm, I'm feeling a little rundown.\nUm, but otherwise, otherwise pretty normal.\nOkay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that?\nUh, it's just like they've sort of swollen up a bit.\nOkay. Um, is that, is that both. Kind of. Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing.\nOkay. Uh, I can imagine, yeah. Um, and again, over how long has this have you noticed this for?\nUm, I kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nUh, I think my ankles did swell up a bit last time the heart failure was a problem. Okay.\nOkay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough.\nUm, and some swelling in your ankles.\nUm, but importantly, no chest pain.\nUm, and, and have you had, have you, have you noticed your heartbeat racing at all?\nSo palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers?\nUh, no. Okay. And how about your appetite? Are you eating and drinking okay? Yeah, I'm, I'm that's fine. Okay. And your water work, are you passing urine okay?\nUh, yeah, that yeah. I usually pee a lot. Yeah.\nA little bit since the drugs came out. Sure. Okay. All right.\nUm, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\nUh, well, I was told I had, like, uh, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain, and they took me to hospital. Okay. And, um, they, uh, but then I just got better. Okay. And when, when you say small heart attack, did they give you a name for what happened?\nA, a name of a diagnosis?\nUh, I can't remember. They just called it a something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um?\nUm, uh, no, they, they said they, it seemed it was, like, more than angina.\nOkay. Um, uh, but, um, I didn't but I only had to stay in hospital for a few days. Okay. Uh, and yeah, I've been okay since then. You've been okay since then.\nOkay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\nUh, no, I think I'm otherwise I'm okay. Okay.\nUm, do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Uh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking?\nUh, I can't remember. I'm sorry, doctor.\nThat's okay. I have to check.\nNo problems. Um, any other medications?\nUh, yeah, I take aspirin. Okay.\nAnd, uh, bisoprolol.\nIs that metoprolol, was this?\nOr. Uh, bisoprolol. Sorry, the connection's not very good. Okay, thank you. Yep.\nGreat. Um, and, uh, simvastatin. Simvastatin.\nOkay. All right. Any allergies at all to any medications?\nI don't know. No. No, no allergies. Okay. And is there anything in the family that's, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\nUh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away?\nUh, he was, um, early 60s. Early 60s.\nOkay. Uh, anything else I should be aware of?\nUm, my mother had osteoporosis. Okay.\nDid your mother still with us?\nUh, yeah, she's still living. Okay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. Uh, I've got two cats. You've got two cats. Okay, great. Do they have names?\nThey're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay.\nUm, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\nUh, I work part-time, as a, uh, lorry driver.\nOkay. And how is that? Is that quite stressful, long hours?\nUh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting. Hmm. Um, I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah, and it's certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours? Or do you s do, do you do a lot of night driving, weekend driving?\nOh, no. I, I, I, I only take shifts during the day. Okay. I don't like working at night. Okay. All right. And what about smoking and alcohol, sir? Because they can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\nNot anymore. So you used to smoke?\nYeah.\nAnd how many did you smoke a day on average?\nOh, it was about, about a pack a day.\nBack in the day. Um, and how many, how many years was that for?\nOh, that was, oof, a good 25 years. Okay.\nWell done for stopping. I'm, I must be very difficult for you, but well done for stopping. Um, and what, and what about alcohol?\nI don't drink alcohol. Okay. Do you do much in the way of exercise, sir?\nUh, I try and walk to the shops, at least once a day. Okay. Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless even walking to the st uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen, um,\num, and, you know. That's. It's. What's going on? So it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now, there's a couple of options for us to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day, we can\ngive you two tablets a day for the first few days.\nUm, and see, and see how you're getting on.\nOkay, if you think that would be best. I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test, and maybe an echocardiogram of your heart to see how well your heart's pumping.\nOkay.\nIs that something you've had. What does that?\nYeah. So, um, an echo scan, uh, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed. And it's just to get a good. Oh, yes, I remember now.\nSorry?\nUh, yeah, I remember now. You remember now. Okay, fine. That's something I can organise for you today, and, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function.\nUm, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day. But I really like, would like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me\na call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on.\nOkay. Do you have any questions for me?\nUh, nothing else. All pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day. Okay. See you soon. Okay. Thank you.","marks":[[93,115,".",false],[128,136,"Nice to see you",false],[187,187,"Are you the doctor",false],[420,420,"now",false],[614,618,"really",false],[1067,1071,"just",false],[1117,1128,"you're",false],[1158,1162,"for",false],[1224,1227,"it's",false],[1706,1714,"run-down",false],[1866,1873,"it's",false],[1942,1953,".",false],[2009,2014,"Both ankles OK.",false],[2149,2153,"Past",false],[2373,2376,"you're",false],[2464,2468,"in",false],[2580,2595,"reporting",false],[2637,2637,"any",false],[2647,2647,"any",false],[2871,2874,"I",false],[2908,2918,"waterworks",false],[2990,3008,"ever",false],[3025,3034,". Yeah.",false],[3041,3057,"OK. Alright.",false],[3071,3083,"",false],[3368,3370,"into",false],[3594,3594,"something",false],[3640,3665,"It's more hard to say. 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OK.",false],[9768,9784,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","Note captures gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","Note captures worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","Note captures previously walked to shops, now sits to catch breath."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Note captures breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","yes","Note captures concern HF worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","Note captures mild dry cough."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","Note captures run-down, otherwise normal."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","yes","Note captures ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","Note captures ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","Note captures urine OK, frequent since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Note captures known heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Only 'diagnosed some time ago'; breathlessness at diagnosis improving with medication not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","Note captures small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'a few days hospital stay' but no chest pain presentation."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","yes","Note captures previous echo."],["The note captures: No other past medical history apart from the heart problems.","partial","PMH listed as HF and heart attack only; no explicit statement of no other history."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose not recalled' but current one-tablet-daily dose not recorded."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","yes","Note captures bisoprolol."],["The note captures: No known drug allergies.","yes","Note captures NKDA."],["The note captures: Father died of a heart attack.","yes","Note captures father died of heart attack."],["The note captures: Father was in his early sixties when he died.","yes","Note captures father early sixties."],["The note captures: Mother has osteoporosis.","no","Mother's osteoporosis not recorded."],["The note captures: Lives alone.","yes","Note captures lives alone."],["The note captures: Works part-time as a lorry driver.","yes","Note captures part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","'concerns about work capacity' but not that work is exhausting."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","Note captures pack a day."],["The note captures: Smoked for about 25 years.","yes","Note captures 25 years."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual daily walk to shops as exercise not recorded."],["The note captures: Chest examination OK.","no","No examination findings documented."],["The note captures: Oxygen saturations OK.","no","Saturations not documented."],["The note captures: Blood pressure OK.","no","Blood pressure not documented."],["The note captures: Otherwise well at the moment.","yes","Note captures otherwise well at moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","no","Increase recorded without the 'first few days' duration."],["The note captures: Blood test: full blood count to look for anaemia.","yes","Note captures FBC for anaemia."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo to be organized but no 1-2 week timeframe."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Current medications include ... simvastatin","Simvastatin is never mentioned in the transcript."],["symptoms highly suggestive of a flare-up of their pre-existing heart failure","Clinician only said he wondered whether it was a flare-up; 'highly suggestive' overstates the certainty."],["Their history of heart failure and a previous cardiac event are significant risk factors for such an exacerbation.","Clinician never made this risk-factor statement."],["The absence of chest pain, palpitations, and fever reduces the likelihood of acute coronary syndrome or infection as primary causes, though these should be considered in the differential.","Clinician gave no differential of acute coronary syndrome or infection."]],"note":"S - Subjective\n- The patient presents with shortness of breath, which has gradually worsened over the past couple of weeks and significantly in the last few days.\n- They report increased breathlessness with minimal exertion, stating they now need to sit down when walking to the shops and experience breathlessness even around the house.\n- The patient expresses concern that their known heart failure might be worsening and reports a dry cough, described as not too troublesome.\n- They have noticed bilateral ankle swelling in the last few days, similar to a previous episode when their heart failure was problematic.\n- Past medical history includes heart failure, diagnosed some time ago, and a \"small heart attack\" about five years prior, which they describe as more than angina and resulted in a few days hospital stay. Social history includes living alone with two cats, working part-time as a lorry driver during the day, a 25-year history of smoking a pack a day (now stopped), and no alcohol consumption.\n\nO - Objective\n- The patient reports feeling a little rundown but otherwise pretty normal in general health.\n- They deny chest pain, palpitations, skipped heartbeats, temperatures, or fevers.\n- Appetite and fluid intake are reported as fine, and they are passing urine as usual, noting increased frequency since starting diuretics.\n- Current medications include furosemide (dose not recalled), aspirin, bisoprolol, and simvastatin.\n- The patient reports no known drug allergies (NKDA).\n\nA - Assessment\n- The patient presents with symptoms highly suggestive of a flare-up of their pre-existing heart failure, characterized by worsening shortness of breath and new-onset bilateral ankle swelling.\n- Their history of heart failure and a previous cardiac event are significant risk factors for such an exacerbation.\n- The absence of chest pain, palpitations, and fever reduces the likelihood of acute coronary syndrome or infection as primary causes, though these should be considered in the differential.\n- The patient's occupational role as a lorry driver and concerns about work capacity highlight the need for effective symptom management.\n- The patient's father died of a heart attack in his early 60s, indicating a relevant family history of cardiac disease.\n\nP - Plan\n- The physician plans to increase the patient's furosemide dosage to one tablet twice a day, with a recommendation for follow-up in approximately one week to assess symptom improvement.\n- Blood tests will be ordered to check full blood count (for anemia) and kidney function.\n- An echocardiogram of the heart will be organized to assess cardiac pumping function, which the patient recalls having had previously.\n- The patient was advised to contact the physician sooner if symptoms worsen, including increased breathlessness, chest pain, palpitations, or dizziness.\n- Patient education included the rationale for increasing furosemide and the purpose of the planned investigations to evaluate heart function.\n","review":393.18421052631584,"saved":92.81578947368416,"faster":19.097899068659295,"clean":false,"effort":31.132075471698112,"sig":[["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Only 'diagnosed some time ago'; breathlessness at diagnosis improving with medication not recorded."],["partial","That episode presented with chest pain and he was admitted to hospital.","'a few days hospital stay' but no chest pain presentation."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["partial","No other past medical history apart from the heart problems.","PMH listed as HF and heart attack only; no explicit statement of no other history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose not recalled' but current one-tablet-daily dose not recorded."],["missing","Mother has osteoporosis.","Mother's osteoporosis not recorded."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","'concerns about work capacity' but not that work is exhausting."],["missing","Usual exercise is walking to the shops at least once a day.","Usual daily walk to shops as exercise not recorded."],["missing","Chest examination OK.","No examination findings documented."],["missing","Oxygen saturations OK.","Saturations not documented."],["missing","Blood pressure OK.","Blood pressure not documented."],["missing","Increased furosemide dose for the first few days, then see how he gets on.","Increase recorded without the 'first few days' duration."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo to be organized but no 1-2 week timeframe."],["fabrication","Current medications include ... simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","symptoms highly suggestive of a flare-up of their pre-existing heart failure","Clinician only said he wondered whether it was a flare-up; 'highly suggestive' overstates the certainty."],["fabrication","Their history of heart failure and a previous cardiac event are significant risk factors for such an exacerbation.","Clinician never made this risk-factor statement."],["fabrication","The absence of chest pain, palpitations, and fever reduces the likelihood of acute coronary syndrome or infection as primary causes, though these should be considered in the differential.","Clinician gave no differential of acute coronary syndrome or infection."]],"mb":31.823927,"latency":27.88,"finalised":404.17421052631585},{"label":"Run 5","wer":15.272531030760927,"text":"Okay. Hello.\nHello there.\nUh, hello. Can you hear me okay?\nYes, I can hear you. Okay, great. Are you the doctor? Oh, I am, yes. Dr. Sood here, Oscar. Um, how can I help you this afternoon? Um, I'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about you? When did it all start?\nUh, well, it seems to have been slowly getting worse over the last couple of weeks.\nUm, it's become quite troublesome in the last few days.\nOkay. Uh, I kind of normally I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house.\nOkay. And, uh, it's got me kind of worried.\nI don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\nUm, well, I've, I've, uh, I've got, um, heart failure. Okay. Uh, I was told that, uh, a while ago, um, and I got a bit breathless when I was first diagnosed. Right.\nAnd put on some medicine that, that, um, that helped, but I'm a bit worried it's, it's getting worse. Right.\nOkay. So you mentioned you've been feeling, uh, short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. Um, and you're now feeling more breathless on kind of minimal, minimal exertion, you mentioned.\nUm, have you noticed any other symptoms at all, uh, with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing, coughing at all?\nUh, I've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\nUm, I'm feeling a little rundown.\nUm, but otherwise, otherwise pretty normal.\nOkay. I've noticed my ankles have got a bit bigger. Okay. And what do you mean by that?\nUh, it's just like they've sort of swollen up a bit.\nOkay. Um, is that, is that both ankles? Both ankles? Um, yeah, both ankles. Yeah, it's a bit embarrassing.\nOkay. Uh, I can imagine, yeah. Um, and again, over how long has this, have you noticed this for?\nUm, I kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nUh, I think my ankles did swell up a bit last time the heart failure was a problem. Okay.\nOkay. Um, fine. Okay. So, um, just to really recap, so you really, in the last couple of weeks, uh, you've been feeling breathless, uh, but worse over the last couple of days. You mentioned you had a bit of a dry cough.\nUm, and some swelling in your ankles.\nUm, but importantly, no chest pain. Um, and, and, and have you had any, have you, have you noticed your heartbeat racing at all?\nSo palpitations or skipped heartbeat? No, not really. Okay. And any temperatures or fevers?\nUh, no. Okay. And how about your appetite? Are you eating and drinking okay? Yeah, I'm, I'm, that's fine. Okay. And your water work, are you passing urine okay?\nUh, yeah, that, yeah. I usually pee a lot. Yeah.\nA little bit since the drugs came out. Sure. Okay. All right.\nUm, fine. So moving on to your, your past medical history. You mentioned heart failure. Any, any other medical history I should be aware of?\nUh, well, I was told I had, like, uh, they called it like a small heart attack about five years ago. Um, I, uh, I had, I, I had, like, some chest pain and they took me to hospital. Okay. And, um, they, uh, but then I just got better. Okay. And when, when you say small heart attack, did they give you a name for what happened?\nA, a name of a diagnosis?\nUh, I can't remember. They just called it a. Something like that, a small heart attack. Small heart attack. Okay. Was it something like angina or, um? Um, uh, no, they, they said they, it seemed it was, like, more than angina.\nOkay. Um, uh, but, um, I didn't, but I only had to stay in hospital for a few days and. Okay. Uh, and yeah, I've been okay since then. You've been okay since then. Okay. All right. So apart from the, uh, the heart, the heart problems, the heart failure, any other problems I should be aware of?\nUh, no, I think I'm otherwise, I'm okay. Okay.\nUm, do you take any regular medications apart from your, your diuretics that you're taking? And do you know which ones?\nUh, yeah, I take something called furosemide. Furosemide. And do you know which dose you're taking?\nUh, I can't remember. I'm sorry, doctor.\nThat's okay. I have to check.\nNo problems. Um, any other medications?\nUh, yeah, I take aspirin and, uh, bisoprolol.\nIs that metoprolol, was this?\nOr? Uh, bisoprolol. Sorry, the connection's not very good. Okay, thank you. Yep.\nGreat. Um, and, uh, simvastatin. Simvastatin.\nOkay. All right. Any allergies at all? To any medications?\nI don't know. No. No, no allergies. Okay. And is there anything in the family that's, uh, that, that's, uh, that's important for me to know? Any family history of medical problems, heart problems, lung problems?\nUh, my, my father died of a, uh, of a heart attack. I'm sorry to hear that. And, um, how old was your father when he passed away?\nUh, he was, um, early 60s. Early 60s.\nOkay. Uh, anything else I should be aware of?\nUm, my mother had osteoporosis. Okay.\nDid your mother still live with us?\nUh, yeah, she's still living.\nOkay. All right. Um, and socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? Uh, I live on my own. Uh, I've got two cats. You've got two cats. Okay, great. Do they have names? They're my family. Uh, they're, they're called, um, they're called Polly and Tim. Okay.\nUm, so this is you and your cats. And, um, in terms of day-to-day, are you working at the moment?\nUh, I work part-time as a, uh, lorry driver. Okay. And how is that? Is that quite stressful, long hours?\nUh, it's okay. Um, I, uh, yeah, like, when I'm working, it's pretty exhausting. Hmm. Um, I guess I'm a bit worried that if I get sick, I won't, if I get more sick, then I won't be able to work properly. Yeah, it is certainly a consideration, isn't it? So let's, let's try and get you better soon so it doesn't have any, um, impact on your, on your job. And, and do you find yourself doing a lot of anti-social hours?\nOr do you self, do, do you do a lot of night driving, weekend driving?\nOh, no, I, I, I, I only take shifts during the day.\nOkay. I don't like working at night. Okay.\nAll right. And what about smoking and alcohol, sir? Because it, it can sometimes be very important when it comes to heart problems. So do you, do you smoke at all?\nNot anymore. So you used to smoke? Yeah. And how many did you smoke a day on average?\nOh, it was about, about a pack a day back in the day. Um, and how many, how many years was that for?\nOh, that was, oof, a good 25 years. Okay.\nWell done for stopping. I'm, I must be very difficult for you, but well done for stopping.\nUm, and what, and what about alcohol?\nI don't drink alcohol. Okay. Do you do much in the way of exercise, sir?\nUh, I try and walk to the shops at least once a day. Okay. Um, but, uh, that's about it. I've, yeah, I don't, I don't go running like I used to when I was young. Right. Okay. And certainly now with your symptoms, you, you said you're feeling more breathless, even walking to the sto uh, to the shops, you said. Um, right. So, um, based on your, based on your history and having listened to your story, uh, I, I wonder whether you've had a flare-up of your heart failure, sir. Um, we can sometimes happen. Um,\num, and, you know. That's. It's. What's going on? So, it seems like your heart's not pumping as well as it should be. Um, and obviously having diagnosed with heart failure, there's obviously, um, it's the first thing that comes to my mind. Um, now there's a couple of options to move forward. Um, given that you otherwise are well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than one tablet a day,\nwe can give you two tablets a day for the first few days. Um, and see, and see how you're getting on.\nOkay. Okay. If you think that would be best. I think, I think it's, it's, it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay.\nIs that something you've had. What does that? Yeah. So, um, an echo sca uh, it's a, it's a jelly scan of your heart. You may have had it done before when you were diagnosed.\nAnd it's just to get a good. Oh, we still remember now. Sorry?\nUh, yeah, I remember now.\nYou remember now. Okay, fine. That's something I can organise for you today and, and it may take a week or two weeks for that to be organised. But I think certainly in the meantime, let's, um, let's, let's get a blood test done. We can check your, um, you know, your full blood count, look for signs of anaemia. We can have a check of your kidney function.\nUm, and we can definitely increase your, um, your furosemide, uh, to, you know, one tablet twice a day.\nBut I'd really like, would like you to come back and see me in about a week's time to see how you're getting on.\nDoes that sound reasonable? I think that sounds like a good plan. And of course, in the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, uh, you know, certainly I want you to give me a call sooner than that and we can have a chat on the phone as well.\nOkay. I'll see how I get on.\nOkay. Do you have any questions for me?\nUh, nothing. That's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best. Have a good day. Okay.\nSee you soon. Okay. Thank you.","marks":[[93,115,".",false],[128,136,"Nice to see you",false],[187,187,"Are you the doctor",false],[420,420,"now",false],[614,618,"really",false],[1067,1071,"just",false],[1117,1128,"you're",false],[1158,1162,"for",false],[1224,1227,"it's",false],[1706,1714,"run-down",false],[1866,1873,"it's",false],[1932,1951,"Kind of .",false],[2007,2012,"Both ankles OK.",false],[2148,2152,"Past",false],[2372,2375,"you're",false],[2463,2467,"in",false],[2579,2594,"reporting",false],[2655,2655,"any",false],[2879,2882,"I",false],[2917,2927,"waterworks",false],[3000,3018,"ever",false],[3035,3044,". Yeah.",false],[3051,3067,"OK. Alright.",false],[3081,3093,"",false],[3377,3379,"into",false],[3603,3603,"something",false],[3650,3675,"It's more hard to say. 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OK.",false],[9794,9810,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","Note captures gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","Note captures worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","Note captures previously walked to shops, now sits to catch breath."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Note captures breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","yes","Note captures concern HF worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","Note captures mild dry cough."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","Note captures run-down, otherwise normal."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","yes","Note captures ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","Note captures ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","Note captures urine OK, frequent since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Note captures known heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'previously managed with medication' but not breathlessness at diagnosis improving."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","Note captures small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'short hospital stay' but no chest pain presentation."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","yes","Note captures previous echo."],["The note captures: No other past medical history apart from the heart problems.","no","No statement that there is no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'furosemide (dose unknown)' but current one-tablet-daily dose not recorded."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","yes","Note captures bisoprolol."],["The note captures: No known drug allergies.","yes","Note captures NKDA."],["The note captures: Father died of a heart attack.","yes","Note captures father died of heart attack."],["The note captures: Father was in his early sixties when he died.","yes","Note captures father early sixties."],["The note captures: Mother has osteoporosis.","yes","Note captures mother osteoporosis."],["The note captures: Lives alone.","yes","Note captures lives alone."],["The note captures: Works part-time as a lorry driver.","yes","Note captures part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","Concern about impact of illness on work recorded but not that work is exhausting."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","Note captures pack a day."],["The note captures: Smoked for about 25 years.","yes","Note captures 25 years."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","Note captures walks to shops daily."],["The note captures: Chest examination OK.","no","No examination findings documented."],["The note captures: Oxygen saturations OK.","no","Saturations not documented."],["The note captures: Blood pressure OK.","no","Blood pressure not documented."],["The note captures: Otherwise well at the moment.","yes","Note captures otherwise well at moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","Note captures for first few days then review."],["The note captures: Blood test: full blood count to look for anaemia.","yes","Note captures FBC for anaemia."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo to be organized but no 1-2 week timeframe."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Physician noted patient's general health as \"a little rundown\" but otherwise \"pretty normal.\"","This was the patient's own report, not a physician observation."],["Patient reports taking ... simvastatin","Simvastatin is never mentioned in the transcript."],["Family history of early-onset heart attack (father died in early 60s) and maternal osteoporosis are noted risk factors.","Clinician never characterised the family history as early-onset or as risk factors; osteoporosis was not linked to the presentation."]],"note":"S - Subjective\n- Patient presents with increasing shortness of breath over the last couple of weeks, worsening significantly in the last few days.\n- Patient reports breathlessness on minimal exertion, including walking to shops (requiring sitting down) and even around the house. They express worry about their condition.\n- History of heart failure, previously managed with medication, with current concern that the condition is worsening.\n- Associated symptoms include a dry cough (not troublesome) and bilateral ankle swelling noticed over the last few days, similar to a previous episode during a heart failure exacerbation.\n- Denies chest pain, palpitations, skipped heartbeats, temperatures, or fevers. Appetite and urination are normal, noting increased urination since starting diuretics.\n\nO - Objective\n- The encounter was conducted via teleconsultation.\n- Physician noted patient's general health as \"a little rundown\" but otherwise \"pretty normal.\"\n- Patient reports taking furosemide (dose unknown), aspirin, bisoprolol, and simvastatin.\n- No known drug allergies.\n- Social history: Lives alone with two cats (Polly and Tim). Works part-time as a lorry driver during day shifts; concerned about impact of illness on work.\n- Smoking history: Quit smoking, previously a pack a day for 25 years.\n- Alcohol history: Denies alcohol consumption.\n- Exercise: Attempts to walk to shops daily, no other regular exercise.\n\nA - Assessment\n- Suspected flare-up of chronic heart failure, consistent with reported worsening shortness of breath and new onset bilateral ankle swelling in a patient with a known history of heart failure.\n- Patient's history of a \"small heart attack\" five years prior (unspecified diagnosis, described as \"more than angina\" but short hospital stay) is a relevant cardiac comorbidity.\n- Family history of early-onset heart attack (father died in early 60s) and maternal osteoporosis are noted risk factors.\n- Occupational concern regarding potential impact of worsening health on part-time lorry driving job.\n\nP - Plan\n- Increase furosemide dose to one tablet twice a day for a few days, with a follow-up appointment in one week to assess symptom improvement.\n- Blood tests to be arranged, including full blood count (to check for anemia) and kidney function.\n- Echocardiogram of the heart to be organized to assess cardiac pumping function, which the patient recalls having had previously.\n- Patient advised to call sooner if symptoms worsen (increased breathlessness, chest pain, palpitations, dizziness).\n- Patient education provided on the likely cause of symptoms (heart failure flare-up) and rationale for treatment plan.\n","review":298.9605263157895,"saved":187.03947368421052,"faster":38.485488412388996,"clean":false,"effort":22.641509433962266,"sig":[["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'previously managed with medication' but not breathlessness at diagnosis improving."],["partial","That episode presented with chest pain and he was admitted to hospital.","'short hospital stay' but no chest pain presentation."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","No other past medical history apart from the heart problems.","No statement that there is no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'furosemide (dose unknown)' but current one-tablet-daily dose not recorded."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","Concern about impact of illness on work recorded but not that work is exhausting."],["missing","Chest examination OK.","No examination findings documented."],["missing","Oxygen saturations OK.","Saturations not documented."],["missing","Blood pressure OK.","Blood pressure not documented."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo to be organized but no 1-2 week timeframe."],["fabrication","Physician noted patient's general health as \"a little rundown\" but otherwise \"pretty normal.\"","This was the patient's own report, not a physician observation."],["fabrication","Patient reports taking ... simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","Family history of early-onset heart attack (father died in early 60s) and maternal osteoporosis are noted risk factors.","Clinician never characterised the family history as early-onset or as risk factors; osteoporosis was not linked to the presentation."]],"mb":31.956825,"latency":26.001,"finalised":309.9415263157895}],"lyrebird":[{"label":"Run 1","wer":37.452779276848354,"text":"Hello? Hello there. Hello. Can you hear me okay? Yes. I can hear you. Okay. Great. Are you the doctor? I am. Yes. Doctor. Sood here. Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you wanna tell me a bit more about us? When did it all start?\n\nWell, it seems to have been slowly getting worse over the last couple of weeks. Mhmm. It's become quite troublesome in the last 2 days. Yeah. I kind of normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\n\nSwelling in your ankles. But importantly, no chest pain. And and have you had have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No. Not really. Okay. And any temperatures or fevers? No. Okay. And how about your appetite? Are you eating and drinking okay? Yeah. I that's fine. Okay. And your water works? Are you passing urine okay? Yeah. That yeah. I usually\n\nWell, I've I've I've got heart failure. Okay. I was told that a while ago, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that that helped, but I'm a bit worried it's it's getting worse. Right. Okay. So you mentioned you've short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And\n\nYou're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nI'm feeling a little run down, but otherwise otherwise, pretty normal. Okay. I've noticed my ankles have gotten bigger. Okay. And what do you mean by that? It's just like it's sort of swollen up a bit. Okay. Is that is that both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this\n\nI kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past? I think my ankles did swell up a bit last time the heart failure was a problem. Okay. Okay. Fine. Okay. So just to really recap, so really, in the last couple of weeks, you've been feeling breathless but worse in the last couple of days. You mentioned you had a bit of a dry cough and some\n\nYeah. The drugs Sure. Okay. Alright. Fine. So moving on to your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Well, I was told I had, like, a they called it, like, a small heart attack about 5 years ago. I I had I I had, like, chest pain, and they took me to hospital. Okay. And they\n\nDo you know which dose you're taking? I can't remember. I'm sorry, doctor. It's okay. Have to check. No problems. Any other medications? Yeah. I take aspirin. Okay. And omeprazole. Was this? Or Metoprolol. Sorry. The connection is not very okay. Thank you. Yep.\n\nBut then I just got better. Okay. And when you say small heart attack, did they give you a name for what happened, a name of a diagnosis? I can't remember. I just called it as something like that. Small heart attack. Small heart attack. Okay. Was it, like, angina? Or No. They they said they it seemed it was, like, more than angina. Okay.\n\nBut I didn't but I only had to stay in hospital for a few days. Okay. Okay. Yeah. I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of? No. I think I'm otherwise, I'm okay. Okay. Do you take any regular medications apart from your your diuretics that you're taking? Do you know which ones? Yeah. I take something called furosemide.\n\nEarly sixties. Early sixties. Okay. Anything else I should be aware of? My mother had osteoporosis. Okay. Is your mother still with us? Yeah. She's still living. Okay. Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? I live on my own. Alright. I got 2 cats. You got 2 cats? Okay.\n\nSimvastatin. Simvastatin. Okay. Alright. Any allergies at all to any medications? No. No allergies. Okay. And is there anything in the family that's that that's that's important for me to know? Any family history of medical problems, heart problems, lung problems? My my father died of a of a heart attack. I'm sorry to hear that. And how old was your father when he passed away? He was\n\nYears was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in a way of exercise, sir? I try and walk to the shops at least once a day. Okay. Okay. But that's about it. I've yeah. I don't\n\nGreat. Do they have names? They're my family. They're they're called they're called Polly and Tim. Okay. So this is you and your cats. And in terms of day to day, are you working at the moment? I work part time as a lorry driver. Okay. And how is that? Is that quite stressful, long hours?\n\nIt's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. There's certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do do a lot of night driving, weekend driving?\n\nOh, no. I I I only take shifts during the day. Okay. I don't like working at night. Okay. Alright. And what about smoking and alcohol? Because it they can sometimes be very important when it comes to heart problems. Do you do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many\n\nI don't get running like I used to when I was young. Right. Okay. And, certainly, now with your symptoms, you you said you're feeling more breathless even walking to the to the shop, you said. Right. So based on your based on your history and having listened to your story, I wonder whether you've had a up of your heart failure, sir, which can sometimes happen. You know, it's What's going on? So I see that your heart's not pumping as well as it should be. And\n\nObviously, having diagnosed with heart failure is obviously the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than 1 tablet a day, can give you 2 tablets a day for the first few days and see and see how you're getting on. Okay. I think that would be bad. I think I think\n\nIt's it's it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Design. Yeah. So an echo scan it's a it's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good remember now. Sorry? Yeah. I remember now. You remember now? Okay. Fine. That's something I can organize for you today.\n\nThey may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's let's let's get a blood test done. We can check your, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your your furosemide to, you know, 1 tablet twice a day. But I really like we'd like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And\n\nIn the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And then I wish you all the best. Have a good day. See you soon. Okay. Thank you.","marks":[[83,101,".",false],[114,126,"Nice to see you",false],[173,173,"Are you the doctor Um",false],[255,260,"want to",false],[286,288,"it",false],[394,399,"Um now",false],[442,443,"few",false],[587,591,"really",false],[787,1189,"Um",false],[1398,1402,"just",false],[1448,1454,"you're feeling uh",false],[1536,1539,"it's",false],[1808,1808,"coughing",false],[1986,1994,"run-down um",false],[2070,2076,"got a bit",false],[2194,2200,"Kind of . Um",false],[2252,2257,"Both ankles OK. Uh",false],[2377,2381,"Past",false],[2587,2587,"you're",false],[2745,2745,"swelling in your ankles. Um reporting no chest pain. Um and and have you had any have you any have you noticed your heartbeat racing at all So palpitations or skipped heartbeat No not really. OK. And any temperatures or fevers Uh no. OK. And how about your appetite Are you eating and drinking OK",false],[2752,2752,"I I'm that's fine. OK. And your waterworks Are you passing urine OK Uh yeah but yeah. I usually pee a lot ever since",false],[2762,2762,". Yeah.",false],[2793,2805,"your uh",false],[3029,3029,"some",false],[3060,3062,"into",false],[3089,3350,"uh",true],[3389,3389,"when",false],[3525,3527,"something a uh",false],[3569,3594,"It's more hard to say. OK.",false],[4049,4053,"",false],[4149,4149,". Do you know which dose you're taking I can't remember I'm sorry doctor. I have to check. That's OK. No problems. Um Any other medications Uh yeah. I take Aspirin. OK. And uh Bisoprolol. The Metoprolol was it Or Uh Bisoprolol. Sorry the connection's not very good. OK. Thank you yeah. Um . And a thousand OK. Alright. Any allergies at all Any medications Uh no no allergies. No. OK. And is there anything in the family that's uh that that's uh that's important for me to know Any family history of medical problems heart problems lung problems Uh my my father died of a uh of a heart attack. I'm sorry to hear that. And um how old was your father when he passed away Uh he was um",false],[4181,4186,"OK. Alright.",false],[4447,4455,"Well",false],[4470,4473,"You've",false],[4486,5228,"OK",true],[5338,5345,"it's just",false],[5707,5714,"that's",false],[5748,5753,"it",false],[5854,5854,"No. Uh",false],[5895,5905,"anti-social",false],[5968,5970,"Ohh",false],[6103,6118,"So 'cause that",false],[6216,6224,"any more.",false],[6298,6300,"Ooh",false],[6372,6372,"years was that for Ohh that was oof good twenty five years. OK. And what about the stopping That must have been difficult for you. stopping. Um and what what about alcohol",false],[6382,6385,"drink alcohol. OK. Do you do much in the way of exercise sir Uh I try and walk to the shops at least once a day. OK. Um but uh that's about it I've. Yeah I don't I don't go",false],[6483,6483,"you're",false],[6574,6576,"Ohh um",false],[6600,6604,"you",false],[6678,6680,"flare-up",false],[6737,6777,"Um um and uh Mmm.",false],[6782,6782,"It's . So it seems like",false],[6885,6887,"there's",false],[6897,6897,"What's going on. Um that's",false],[6985,6985,"Um Mmm.",false],[7213,7221,"do",false],[7300,7307,"OK. If you",false],[7314,7324,"that'll",false],[7328,7332,"better. Uh",false],[7615,7622,"before",false],[7635,7644,"",false],[7659,7664,"general",false],[7689,7692,"might",false],[7724,7730,"you were",false],[7769,7769,"What does that Ohh yes I",false],[7826,7836,"that. 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OK.",false],[8904,8920,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","\"Progressive dyspnoea\" captures presenting shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","\"Progressive dyspnoea over 2 weeks\" captures gradual worsening over the last couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","\"significantly worsened in last 2 days\" matches the doctor's recap, accepted per author context."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","\"Now breathless walking to shops, requires rest breaks\" captures the change from walking to the shops without difficulty."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","\"Breathless at home with minimal exertion\"."],["The note captures: Concerned that his heart failure is getting worse.","no","The note records only concern about work; the patient's worry that his heart failure is getting worse is not captured."],["The note captures: No chest pain.","yes","\"Denies chest pain\"."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","\"Dry cough, not troublesome\"."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","\"Feeling run down\" captures the point; otherwise-normal is implicit."],["The note captures: Swelling of both ankles.","yes","\"Bilateral ankle oedema\"."],["The note captures: Ankle swelling noticed over the last few days.","yes","\"Bilateral ankle oedema noted over last few days\"."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","\"Previous ankle oedema during heart failure exacerbation\"."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","\"Denies palpitations\"."],["The note captures: No fevers or temperatures.","yes","\"Denies fever\"."],["The note captures: Eating and drinking normally (appetite fine).","yes","\"Appetite normal\" captures eating and drinking normally."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","\"Urine output normal\" captures passing urine OK but omits that he urinates a lot since starting the diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","\"Known heart failure\"."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","\"Known heart failure with previous similar presentation\" hints at prior breathlessness but omits that it improved with medication."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","\"myocardial infarction 5 years ago\" is accepted wording for the small heart attack."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","\"hospitalised for few days\" captures admission but omits that it presented with chest pain."],["The note captures: Has been well since the heart attack.","no","The note does not state that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","The previous echocardiogram around the time of diagnosis is not mentioned."],["The note captures: No other past medical history apart from the heart problems.","partial","The PMH lists only heart failure and MI but does not explicitly state there is no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","\"furosemide\" listed in current medications."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","\"furosemide (dose unknown)\" captures unknown dose but omits that he takes one tablet a day."],["The note captures: Takes aspirin.","yes","\"aspirin\" listed."],["The note captures: Takes bisoprolol.","no","The note lists \"metoprolol\" instead of bisoprolol, which the patient explicitly confirmed; wrong medication."],["The note captures: No known drug allergies.","yes","\"No known drug allergies\"."],["The note captures: Father died of a heart attack.","yes","\"father died of myocardial infarction\"."],["The note captures: Father was in his early sixties when he died.","yes","\"in early 60s\"."],["The note captures: Mother has osteoporosis.","yes","\"mother alive with osteoporosis\"."],["The note captures: Lives alone.","yes","\"lives alone\"."],["The note captures: Works part-time as a lorry driver.","yes","\"part-time lorry driver\"."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","\"Concerned about impact on ability to work\" captures the worry but omits that he finds work exhausting."],["The note captures: Ex-smoker.","yes","\"ex-smoker\"."],["The note captures: Smoked about a pack a day.","yes","\"1 pack/day\"."],["The note captures: Smoked for about 25 years.","yes","\"x 25 years\"."],["The note captures: Does not drink alcohol.","yes","\"nil alcohol\"."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","\"walks to shops daily\"."],["The note captures: Chest examination OK.","yes","\"Chest examination: within normal limits\"."],["The note captures: Oxygen saturations OK.","yes","\"Oxygen saturations: within normal limits\"."],["The note captures: Blood pressure OK.","yes","\"Blood pressure: within normal limits\"."],["The note captures: Otherwise well at the moment.","no","The note does not record that he is otherwise well at the moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","partial","\"Acute exacerbation of heart failure\" is stated as definite rather than possible and omits the heart not pumping as well as it should."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","\"Increase furosemide to 1 tablet BD\" matches one tablet twice a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","partial","The increase is recorded but not that it is for the first few days and then reassess."],["The note captures: Blood test: full blood count to look for anaemia.","yes","\"FBC (anaemia screen)\"."],["The note captures: Blood test: kidney function.","yes","\"renal function\"."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","\"Arrange echocardiogram\" is recorded without its purpose of assessing how well the heart is pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","\"Arrange echocardiogram (1-2 weeks)\" captures the arrangement and timeframe."],["The note captures: Follow-up review in about one week.","yes","\"Review in 1 week\"."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","\"return sooner if worsening dyspnoea\"."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","\"chest pain, palpitations, or dizziness develop\"."]],"claims":[["Urine output normal","Patient said he passes urine OK but pees a lot since starting the drugs, so output is not reported as normal."],["Current medications: ... metoprolol","Patient said bisoprolol, and repeated bisoprolol when the doctor asked if it was metoprolol."],["Current medications: ... simvastatin","Simvastatin is never mentioned in the transcript."],["Current medications: ... omeprazole","Omeprazole is never mentioned in the transcript."],["ex-smoker ... quit 25 years ago","No quit date was given; 25 years was the duration of smoking."],["Assessment: Acute exacerbation of heart failure","Doctor only wondered whether it was a flare-up of heart failure; the note states it as established fact."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nProgressive dyspnoea over 2 weeks, significantly worsened in last 2 days\n\nNow breathless walking to shops, requires rest breaks\n\nBreathless at home with minimal exertion\n\nDry cough, not troublesome\n\nBilateral ankle oedema noted over last few days\n\nFeeling run down\n\nDenies chest pain\n\nDenies palpitations\n\nDenies fever\n\nAppetite normal\n\nUrine output normal\n\nKnown heart failure with previous similar presentation\n\nPrevious ankle oedema during heart failure exacerbation\n\nPast medical history: heart failure, myocardial infarction 5 years ago (hospitalised for few days)\n\nCurrent medications: furosemide (dose unknown), aspirin, metoprolol, simvastatin, omeprazole\n\nNo known drug allergies\n\nFamily history: father died of myocardial infarction in early 60s, mother alive with osteoporosis\n\nSocial history: lives alone with 2 cats (Polly and Tim), part-time lorry driver (day shifts only), ex-smoker (1 pack/day x 25 years, quit 25 years ago), nil alcohol, walks to shops daily\n\nConcerned about impact on ability to work\n\n\n\n\nObjective:\n\nChest examination: within normal limits\n\nOxygen saturations: within normal limits\n\nBlood pressure: within normal limits\n\n\n\n\nAssessment:\n\nAcute exacerbation of heart failure\n\n\n\n\nPlan:\n\nIncrease furosemide to 1 tablet BD\n\nPathology: FBC (anaemia screen), renal function\n\nArrange echocardiogram (1-2 weeks)\n\nReview in 1 week\n\nAdvised to return sooner if worsening dyspnoea, chest pain, palpitations, or dizziness develop","review":346.75,"saved":139.25,"faster":28.6522633744856,"clean":false,"effort":32.075471698113205,"sig":[["missing","Concerned that his heart failure is getting worse.","The note records only concern about work; the patient's worry that his heart failure is getting worse is not captured."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","\"Urine output normal\" captures passing urine OK but omits that he urinates a lot since starting the diuretic."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","\"Known heart failure with previous similar presentation\" hints at prior breathlessness but omits that it improved with medication."],["partial","That episode presented with chest pain and he was admitted to hospital.","\"hospitalised for few days\" captures admission but omits that it presented with chest pain."],["missing","Has been well since the heart attack.","The note does not state that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","The previous echocardiogram around the time of diagnosis is not mentioned."],["partial","No other past medical history apart from the heart problems.","The PMH lists only heart failure and MI but does not explicitly state there is no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","\"furosemide (dose unknown)\" captures unknown dose but omits that he takes one tablet a day."],["missing","Takes bisoprolol.","The note lists \"metoprolol\" instead of bisoprolol, which the patient explicitly confirmed; wrong medication."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","\"Concerned about impact on ability to work\" captures the worry but omits that he finds work exhausting."],["missing","Otherwise well at the moment.","The note does not record that he is otherwise well at the moment."],["partial","Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","\"Acute exacerbation of heart failure\" is stated as definite rather than possible and omits the heart not pumping as well as it should."],["partial","Increased furosemide dose for the first few days, then see how he gets on.","The increase is recorded but not that it is for the first few days and then reassess."],["partial","Echocardiogram to assess how well the heart is pumping.","\"Arrange echocardiogram\" is recorded without its purpose of assessing how well the heart is pumping."],["fabrication","Urine output normal","Patient said he passes urine OK but pees a lot since starting the drugs, so output is not reported as normal."],["fabrication","Current medications: ... metoprolol","Patient said bisoprolol, and repeated bisoprolol when the doctor asked if it was metoprolol."],["fabrication","Current medications: ... simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","Current medications: ... omeprazole","Omeprazole is never mentioned in the transcript."],["fabrication","ex-smoker ... quit 25 years ago","No quit date was given; 25 years was the duration of smoking."],["fabrication","Assessment: Acute exacerbation of heart failure","Doctor only wondered whether it was a flare-up of heart failure; the note states it as established fact."]],"mb":22.155591,"latency":35.103,"finalised":381.853},{"label":"Run 2","wer":20.4533189422558,"text":"Hello? Hello there. Hello. Can you hear me okay? Yes. I can hear you. Okay. Great. Are you the doctor? I am. Yes. Doctor. Sood here. Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you wanna tell me a bit more about us? When did it all start?\n\nWell, it seems to have been slowly getting worse over the last couple of weeks. Mhmm. It's become quite troublesome in the last 2 days. Yeah. I kind of normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\n\nWell, I've I've I've got heart failure. Okay. I was told that a while ago, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that that helped, but I'm a bit worried it's it's getting worse. Right. Okay. So you mentioned you've short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And\n\nYou're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nI'm feeling a little run down, but otherwise otherwise, pretty normal. Okay. I've noticed my ankles have gotten bigger. Okay. And what do you mean by that? It's just like it's sort of swollen up a bit. Okay. Is that is that both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this\n\nI kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past? I think my ankles did swell up a bit last time the heart failure was a problem. Okay. Okay. Fine. Okay. So just to really recap, so really the last couple of weeks, you've been feeling breathless but worse in the last couple of days. You mentioned you had a bit of a dry cough and some\n\nSwelling in your ankles. But importantly, no chest pain. And and have you had have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No. Not really. Okay. And any temperatures or fevers? No. Okay. And how about your appetite? Are you eating and drinking okay? Yeah. I'm I'm that's fine. Okay. And your water works? Are you passing urine okay? Yeah. That yeah. I usually\n\nA lot. Yeah. The the drugs Sure. Okay. Alright. Fine. So moving on to your your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Well, I was told I had, like, they called it, like, a small heart attack about 5 years ago. I I had I I had, like, chest pain, and they took me to hospital. Okay. And they\n\nBut then I just got better. Okay. And when you say small heart attack, did they give you a name for what happened, a name of a diagnosis? I can't remember. I just called it as something like that. Small heart attack. Small heart attack. Okay. Was it, like, angina? Or No. They they said they it seemed it was, like, more than angina. Okay.\n\nBut I didn't but I only had to stay in hospital for a few days. Okay. Okay. Yeah. I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of? No. I think I'm otherwise, I'm okay. Okay. Do you take any regular medications apart from your your diuretics that you're taking? Do you know which ones? Yeah. I take something called furosemide.\n\nDo you know which dose you're taking? I can't remember. I'm sorry, doctor. It's okay. Have to check. No problems. Any other medications? Yeah. I take aspirin. Okay. And omeprazole. Was this? Or Metoprolol. Sorry. The connection is not very okay. Thank you. Yep.\n\nSimvastatin. Simvastatin. Okay. Alright. Any allergies at all to any medications? No. No allergies. Okay. And is there anything in the family that's that that's that's important for me to know? Any family history of medical problems, heart problems, lung problems? My my father died of a of a heart attack. I'm sorry to hear that. And how old was your father when he passed away? He was\n\nEarly sixties. Early sixties. Okay. Anything else I should be aware of? My mother had osteoporosis. Okay. Is your mother still with us? Yeah. She's still living. Okay. Alright. And socially, sir, just tell me bit more about your situation at home. Who lives at home with you? I live on my own. Alright. I got 2 cats. You got 2 cats? Okay.\n\nGreat. Do they have names? They're my family. They're they're called they're called Polly and Tim. Okay. So this is you and your cats. And in terms of day to day, are you working at the moment? I work part time as a lorry driver. Okay. And how is that? Is that quite stressful, long hours?\n\nIt's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. There's certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving?\n\nOh, no. I I I only take shifts during the day. Okay. I don't like working at night. Okay. Alright. And what about smoking and alcohol? Because it they can sometimes be very important when it comes to heart problems. Do do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many\n\nYears was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in a way of exercise, sir? I try and walk to the shops at least once a day. Okay. Okay. But that's about it. I've yeah. I don't\n\nI don't get running like I used to when I was young. Right. Okay. And, certainly, now with your symptoms, you you said you're feeling more breathless even walking to the to the shop, you said. Right. So based on your based on your history and having listened to your story, I wonder whether you've had a up of your heart failure, sir, which can sometimes happen. You know, it's What's going on? So I see that your heart's not pumping as well as it should be. And\n\nObviously, having diagnosed with heart failure is obviously the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than 1 tablet a day, can give you 2 tablets a day for the first few days and see and see how you're getting on. Okay. I think that would be bad. I think I think\n\nIt's it's it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Design. Yeah. So an echo scan it's a it's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good remember now. Sorry? Yeah. I remember now. You remember now. Okay. Fine. But that's something I can organize for you today.\n\nThey may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's let's let's get a blood test done. We can check your, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your your furosemide to, you know, 1 tablet twice a day. But I really like we'd like you to come back and see me in about a week's time to see how you're getting on. That sound reasonable? I think that sounds like a good plan. And\n\nIn the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. No. I wish you all the best. Have a good day. Okay. See you soon. Okay. Thank you.\n\nyou","marks":[[83,101,".",false],[114,126,"Nice to see you",false],[173,173,"Are you the doctor Um",false],[255,260,"want to",false],[286,288,"it",false],[394,399,"Um now",false],[442,443,"few",false],[587,591,"really",false],[994,998,"just",false],[1044,1050,"you're feeling uh",false],[1132,1135,"it's",false],[1404,1404,"coughing",false],[1582,1590,"run-down um",false],[1666,1672,"got a bit",false],[1790,1796,"Kind of . Um",false],[1848,1853,"Both ankles OK. Uh",false],[1973,1977,"Past",false],[2183,2183,"you're",false],[2364,2379,"Um reporting",false],[2416,2416,"any",false],[2425,2425,"any",false],[2644,2647,"I",false],[2680,2691,"waterworks",false],[2747,2747,"pee",false],[2756,2765,"ever since",false],[2775,2775,". Yeah.",false],[2806,2818,"",false],[3045,3045,"some",false],[3076,3078,"into",false],[3142,3142,"when",false],[3278,3280,"something a uh",false],[3322,3347,"It's more hard to say. 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OK.",false],[8914,8935,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'Progressive dyspnoea' captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'Progressive dyspnoea over 2 weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'significantly worse in last 2 days' (doctor's recap accepted)."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'Previously able to walk to shops without difficulty, now requires rest breaks'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","partial","'Breathless at rest in house' overstates; patient described breathlessness moving about the house, not at rest."],["The note captures: Concerned that his heart failure is getting worse.","yes","'Concerned symptoms represent worsening heart failure'."],["The note captures: No chest pain.","yes","'No chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Feeling run down' captured but 'otherwise normal' omitted."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle oedema'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noted over last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","partial","Only vague 'heart failure with similar presentation at initial diagnosis'; prior ankle swelling not explicit."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'No palpitations or irregular heartbeat'."],["The note captures: No fevers or temperatures.","yes","'No fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","yes","'Polyuria (attributed to diuretics)'."],["The note captures: Known heart failure, diagnosed some time ago.","yes","PMH lists heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","'similar presentation at initial diagnosis' but improvement with medication not stated."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'myocardial infarction 5 years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Hospitalisation captured ('hospitalised for few days') but presenting chest pain omitted."],["The note captures: Has been well since the heart attack.","yes","'recovered well'."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement that there is no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'furosemide (dose unknown)'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unknown' captured but current one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","no","Lists 'metoprolol' instead of bisoprolol, which the patient corrected."],["The note captures: No known drug allergies.","yes","'No known drug allergies'."],["The note captures: Father died of a heart attack.","yes","'father died of MI'."],["The note captures: Father was in his early sixties when he died.","yes","'in early 60s'."],["The note captures: Mother has osteoporosis.","yes","'mother alive with osteoporosis'."],["The note captures: Lives alone.","yes","'lives alone with 2 cats'."],["The note captures: Works part-time as a lorry driver.","yes","'part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","'Worried about impact on ability to work' but work being exhausting omitted."],["The note captures: Ex-smoker.","yes","'ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'nil alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'usually walks to shops daily'."],["The note captures: Chest examination OK.","yes","'Chest examination: within normal limits'."],["The note captures: Oxygen saturations OK.","yes","'Oxygen saturations: within normal limits'."],["The note captures: Blood pressure OK.","yes","'Blood pressure: within normal limits'."],["The note captures: Otherwise well at the moment.","no","Doctor's statement that he is otherwise well not captured."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","partial","'Acute decompensated heart failure' stated as definite, not suspected; pumping explanation omitted."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to 1 tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","no","Duration of 'first few days' then reassess not captured."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'FBC' listed but purpose (anaemia) omitted."],["The note captures: Blood test: kidney function.","yes","'UEC' covers kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","'Arrange echocardiogram' without stating it assesses pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'Arrange echocardiogram (anticipated 1-2 weeks)'."],["The note captures: Follow-up review in about one week.","yes","'Review in 1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'return sooner if worsening dyspnoea'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations, or dizziness'."]],"claims":[["Breathless at rest in house","Patient said breathless just moving about the house (minimal exertion), not at rest."],["Medications: ... omeprazole","Omeprazole is never mentioned in the transcript."],["Medications: ... metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["Medications: ... simvastatin","Simvastatin is never mentioned in the transcript."],["Assessment: Acute decompensated heart failure","Doctor only wondered whether it was a flare-up; written as a definite diagnosis."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nProgressive dyspnoea over 2 weeks, significantly worse in last 2 days\n\nPreviously able to walk to shops without difficulty, now requires rest breaks\n\nBreathless at rest in house\n\nDry cough, not troublesome\n\nBilateral ankle oedema noted over last few days\n\nFeeling run down\n\nNo chest pain\n\nNo palpitations or irregular heartbeat\n\nNo fever\n\nAppetite normal\n\nPolyuria (attributed to diuretics)\n\nPast medical history: heart failure with similar presentation at initial diagnosis; myocardial infarction 5 years ago (hospitalised for few days, recovered well)\n\nMedications: furosemide (dose unknown), aspirin, omeprazole, metoprolol, simvastatin\n\nNo known drug allergies\n\nFamily history: father died of MI in early 60s; mother alive with osteoporosis\n\nSocial history: lives alone with 2 cats; part-time lorry driver (day shifts only); ex-smoker (1 pack/day for 25 years, now quit); nil alcohol; usually walks to shops daily (now limited by SOB)\n\nConcerned symptoms represent worsening heart failure\n\nWorried about impact on ability to work\n\n\n\n\nObjective:\n\nChest examination: within normal limits\n\nOxygen saturations: within normal limits\n\nBlood pressure: within normal limits\n\n\n\n\nAssessment:\n\nAcute decompensated heart failure\n\n\n\n\nPlan:\n\nIncrease furosemide to 1 tablet twice daily\n\nPathology: FBC, UEC\n\nArrange echocardiogram (anticipated 1-2 weeks)\n\nReview in 1 week\n\nPatient advised to return sooner if worsening dyspnoea, chest pain, palpitations, or dizziness develop","review":357.5131578947368,"saved":128.48684210526318,"faster":26.437621832358676,"clean":false,"effort":30.18867924528302,"sig":[["partial","Now breathless just moving about the house (breathless on minimal exertion).","'Breathless at rest in house' overstates; patient described breathlessness moving about the house, not at rest."],["partial","Feels a little run-down; otherwise feels generally normal.","'Feeling run down' captured but 'otherwise normal' omitted."],["partial","Ankles also swelled previously when his heart failure was a problem.","Only vague 'heart failure with similar presentation at initial diagnosis'; prior ankle swelling not explicit."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","'similar presentation at initial diagnosis' but improvement with medication not stated."],["partial","That episode presented with chest pain and he was admitted to hospital.","Hospitalisation captured ('hospitalised for few days') but presenting chest pain omitted."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement that there is no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unknown' captured but current one tablet daily not stated."],["missing","Takes bisoprolol.","Lists 'metoprolol' instead of bisoprolol, which the patient corrected."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","'Worried about impact on ability to work' but work being exhausting omitted."],["missing","Otherwise well at the moment.","Doctor's statement that he is otherwise well not captured."],["partial","Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","'Acute decompensated heart failure' stated as definite, not suspected; pumping explanation omitted."],["missing","Increased furosemide dose for the first few days, then see how he gets on.","Duration of 'first few days' then reassess not captured."],["partial","Blood test: full blood count to look for anaemia.","'FBC' listed but purpose (anaemia) omitted."],["partial","Echocardiogram to assess how well the heart is pumping.","'Arrange echocardiogram' without stating it assesses pumping."],["fabrication","Breathless at rest in house","Patient said breathless just moving about the house (minimal exertion), not at rest."],["fabrication","Medications: ... omeprazole","Omeprazole is never mentioned in the transcript."],["fabrication","Medications: ... metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["fabrication","Medications: ... simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","Assessment: Acute decompensated heart failure","Doctor only wondered whether it was a flare-up; written as a definite diagnosis."]],"mb":16.385357,"latency":36.859,"finalised":394.3721578947368},{"label":"Run 3","wer":29.951430113329735,"text":"Hello? Hello there. Hello. Can you hear me okay? Yes. I can hear you. Okay. Great. Are you the doctor? I am. Yes. Doctor. Sood here. Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you wanna tell me a bit more about us? When did it all start?\n\nWell, it seems to have been slowly getting worse over the last couple of weeks. Mhmm. It's become quite troublesome in the last 2 days. Yeah. I kind of normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\n\nWell, I've I've I've got heart failure. Okay. I was told that a while ago, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that that helped, but I'm a bit worried it's it's getting worse. Right. Okay. So you mentioned you've short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And\n\nYou're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nI kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past? I think my ankles did swell up a bit last time the heart failure was a problem. Okay. Okay. Fine. Okay. So just to really recap, so really, in the last couple of weeks, you've been feeling breathless but worse in the last couple of days. You mentioned you had a bit of a dry cough and some\n\nI'm feeling a little run down, but otherwise otherwise, pretty normal. Okay. I've noticed my ankles have gotten bigger. Okay. And what do you mean by that? It's just like it's sort of swollen up a bit. Okay. Is that is that both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this\n\nYeah. The drugs Sure. Okay. Alright. Fine. So moving on to your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Well, I was told I had, like, a they called it, like, a small heart attack about 5 years ago. I I had I I had, like, chest pain, and they took me to hospital. Okay. And they\n\nBut then I just got better. Okay. And when when you say small heart attack, did they give you a name for what happened, a name of a diagnosis? I can't remember. They just called it as something like that. Small heart attack. Small heart attack. Okay. Was it, like, angina? Or No. They they said they it seemed it was, like, more than angina. Okay.\n\nSwelling in your ankles. But importantly, no chest pain. And and have you had have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No. Not really. Okay. And any temperatures or fevers? No. Okay. And how about your appetite? Are you eating and drinking okay? Yeah. I that's fine. Okay. And your water works? Are you passing urine okay? Yeah. That yeah. I use\n\nBut I didn't but I only had to stay in hospital for a few days. Okay. Yeah. I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of? No. I think I'm otherwise, I'm okay. Okay. Do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Yeah. I take something called furosemide.\n\nDo you know which dose you're taking? I can't remember. I'm sorry, doctor. It's okay. Have to check. No problems. Any other medications? Yeah. I take aspirin. Okay. And omeprazole. Was this? Or Metoprolol. Sorry. The connection is not very okay. Thank you. Yep.\n\nSimvastatin. Simvastatin. Okay. Alright. Any allergies at all? Any medications? No. No allergies. Okay. And is there anything in the family that's that that's that's important for me to know? Any family history of medical problems, heart problems, lung problems? My my father died of a of a heart attack. I'm sorry to hear that. And how old was your father when he passed away? He was\n\nEarly sixties. Early sixties. Okay. Anything else I should be aware of? My mother had osteoporosis. Okay. Is your mother still with us? Yeah. She's still living. Okay. Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? I live on my own. Alright. I got 2 cats. You got 2 cats? Okay.\n\nGreat. Do they have names? They're my family. They're they're called they're called Polly and Tim. Okay. So this is you and your cats. And in terms of day to day, are you working at the moment? I work part time as a lorry driver. Okay. And how is that? Is that quite stressful, long hours?\n\nIt's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. There's certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving?\n\nOh, no. I I I only take shifts during the day. I don't like working at night. Okay. Alright. And what about smoking and alcohol? Because it they can sometimes be very important when it comes to heart problems. Do you do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many\n\nYears was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in a way of exercise, sir? I try and walk to the shops at least once a day. Okay. Okay. But that's about it. I've yeah. I don't\n\nI don't get running like I used to when I was young. Right. Okay. And, certainly, now with your symptoms, you you said you're feeling more breathless even walking to to the shop, you said. Right. So based on your based on your history and having listened to your story, I wonder whether you've had a flare up of your heart failure, sir, which can sometimes happen. You know, it's What's going on? So I see that your heart's not pumping as well as it should be. And, of\n\nHaving diagnosed with heart failure is obviously the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than 1 tablet a day, we can give you 2 tablets a day for the first few days and see and see how you're getting on. Okay. I think that would be bad. I think I think\n\nIt's it's it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Design. Yeah. So an echo scan it's a it's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good remember now. Sorry? Yeah. I remember now. You remember now? Okay. Fine. That's something I can organize for you today.\n\nThey may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's let's let's get a blood test done. We can check your, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your your furosemide to, you know, 1 tablet twice a day. But I really like we'd like you to come back and see him in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And\n\nIn the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And then I wish you all the best. Have a good day. Okay. See you soon. Okay. Thank you.\n\nyou","marks":[[83,101,".",false],[114,126,"Nice to see you",false],[173,173,"Are you the doctor Um",false],[255,260,"want to",false],[286,288,"it",false],[394,399,"Um now",false],[442,443,"few",false],[587,591,"really",false],[994,998,"just",false],[1044,1050,"you're feeling uh",false],[1132,1135,"it's",false],[1567,1567,"Um I'm feeling a little run-down um but otherwise otherwise pretty normal. OK. I've noticed my ankles have got a bit bigger. OK. And what do you mean by that Uh it's just like it's sort of swollen up a bit. OK. Um is that is that both Kind of . Um yeah both ankles. Yeah it's a bit embarrassing. Both ankles OK. Uh I can imagine yeah. Um and again over how long has this have you noticed this for Um",false],[1610,1614,"Past",false],[1820,1820,"you're",false],[1980,2072,"swelling in your",false],[2080,2105,"Um reporting no chest pain. 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OK.",false],[8909,8930,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","Note captures gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","Note captures worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","Note captures previously walked to shops, now sits to catch breath."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Note captures breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","yes","Note captures concern HF worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","Note captures mild dry cough."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Lethargy for few days' approximates run-down but omits otherwise-normal and adds a duration."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","partial","States ankle swelling over 'last 2 days' rather than the reported last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","partial","Links previous dyspnoea and ankle swelling to HF diagnosis rather than a previous HF flare."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'Urinary output normal' omits frequent urination since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Note captures known heart failure."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","Records dyspnoea at HF diagnosis but not improvement with medication."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'Myocardial infarction approximately 5 years ago' is accepted."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","'hospitalised for few days' but no chest pain presentation."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Note does not document previous echo."],["The note captures: No other past medical history apart from the heart problems.","partial","PMH lists only HF and MI; not explicitly stated no other history."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'Furosemide (dose unknown)' without current one-tablet-daily dose."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","no","Lists 'Metoprolol' instead of bisoprolol; wrong medication."],["The note captures: No known drug allergies.","yes","Note captures NKDA."],["The note captures: Father died of a heart attack.","yes","Note captures father died of heart attack."],["The note captures: Father was in his early sixties when he died.","yes","Note captures father early sixties."],["The note captures: Mother has osteoporosis.","yes","Note captures mother osteoporosis."],["The note captures: Lives alone.","yes","Note captures lives alone."],["The note captures: Works part-time as a lorry driver.","yes","Note captures part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Occupation recorded but no work exhaustion or concern."],["The note captures: Ex-smoker.","yes","Note captures ex-smoker."],["The note captures: Smoked about a pack a day.","yes","Note captures pack a day."],["The note captures: Smoked for about 25 years.","yes","Note captures 25 years."],["The note captures: Does not drink alcohol.","yes","Note captures no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","Note captures walks to shops daily."],["The note captures: Chest examination OK.","yes","Note captures chest exam OK."],["The note captures: Oxygen saturations OK.","yes","Note captures saturations OK."],["The note captures: Blood pressure OK.","yes","Note captures BP OK."],["The note captures: Otherwise well at the moment.","no","Doctor's otherwise-well statement not recorded."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","partial","'Acute decompensated heart failure' stated as definite rather than suspected."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","no","Increase recorded without the 'first few days' duration."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'Full blood count' listed without anaemia purpose."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","'Echocardiogram to be arranged' without purpose of assessing pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","Note captures echo requested, 1-2 weeks."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Bilateral ankle swelling noted over last 2 days","Patient said he noticed the ankle swelling over the last few days, not 2 days."],["Lethargy for few days","Patient said he felt a little run-down; no duration was given."],["Urinary output normal","Patient said he pees a lot since starting the drugs, not that output is normal."],["Omeprazole","Omeprazole is never mentioned in the transcript."],["Metoprolol","Patient confirmed bisoprolol, correcting the doctor's query about metoprolol."],["Simvastatin","Simvastatin is never mentioned in the transcript."],["Assessment: Acute decompensated heart failure","Clinician only wondered whether it was a flare-up; stated here as a definite diagnosis."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nProgressive dyspnoea over 2 weeks, significantly worsened over last 2 days\n\nDyspnoea on minimal exertion (walking to shops, moving around house)\n\nPreviously able to walk to shops without difficulty\n\nDry cough, not troublesome\n\nBilateral ankle swelling noted over last 2 days\n\nLethargy for few days\n\nDenies chest pain\n\nDenies palpitations\n\nDenies fever\n\nAppetite normal\n\nUrinary output normal\n\nConcerned symptoms represent worsening of known heart failure\n\nPrevious episode of dyspnoea and ankle swelling at time of heart failure diagnosis\n\n\n\n\nPast Medical History:\n\nHeart failure\n\nMyocardial infarction approximately 5 years ago (hospitalised for few days)\n\n\n\n\nMedications:\n\nFurosemide (dose unknown)\n\nAspirin\n\nOmeprazole\n\nMetoprolol\n\nSimvastatin\n\n\n\n\nAllergies:\n\nNKDA\n\n\n\n\nFamily History:\n\nFather deceased from myocardial infarction in early 60s\n\nMother alive with osteoporosis\n\n\n\n\nSocial History:\n\nLives alone with 2 cats\n\nPart-time lorry driver, day shifts only\n\nEx-smoker: 1 pack per day for 25 years, ceased\n\nNon-drinker\n\nExercise: usually walks to shops daily, now limited by dyspnoea\n\n\n\n\nObjective:\n\nChest examination: normal\n\nOxygen saturations: normal\n\nBlood pressure: normal\n\n\n\n\nAssessment:\n\nAcute decompensated heart failure\n\n\n\n\nPlan:\n\nIncrease furosemide to 1 tablet twice daily\n\nFull blood count\n\nUrea, electrolytes and creatinine\n\nEchocardiogram to be arranged (anticipated 1-2 weeks)\n\nReview in 1 week\n\nPatient advised to return sooner if worsening dyspnoea, chest pain, palpitations or dizziness develop","review":411.4473684210526,"saved":74.5526315789474,"faster":15.340047649989177,"clean":false,"effort":36.79245283018868,"sig":[["partial","Feels a little run-down; otherwise feels generally normal.","'Lethargy for few days' approximates run-down but omits otherwise-normal and adds a duration."],["partial","Ankle swelling noticed over the last few days.","States ankle swelling over 'last 2 days' rather than the reported last few days."],["partial","Ankles also swelled previously when his heart failure was a problem.","Links previous dyspnoea and ankle swelling to HF diagnosis rather than a previous HF flare."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'Urinary output normal' omits frequent urination since diuretic."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","Records dyspnoea at HF diagnosis but not improvement with medication."],["partial","That episode presented with chest pain and he was admitted to hospital.","'hospitalised for few days' but no chest pain presentation."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Note does not document previous echo."],["partial","No other past medical history apart from the heart problems.","PMH lists only HF and MI; not explicitly stated no other history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'Furosemide (dose unknown)' without current one-tablet-daily dose."],["missing","Takes bisoprolol.","Lists 'Metoprolol' instead of bisoprolol; wrong medication."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Occupation recorded but no work exhaustion or concern."],["missing","Otherwise well at the moment.","Doctor's otherwise-well statement not recorded."],["partial","Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","'Acute decompensated heart failure' stated as definite rather than suspected."],["missing","Increased furosemide dose for the first few days, then see how he gets on.","Increase recorded without the 'first few days' duration."],["partial","Blood test: full blood count to look for anaemia.","'Full blood count' listed without anaemia purpose."],["partial","Echocardiogram to assess how well the heart is pumping.","'Echocardiogram to be arranged' without purpose of assessing pumping."],["fabrication","Bilateral ankle swelling noted over last 2 days","Patient said he noticed the ankle swelling over the last few days, not 2 days."],["fabrication","Lethargy for few days","Patient said he felt a little run-down; no duration was given."],["fabrication","Urinary output normal","Patient said he pees a lot since starting the drugs, not that output is normal."],["fabrication","Omeprazole","Omeprazole is never mentioned in the transcript."],["fabrication","Metoprolol","Patient confirmed bisoprolol, correcting the doctor's query about metoprolol."],["fabrication","Simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","Assessment: Acute decompensated heart failure","Clinician only wondered whether it was a flare-up; stated here as a definite diagnosis."]],"mb":18.449494,"latency":38.094,"finalised":449.5413684210526},{"label":"Run 4","wer":20.18348623853211,"text":"Hello? Hello there. Hello. Can you hear me okay? Yes. I can hear you. Okay. Great. Are you the doctor? I am. Yes. Doctor. Sood here. Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you wanna tell me a bit more about us? When did it all start?\n\nWell, it seems to have been slowly getting worse over the last couple of weeks. Mhmm. It's become quite troublesome in the last 2 days. Yeah. I kind of normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\n\nWell, I've I've I've got heart failure. Okay. I was told that a while ago, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that that helped, but I'm a bit worried it's it's getting worse. Right. Okay. So you mentioned you've short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And\n\nYou're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nI'm feeling a little run down, but otherwise otherwise, pretty normal. Okay. I've noticed my ankles have gotten bigger. Okay. And what do you mean by that? It's just like it's sort of swollen up a bit. Okay. Is that is that both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this\n\nI kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past? I think my ankles did swell up a bit last time the heart failure was a problem. Okay. Okay. Fine. Okay. So just to really recap, so really, in the last couple of weeks, you've been feeling breathless but worse in the last couple of days. You mentioned you had a bit of a dry cough and some\n\nSwelling in your ankles. But importantly, no chest pain. And and have you had have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No. Not really. Okay. And any temperatures or fevers? No. Okay. And how about your appetite? Are you eating and drinking okay? Yeah. I that's fine. Okay. And your water works? Are you passing urine okay? Yeah. That yeah. I usually\n\nYeah. The drugs Sure. Okay. Alright. Fine. So moving on to your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Well, I was told I had, like, a they called it, like, a small heart attack about 5 years ago. I I had I I had, like, chest pain, and they took me to hospital. Okay. And they\n\nBut then I just got better. Okay. And when you say small heart attack, did they give you a name for what happened, a name of a diagnosis? I can't remember. I just called it as something like that. Small heart attack. Small heart attack. Okay. Was it, like, angina? Or No. They they said they it seemed it was, like, more than angina. Okay.\n\nBut I didn't but I only had to stay in hospital for a few days. Okay. Okay. Yeah. I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of? No. I think I'm otherwise, I'm okay. Okay. Do you take any regular medications apart from your is it diuretics that you're taking? Do you know which ones? Yeah. I take something called furosemide.\n\nDo you know which dose you're taking? I can't remember. I'm sorry, doctor. It's okay. Have to check. No problems. Any other medications? Yeah. I take aspirin. Okay. And omeprazole. Was this? Or Metoprolol. Sorry. The connection is not very okay. Thank you. Yep.\n\nSimvastatin. Simvastatin. Okay. Alright. Any allergies at all to any medications? No. No allergies. Okay. And is there anything in the family that's that that's that's important for me to know? Any family history of medical problems, heart problems, lung problems? My my father died of a of a heart attack. I'm sorry to hear that. And how old was your father when he passed away? He was\n\nEarly sixties. Early sixties. Okay. Anything else I should be aware of? My mother had osteoporosis. Okay. Is your mother still with us? Yeah. She's still living. Okay. Alright. And socially, sir, just tell me a bit more about your situation at home. Who lives at home with you? I live on my own. Alright. I got 2 cats. You got 2 cats? Okay.\n\nGreat. Do they have names? They're my family. They're they're called they're called Polly and Tim. Okay. So this is you and your cats. And in terms of day to day, are you working at the moment? I work part time as a lorry driver. Okay. And how is that? Is that quite stressful, long hours?\n\nIt's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. There's certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do you do a lot of night driving, weekend driving?\n\nOh, no. I I I only take shifts during the day. Okay. I don't like working at night. Okay. Alright. And what about smoking and alcohol? Because it they can sometimes be very important when it comes to heart problems. Do you do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many\n\nYears was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in a way of exercise, sir? I try and walk to the shops at least once a day. Okay. Okay. But that's about it. I've yeah. I don't\n\nI don't get running like I used to when I was young. Right. Okay. And, certainly, now with your symptoms, you you said you're feeling more breathless even walking to the to the shop, you said. Right. So based on your based on your history and having listened to your story, I wonder whether you've had a up of your heart failure, sir, which can sometimes happen. You know, it's What's going on? So I see that your heart's not pumping as well as it should be. And\n\nObviously, having diagnosed with heart failure is obviously the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than 1 tablet a day, can give you 2 tablets a day for the first few days and see and see how you're getting on. Okay. I think that would be bad. I think I think\n\nIt's it's it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Design. Yeah. So an echo scan it's a it's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good remember now. Sorry? Yeah. I remember now. You remember now? Okay. Fine. That's something I can organize for you today.\n\nThey may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's let's let's get a blood test done. We can check your, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your your furosemide to, you know, 1 tablet twice a day. But I really like we'd like you to come back and see me in about a week's time to see how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And\n\nIn the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do you have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. And then I wish you all the best. Have a good day. See you soon. Okay. Thank you.\n\nyou","marks":[[83,101,".",false],[114,126,"Nice to see you",false],[173,173,"Are you the doctor Um",false],[255,260,"want to",false],[286,288,"it",false],[394,399,"Um now",false],[442,443,"few",false],[587,591,"really",false],[994,998,"just",false],[1044,1050,"you're feeling uh",false],[1132,1135,"it's",false],[1404,1404,"coughing",false],[1582,1590,"run-down um",false],[1666,1672,"got a bit",false],[1790,1796,"Kind of . Um",false],[1848,1853,"Both ankles OK. 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OK.",false],[8909,8930,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'Progressive dyspnoea'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'over 2 weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'significantly worsened in last 2 days' (doctor's 'couple of days' accepted)."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'Previously able to walk to shops without difficulty, now requires rest breaks'."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'Breathless at home with minimal exertion'."],["The note captures: Concerned that his heart failure is getting worse.","yes","'Concerned symptoms represent worsening heart failure'."],["The note captures: No chest pain.","yes","'Denies chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Feeling run down' without the mild qualifier or otherwise normal."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle oedema'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noted over last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'Previous ankle oedema during heart failure exacerbation'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'Denies ... palpitations'."],["The note captures: No fevers or temperatures.","yes","'Denies ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite and fluid intake normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'Urinary output normal' but increased urination since medication omitted."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'Known heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","yes","'similar presentation at initial diagnosis, improved with diuretics'."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Previous heart attack not mentioned."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Not mentioned."],["The note captures: Has been well since the heart attack.","no","Not mentioned."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echo not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Not stated."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide as current medication implied ('Increase furosemide'; 'diuretics')."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","no","Current dose not recorded."],["The note captures: Takes aspirin.","no","Aspirin not mentioned."],["The note captures: Takes bisoprolol.","no","Bisoprolol not mentioned."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","no","Family history not documented."],["The note captures: Father was in his early sixties when he died.","no","Not documented."],["The note captures: Mother has osteoporosis.","no","Not documented."],["The note captures: Lives alone.","no","Living situation not documented."],["The note captures: Works part-time as a lorry driver.","yes","'part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","partial","'Worried about impact on work' but exhaustion at work omitted."],["The note captures: Ex-smoker.","no","Smoking not documented."],["The note captures: Smoked about a pack a day.","no","Not documented."],["The note captures: Smoked for about 25 years.","no","Not documented."],["The note captures: Does not drink alcohol.","no","Alcohol not documented."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual exercise not documented."],["The note captures: Chest examination OK.","yes","'Chest examination: within normal limits'."],["The note captures: Oxygen saturations OK.","yes","'Oxygen saturations: within normal limits'."],["The note captures: Blood pressure OK.","yes","'Blood pressure: within normal limits'."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not stated."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","partial","'Acute exacerbation of chronic heart failure' stated as definite rather than suspected/possible."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to 1 tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for first few days'."],["The note captures: Blood test: full blood count to look for anaemia.","yes","'FBC (anaemia screen)'."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","'Echocardiogram arranged' but purpose (assess pumping) not stated."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'may take 1-2 weeks to organise'."],["The note captures: Follow-up review in about one week.","yes","'Review appointment in 1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'return sooner if worsening dyspnoea'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations, or dizziness'."]],"claims":[["Denies ... dizziness","Dizziness was never asked about; it appears only in the safety-net advice."],["Urinary output normal","Patient said he pees a lot since starting his medication; output was not described as normal."],["Assessment: Acute exacerbation of chronic heart failure","Doctor said he wondered whether it was a flare-up, a possibility rather than a definite diagnosis."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nProgressive dyspnoea over 2 weeks, significantly worsened in last 2 days\n\nPreviously able to walk to shops without difficulty, now requires rest breaks\n\nBreathless at home with minimal exertion\n\nDry cough, not troublesome\n\nBilateral ankle oedema noted over last few days\n\nFeeling run down\n\nDenies chest pain, palpitations, fever, or dizziness\n\nAppetite and fluid intake normal\n\nUrinary output normal\n\nKnown heart failure with similar presentation at initial diagnosis, improved with diuretics\n\nPrevious ankle oedema during heart failure exacerbation\n\nConcerned symptoms represent worsening heart failure\n\nWorried about impact on work as part-time lorry driver\n\n\n\n\nObjective:\n\nChest examination: within normal limits\n\nOxygen saturations: within normal limits\n\nBlood pressure: within normal limits\n\n\n\n\nAssessment:\n\nAcute exacerbation of chronic heart failure\n\n\n\n\nPlan:\n\nIncrease furosemide to 1 tablet twice daily for first few days\n\nPathology: FBC (anaemia screen), renal function\n\nEchocardiogram arranged (may take 1-2 weeks to organise)\n\nReview appointment in 1 week\n\nPatient advised to return sooner if worsening dyspnoea, chest pain, palpitations, or dizziness develop","review":461.17105263157896,"saved":24.82894736842104,"faster":5.108836907082519,"clean":false,"effort":47.16981132075472,"sig":[["partial","Feels a little run-down; otherwise feels generally normal.","'Feeling run down' without the mild qualifier or otherwise normal."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'Urinary output normal' but increased urination since medication omitted."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Previous heart attack not mentioned."],["missing","That episode presented with chest pain and he was admitted to hospital.","Not mentioned."],["missing","Has been well since the heart attack.","Not mentioned."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echo not mentioned."],["missing","No other past medical history apart from the heart problems.","Not stated."],["missing","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Current dose not recorded."],["missing","Takes aspirin.","Aspirin not mentioned."],["missing","Takes bisoprolol.","Bisoprolol not mentioned."],["missing","No known drug allergies.","Allergies not documented."],["missing","Father died of a heart attack.","Family history not documented."],["missing","Father was in his early sixties when he died.","Not documented."],["missing","Mother has osteoporosis.","Not documented."],["missing","Lives alone.","Living situation not documented."],["partial","Finds work exhausting and is worried that worsening illness will stop him working properly.","'Worried about impact on work' but exhaustion at work omitted."],["missing","Ex-smoker.","Smoking not documented."],["missing","Smoked about a pack a day.","Not documented."],["missing","Smoked for about 25 years.","Not documented."],["missing","Does not drink alcohol.","Alcohol not documented."],["missing","Usual exercise is walking to the shops at least once a day.","Usual exercise not documented."],["missing","Otherwise well at the moment.","'Otherwise well' not stated."],["partial","Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","'Acute exacerbation of chronic heart failure' stated as definite rather than suspected/possible."],["partial","Echocardiogram to assess how well the heart is pumping.","'Echocardiogram arranged' but purpose (assess pumping) not stated."],["fabrication","Denies ... dizziness","Dizziness was never asked about; it appears only in the safety-net advice."],["fabrication","Urinary output normal","Patient said he pees a lot since starting his medication; output was not described as normal."],["fabrication","Assessment: Acute exacerbation of chronic heart failure","Doctor said he wondered whether it was a flare-up, a possibility rather than a definite diagnosis."]],"mb":16.429408,"latency":37.04,"finalised":498.211052631579},{"label":"Run 5","wer":20.399352401511063,"text":"Hello? Hello there. Hello. Can you hear me okay? Yes. I can hear you. Okay. Great. Are you the doctor? I am. Yes. Doctor. Sood here. Oscar. How can I help you this afternoon? I'm contacting you because I've been quite short of breath lately. Okay. Do you wanna tell me a bit more about us? When did it all start?\n\nWell, it seems to have been slowly getting worse over the last couple of weeks. Mhmm. It's become quite troublesome in the last 2 days. Yeah. I kind of normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house. Okay. And it's got me kind of worried. Don't really know what's going on. Okay. Okay. Is there anything you're particularly worried about?\n\nWell, I've I've I've got heart failure. Okay. I was told that a while ago, and I got a bit breathless when I was first diagnosed. Right. And put on some medicine that that helped, but I'm a bit worried it's it's getting worse. Right. Okay. So you mentioned you've short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse. And\n\nYou're now feeling more breathless on kind of minimal minimal exertion you mentioned. Have you noticed any other symptoms at all with your breath? So for example, any pain in your chest? No pain in my chest. Okay. Have you found yourself coughing at all? I've got a bit of a dry cough, but it's not too troublesome. Okay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic?\n\nI'm feeling a little run down, but otherwise otherwise, pretty normal. Okay. I've noticed my ankles have gotten bigger. Okay. And what do you mean by that? It's just like it's sort of swollen up a bit. Okay. Is that is that both ankles? Yeah. Both ankles. Yeah. It's a bit embarrassing. Okay. I can imagine. Yeah. And, again, over how long has this have you noticed this\n\nI kind of noticed it the last few days. Last few days. Okay. And is this something that you've had before in the past? I think my ankles did swell up a bit last time the heart failure was a problem. Okay. Okay. Fine. Okay. So just to really recap, so really, in the last couple of weeks, you've been feeling breathless but worse in the last couple of days. You mentioned you had a bit of a dry cough and some\n\nSwelling in your ankles. But importantly, no chest pain. And and have you had have you have you noticed your heartbeat racing at all? So palpitations or skipped heartbeat? No. Not really. Okay. And any temperatures or fevers? No. Okay. And how about your appetite? Are you eating and drinking okay? Yeah. I that's fine. Okay. And your water works? Are you passing urine okay? Yeah. That yeah. I usually\n\nYeah. The drugs Sure. Okay. Alright. Fine. So moving on to your past medical history, you mentioned heart failure. Any any other medical history I should be aware of? Well, I was told I had, like, a they called it, like, a small heart attack about 5 years ago. I I had I I had, like, chest pain, and they took me to hospital. Okay. And they\n\nBut then I just got better. Okay. And when you say small heart attack, did they give you a name for what happened, a name of a diagnosis? I can't remember. I just called it as something like that. Small heart attack. Small heart attack. Okay. Was it, like, angina? Or No. They they said they it seemed it was, like, more than angina. Okay.\n\nBut I didn't but I only had to stay in hospital for a few days. Okay. Okay. Yeah. I've been okay since then. You've been okay since then. Okay. Alright. So apart from the the heart the heart problems, the heart failure, any other problems I should be aware of? No. I think I'm otherwise, I'm okay. Okay. Do you take any regular medications apart from your your diuretics that you're taking? Do you know which ones? Yeah. I take something called furosemide.\n\nDo you know which dose you're taking? I can't remember. I'm sorry, doctor. It's okay. Have to check. No problems. Any other medications? Yeah. I take aspirin. Okay. And omeprazole. Was this? Or Metoprolol. Sorry. The connection is not very okay. Thank you. Yep.\n\nSimvastatin. Simvastatin. Okay. Alright. Any allergies at all to any medications? No. No allergies. Okay. And is there anything in the family that's that that's that's important for me to know? Any family history of medical problems, heart problems, lung problems? My my father died of a of a heart attack. I'm sorry to hear that. And how old was your father when he passed away? He was\n\nEarly sixties. Early sixties. Okay. Anything else I should be aware of? My mother had osteoporosis. Okay. Is your mother still with us? Yeah. She's still living. Okay. Alright. And socially, sir, just tell me bit more about your situation at home. Who lives at home with you? I live on my own. Alright. I got 2 cats. You got 2 cats? Okay.\n\nGreat. Do they have names? They're my family. They're they're called they're called Polly and Tim. Okay. So this is you and your cats. And in terms of day to day, are you working at the moment? I work part time as a lorry driver. Okay. And how is that? Is that quite stressful, long hours?\n\nIt's okay. I yeah. Like, when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't if I get more sick, then I won't be able to work properly. Yeah. There's certainly a consideration, isn't there? So let's let's try and get you better soon so it doesn't have any Yeah. Impact on your on your job. And do you find yourself doing a lot of antisocial hours? Do you do do a lot of night driving, weekend driving?\n\nOh, no. I I I only take shifts during the day. Okay. I don't like working at night. Okay. Alright. And what about smoking and alcohol? Because it they can sometimes be very important when it comes to heart problems. Do you do you smoke at all? Not anymore. So you used to smoke? Yeah. And how many did you smoke a day on average? Oh, it was about about a pack a day back in the day. And how many how many\n\nYears was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what and what about alcohol? I don't drink alcohol. Okay. Do you do much in a way of exercise, sir? I try and walk to the shops at least once a day. Okay. Okay. But that's about it. I've yeah. I don't\n\nI don't get running like I used to when I was young. Right. Okay. And, certainly, now with your symptoms, you you said you're feeling more breathless even walking to the to the shop, you said. Right. So based on your based on your history and having listened to your story, I wonder whether you've had a up of your heart failure, sir, which can sometimes happen. You know, it's What's going on? So I see that your heart's not pumping as well as it should be. And\n\nObviously, having diagnosed with heart failure is obviously the first thing that comes to my mind. Now there's a couple of options to move forward. Given that you're otherwise well at the moment and having examined you, your chest and your saturations and blood pressure all okay, I'm quite happy to increase your dose of furosemide. So maybe rather than 1 tablet a day, can give you 2 tablets a day for the first few days and see and see how you're getting on. Okay. I think that would be bad. I think I think\n\nIt's it's it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests like a blood test and maybe an echocardiogram of your heart to see how well your heart's pumping. Okay. Is that something you've had? Design. Yeah. So an echo scan it's a it's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good remember now. Sorry? Yeah. I remember now. You remember now. Okay. Fine. But that's something I can organize for you today.\n\nThey may take a week or 2 weeks for that to be organized. But I think certainly in the meantime, let's let's let's get a blood test done. We can check your, you know, your full blood count, look for signs of anemia. We can have a check of your kidney function, and we can definitely increase your your furosemide to, you know, 1 tablet twice a day. But I really like we'd like you to come back and see me in about a week's time to see how you're getting on. That sound reasonable? I think that sounds like a good plan. And\n\nIn the meantime, if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, said I want you to give me a call sooner than that, and we can have a chat on the phone as well. Okay. I'll see how I get on. Okay. Do have any questions for me? I think that's all pretty clear. Thank you very much, doctor. Great. No. I wish you all the best. Have a good day. Okay. See you soon. Okay. Thank you.\n\nyou","marks":[[83,101,".",false],[114,126,"Nice to see you",false],[173,173,"Are you the doctor Um",false],[255,260,"want to",false],[286,288,"it",false],[394,399,"Um now",false],[442,443,"few",false],[587,591,"really",false],[994,998,"just",false],[1044,1050,"you're feeling uh",false],[1132,1135,"it's",false],[1404,1404,"coughing",false],[1582,1590,"run-down um",false],[1666,1672,"got a bit",false],[1790,1796,"Kind of . Um",false],[1848,1853,"Both ankles OK. 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OK.",false],[8898,8919,"",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'Progressive dyspnoea'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'Progressive dyspnoea over 2 weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'significantly worse in last 2 days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","yes","'now requires rest breaks' on walk to shops."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'Breathless at home with minimal exertion'."],["The note captures: Concerned that his heart failure is getting worse.","partial","'Concerned symptoms similar to initial heart failure presentation' only loosely conveys worry about worsening HF."],["The note captures: No chest pain.","yes","'No chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'Feeling run down' captured but 'otherwise normal' omitted."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle oedema'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noted over last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","yes","'Previous ankle oedema with heart failure exacerbation'."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'No ... palpitations'."],["The note captures: No fevers or temperatures.","yes","'No ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'Appetite ... normal'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'urinary function normal' omits increased urination since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","PMH: 'Heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","partial","Similarity to initial presentation noted but improvement with medication not stated."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'Myocardial infarction 5 years ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","partial","Hospitalisation captured but chest pain presentation omitted."],["The note captures: Has been well since the heart attack.","yes","'recovered well'."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","No statement of no other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","'Furosemide (dose unknown)'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unknown' but current one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","no","Lists 'Metoprolol' instead of bisoprolol."],["The note captures: No known drug allergies.","yes","'NKDA'."],["The note captures: Father died of a heart attack.","yes","'Father: myocardial infarction, died'."],["The note captures: Father was in his early sixties when he died.","yes","'died early 60s'."],["The note captures: Mother has osteoporosis.","yes","'Mother: osteoporosis'."],["The note captures: Lives alone.","yes","'Lives alone with 2 cats'."],["The note captures: Works part-time as a lorry driver.","yes","'Part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Work exhaustion and worry about working not captured."],["The note captures: Ex-smoker.","yes","'Ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'1 pack per day'."],["The note captures: Smoked for about 25 years.","yes","'for 25 years'."],["The note captures: Does not drink alcohol.","yes","'Non-drinker'."],["The note captures: Usual exercise is walking to the shops at least once a day.","yes","'walks to shops daily'."],["The note captures: Chest examination OK.","yes","'Chest examination: within normal limits'."],["The note captures: Oxygen saturations OK.","yes","'Oxygen saturations: within normal limits'."],["The note captures: Blood pressure OK.","yes","'Blood pressure: within normal limits'."],["The note captures: Otherwise well at the moment.","no","Otherwise well not captured."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","partial","'Heart failure exacerbation' stated as definite, not possible; pumping explanation omitted."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to 1 tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","no","'First few days' duration not captured."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'FBC' without anaemia purpose."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","Echo arranged without stating it assesses pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","yes","'Arrange echocardiogram (anticipated 1-2 weeks)'."],["The note captures: Follow-up review in about one week.","yes","'Review in 1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'return sooner if worsening dyspnoea'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations or dizziness'."]],"claims":[["No ... dizziness","Dizziness was never asked about as a symptom; it was mentioned only in safety-netting advice."],["Medications: Omeprazole","Omeprazole is never mentioned in the transcript."],["Medications: Metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["Medications: Simvastatin","Simvastatin is never mentioned in the transcript."],["Assessment: Heart failure exacerbation","Doctor only wondered whether it was a flare-up; written as a definite diagnosis."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nProgressive dyspnoea over 2 weeks, significantly worse in last 2 days\n\nPreviously able to walk to shops without difficulty, now requires rest breaks\n\nBreathless at home with minimal exertion\n\nDry cough, not troublesome\n\nBilateral ankle oedema noted over last few days\n\nFeeling run down\n\nNo chest pain, palpitations, fever or dizziness\n\nAppetite and urinary function normal\n\nConcerned symptoms similar to initial heart failure presentation\n\nPrevious ankle oedema with heart failure exacerbation\n\n\n\n\nPast Medical History:\n\nHeart failure\n\nMyocardial infarction 5 years ago (hospitalised for few days, recovered well)\n\n\n\n\nMedications:\n\nFurosemide (dose unknown)\n\nAspirin\n\nOmeprazole\n\nMetoprolol\n\nSimvastatin\n\n\n\n\nAllergies:\n\nNKDA\n\n\n\n\nFamily History:\n\nFather: myocardial infarction, died early 60s\n\nMother: osteoporosis, alive\n\n\n\n\nSocial History:\n\nLives alone with 2 cats (Polly and Tim)\n\nPart-time lorry driver, day shifts only\n\nEx-smoker: 1 pack per day for 25 years, ceased\n\nNon-drinker\n\nExercise: walks to shops daily, now limited by dyspnoea\n\n\n\n\nObjective:\n\nChest examination: within normal limits\n\nOxygen saturations: within normal limits\n\nBlood pressure: within normal limits\n\n\n\n\nAssessment:\n\nHeart failure exacerbation\n\n\n\n\nPlan:\n\nIncrease furosemide to 1 tablet twice daily\n\nPathology: FBC, renal function\n\nArrange echocardiogram (anticipated 1-2 weeks)\n\nReview in 1 week\n\nAdvised to return sooner if worsening dyspnoea, chest pain, palpitations or dizziness develop","review":363.67105263157896,"saved":122.32894736842104,"faster":25.170565302144247,"clean":false,"effort":32.075471698113205,"sig":[["partial","Concerned that his heart failure is getting worse.","'Concerned symptoms similar to initial heart failure presentation' only loosely conveys worry about worsening HF."],["partial","Feels a little run-down; otherwise feels generally normal.","'Feeling run down' captured but 'otherwise normal' omitted."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'urinary function normal' omits increased urination since diuretic."],["partial","Was breathless when heart failure was first diagnosed and this improved with medication.","Similarity to initial presentation noted but improvement with medication not stated."],["partial","That episode presented with chest pain and he was admitted to hospital.","Hospitalisation captured but chest pain presentation omitted."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","No statement of no other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unknown' but current one tablet daily not stated."],["missing","Takes bisoprolol.","Lists 'Metoprolol' instead of bisoprolol."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Work exhaustion and worry about working not captured."],["missing","Otherwise well at the moment.","Otherwise well not captured."],["partial","Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","'Heart failure exacerbation' stated as definite, not possible; pumping explanation omitted."],["missing","Increased furosemide dose for the first few days, then see how he gets on.","'First few days' duration not captured."],["partial","Blood test: full blood count to look for anaemia.","'FBC' without anaemia purpose."],["partial","Echocardiogram to assess how well the heart is pumping.","Echo arranged without stating it assesses pumping."],["fabrication","No ... dizziness","Dizziness was never asked about as a symptom; it was mentioned only in safety-netting advice."],["fabrication","Medications: Omeprazole","Omeprazole is never mentioned in the transcript."],["fabrication","Medications: Metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["fabrication","Medications: Simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","Assessment: Heart failure exacerbation","Doctor only wondered whether it was a flare-up; written as a definite diagnosis."]],"mb":16.377191,"latency":36.598,"finalised":400.269052631579}],"patientnotes":[{"label":"Run 1","wer":23.853211009174313,"text":"Hello?\nHello there.\nHello? Can you hear me okay? Yes, I can hear you. Okay, great. Are you Dr. I am, yes. Dr. Seed here, Oscar. How can I help you this afternoon?\nI'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about it? When did it all start?\nWell, it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome the last few days. Normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath. And I'm even starting to get a bit breathless just about the house. And it's got me kind of worried. Don't really know what's going on.\nOkay. Is there anything you're particularly worried about?\nWell, I've got heart failure. I was told that a while ago. And I got a bit breathless when I was first diagnosed and put on some medicine. That helped. But I'm a bit worried it's getting worse.\nRight. Okay. So you mentioned me feeling short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal exertion. You mentioned, have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing at all?\nI've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic,\nI'm feeling a little run down, but otherwise. Otherwise pretty normal.\nI've\nnoticed my ankles have Codeine bigger.\nOkay, what do you mean by that?\nIt's just like they've sort of swollen up a bit.\nOkay, is that both ankles? Both ankles?\nYeah, both ankles, yeah. It's a bit embarrassing.\nOkay, I can imagine. Yeah. And again over how long have you noticed this for?\nI kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nI think my ankles did swell up a bit last time. The heart failure was a problem.\nOkay. Okay, fine. Okay, so just to really recap, so you really. The last couple of weeks you've been feeling breathless but worse. In the last couple. Couple of days you mentioned you had a bit of a dry cough.\nAnd some swelling in your ankles. But importantly, no chest pain. Have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\nNo, not really.\nOkay. And any temperatures or fevers?\nNo.\nOkay. And how about your appetite? Are you eating and drinking okay?\nYeah, that's fine.\nOkay. And your waterworks? Are you passing urine okay?\nYeah. Yeah, I usually pee a lot.\nYeah, sure. Okay. All right, fine. So moving on to your past medical history. You mentioned heart failure. Any other medical history I should be aware of?\nWell, I was told I had, like. They called it, like, a small heart attack about five years ago. I. I had. I had, like, chest pain, and they took me to hospital.\nOkay.\nAnd.\nAnd they. But then I just got better.\nOkay, when you say small heart attack, did they give you a name for what happened and a name of a diagnosis?\nI can't remember. They just called it something like that. A small heart attack.\nSmall heart attack. Okay. Was it like angina or.\nNo, they said it was like, more than angina. Okay. But I didn't. But I only had to stay in hospital for a few days.\nOkay.\nYeah, I've been okay since then.\nYou've been okay since then. Okay. All right. So apart from the heart. The heart problems, the heart failure, any other problems I should be aware of?\nNo, I think I'm. Otherwise, I'm okay. Okay.\nDo you take any regular medications, apart from your diuretics that you're taking? Do you know which ones.\nYeah. I take something called Furosemide. And do you know which dose you're taking? I can't remember. I'm sorry, Doctor.\nI have\nto check.\nNo problems. Any other medications?\nYeah, I take Aspirin.\nOkay.\nAnd zoprolol. That\nMetoprolol was this. Sorry, the connection is not very good. Okay. Thank you. Yep. Simvastatin, Simonsatin. Okay. All right. Any allergies at all to any medications? No. No allergies. Okay. Is\nthere anything in the family\nthat's important for me to know? Any family history of medical problems? Heart problems, lung problems?\nMy father died of a heart attack.\nI'm sorry to hear that. How old was your father when he passed away?\nHe was early 60s. Okay.\nAnything else I should be aware of?\nMy mother had osteoporosis.\nOkay. Is your mother still with us? Yes, she's still living. Alright. And socially, sir? Just tell me a bit more about your situation at home. Who lives at home with you?\nI live on my own. Alright. I got two cats.\nYou got two cats? Okay, great.\nDo they have names? They're my family. They're called Polly and\nTim. Okay, so this is you and your cats. And in terms of day to day, are you working at the moment?\nI work part time as a lorry driver.\nOkay. And how is that? Is that quite\nstressful? Long hours? It's okay. Yeah. Like when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't. If I get more sick, then I won't be able to work properly.\nYeah. There's certainly a consideration, isn't there? So let's try and get you better soon. So it doesn't have any impact on your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\nOh, no, I only take shifts during the day. I don't like working at night.\nOkay. All right. And what about smoking and alcohol? Because they can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day.\nBack in the day. And how many years was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what about alcohol?\nI don't drink alcohol.\nOkay. Do you do much in the way of exercise, sir?\nI try and walk to the shops least once a day, but that's about it. Yeah. I don't go running like I used to when I was young.\nRight. And certainly now with your symptoms, you said you're getting more breakfast even walking to the shop. She said. Right. Based on your, based on your history and having listened to your story, I wonder whether you've had a flare up of your heart failure, sir, which can sometimes happen. What's going on.\nIt seems like your heart's not pumping as well as it should be. And obviously, having diagnosed with heart failure, there's obviously the first thing that comes to my mind. Now, there's a couple of options to move forward given that you otherwise well at the moment. And having examined you, your chest and your saturations and blood pressure all okay. I'm quite happy to increase your dose of Furosemide. Maybe rather than one tablet a day, we can give you two tablets a day for the first few days and see how you're getting on. Okay. Do you think that would be better? I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan. It's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good. Sorry.\nYeah, I remember now. Okay, fine. That's something I can organize for you today. And they may take a week or two weeks for that to be organized, but I think certainly in the Memantine let's get a blood test done. We can check your full blood, can look for signs of anemia, we can have a check your Codeine function, and we can definitely increase your Furosemide to one tablet twice a day. But I really would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable? I think that sounds like a good plan. And of course, in the Memantine if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, send. I want you to give me a call sooner than that and we can have a chat on the phone as well. Okay? I'll see how I get on. Okay. Do you have any questions for me? That's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day, okay? Thank you.","marks":[[83,94,".",false],[106,114,"Nice to see you",false],[161,161,"Are you the doctor Um",false],[382,382,"Um now",false],[431,431,"Uh I kind of",false],[553,557,"really",false],[750,750,"I've uh I've",false],[964,966,"you're",false],[991,995,"for",false],[1057,1060,"it's",false],[1135,1135,"minimal",false],[1322,1322,"coughing",false],[1499,1507,"run-down um",false],[1577,1584,"got a bit",true],[1640,1647,"it's",false],[1693,1712,"Kind of . Um",false],[1764,1768,"Both ankles OK. Uh",false],[1814,1814,"has this",false],[1882,1886,"Past",false],[2094,2097,"you're",false],[2185,2192,"",false],[2286,2301,"Um reporting",false],[2317,2317,"Um and and have you had any have you any",false],[2535,2535,"I I'm",false],[2637,2637,"ever since the drugs .",false],[2650,2665,"OK. Alright. Um",false],[2676,2688,"your uh",false],[2748,2748,"any",false],[2909,2909,"some",false],[2940,2942,"into",false],[3002,3006,"OK. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'SOB began gradually ~2 weeks ago'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","Mentions walking to shops as minimal exertion but not previous normal tolerance or needing to sit down."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","no","Patient's concern about worsening heart failure not documented."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","partial","'dry cough' without noting it is mild/not troublesome."],["The note captures: Feels a little run-down; otherwise feels generally normal.","no","Feeling run down not documented."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Previous ankle swelling with heart failure not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","yes","'no ... appetite ... changes'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'no ... urine changes' but omits frequent urination since the diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","partial","Only implied via 'decompensation of chronic heart failure'; no history documented."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Not documented."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Previous heart attack not documented."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Not documented."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unspecified' but baseline one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","no","Lists metoprolol instead of bisoprolol."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","no","Family history not documented."],["The note captures: Father was in his early sixties when he died.","no","Family history not documented."],["The note captures: Mother has osteoporosis.","no","Family history not documented."],["The note captures: Lives alone.","no","Social history not documented."],["The note captures: Works part-time as a lorry driver.","no","Occupation not documented."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Not documented."],["The note captures: Ex-smoker.","no","Smoking history not documented."],["The note captures: Smoked about a pack a day.","no","Smoking history not documented."],["The note captures: Smoked for about 25 years.","no","Smoking history not documented."],["The note captures: Does not drink alcohol.","no","Alcohol not documented."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual exercise not documented."],["The note captures: Chest examination OK.","yes","'Chest exam normal'."],["The note captures: Oxygen saturations OK.","yes","'Oxygen saturation within normal limits'."],["The note captures: Blood pressure OK.","yes","'Blood pressure within normal limits'."],["The note captures: Otherwise well at the moment.","no","'Otherwise well' not documented."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'likely acute decompensation of chronic heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the next few days'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","Full blood count planned but anaemia purpose omitted."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'Arrange echocardiogram to assess cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo arranged but 1-2 week timing not stated."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["Metoprolol","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["Simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports increasing shortness of breath over the past couple of weeks, worsening over the last few days.\n\nHistory of Presenting Complaint::\n\nSOB began gradually ~2 weeks ago, now occurs with minimal exertion (walking to shops, around house).\n\nAssociated dry cough and bilateral ankle swelling noted in last few days; no chest pain, palpitations, fever, appetite or urine changes.\n\nObjective\n\nChest exam normal.\n\nOxygen saturation within normal limits.\n\nBlood pressure within normal limits.\n\nNot discussed\n\nAssessment\n\nAssessment: likely acute decompensation of chronic heart failure.\n\nPlan\n\nMedications::\n\nFurosemide (dose unspecified)\n\nAspirin\n\nMetoprolol\n\nSimvastatin\n\nIncrease Furosemide to one tablet twice daily for the next few days.\n\nArrange blood tests: full blood count and renal function.\n\nArrange echocardiogram to assess cardiac function.\n\nReview in ~1 week to assess response to treatment.\n\nAdvise patient to contact clinic sooner if symptoms worsen (increased breathlessness, chest pain, palpitations, dizziness).","review":558.3552631578948,"saved":-72.3552631578948,"faster":-14.887914230019506,"clean":false,"effort":54.71698113207547,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","Mentions walking to shops as minimal exertion but not previous normal tolerance or needing to sit down."],["missing","Concerned that his heart failure is getting worse.","Patient's concern about worsening heart failure not documented."],["partial","Has a mild dry cough that is not too troublesome.","'dry cough' without noting it is mild/not troublesome."],["missing","Feels a little run-down; otherwise feels generally normal.","Feeling run down not documented."],["missing","Ankles also swelled previously when his heart failure was a problem.","Previous ankle swelling with heart failure not mentioned."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'no ... urine changes' but omits frequent urination since the diuretic."],["partial","Known heart failure, diagnosed some time ago.","Only implied via 'decompensation of chronic heart failure'; no history documented."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Not documented."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Previous heart attack not documented."],["missing","That episode presented with chest pain and he was admitted to hospital.","Not documented."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unspecified' but baseline one tablet daily not stated."],["missing","Takes bisoprolol.","Lists metoprolol instead of bisoprolol."],["missing","No known drug allergies.","Allergies not documented."],["missing","Father died of a heart attack.","Family history not documented."],["missing","Father was in his early sixties when he died.","Family history not documented."],["missing","Mother has osteoporosis.","Family history not documented."],["missing","Lives alone.","Social history not documented."],["missing","Works part-time as a lorry driver.","Occupation not documented."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Not documented."],["missing","Ex-smoker.","Smoking history not documented."],["missing","Smoked about a pack a day.","Smoking history not documented."],["missing","Smoked for about 25 years.","Smoking history not documented."],["missing","Does not drink alcohol.","Alcohol not documented."],["missing","Usual exercise is walking to the shops at least once a day.","Usual exercise not documented."],["missing","Otherwise well at the moment.","'Otherwise well' not documented."],["partial","Blood test: full blood count to look for anaemia.","Full blood count planned but anaemia purpose omitted."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo arranged but 1-2 week timing not stated."],["fabrication","Metoprolol","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["fabrication","Simvastatin","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"mb":28.523869,"latency":24.073,"finalised":582.4282631578948},{"label":"Run 2","wer":23.90717754991905,"text":"Hello?\nHello there.\nHello? Can you hear me okay? Yes, I can hear you. Okay, great. Are you Dr. I am, yes. Dr. Seed here, Oscar. How can I help you this afternoon?\nI'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about it? When did it all start?\nWell, it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome the last few days. Normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath. And I'm even starting to get a bit breathless just about the house. And it's got me kind of worried. Don't really know what's going on.\nOkay. Is there anything you're particularly worried about?\nWell, I've got heart failure. I was told that a while ago. And I got a bit breathless when I was first diagnosed and put on some medicine. That helped. But I'm a bit worried it's getting worse.\nRight. Okay. So you mentioned me feeling short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal exertion. You mentioned, have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing at all?\nI've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic,\nI'm feeling a little run down, but otherwise. Otherwise pretty normal.\nI've\nnoticed my ankles have Codeine bigger.\nOkay, what do you mean by that?\nIt's just like they've sort of swollen up a bit.\nOkay, is that both ankles? Both ankles?\nYeah, both ankles, yeah. It's a bit embarrassing.\nOkay, I can imagine. Yeah. And again over how long have you noticed this for? I\nkind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nI think my ankles did swell up a bit last time. The heart failure was a problem.\nOkay. Okay, fine. Okay, so just to really recap, so you really. The last couple of weeks you've been feeling breathless but worse. In the last couple. Couple of days you mentioned you had a bit of a dry cough.\nAnd some swelling in your ankles. But importantly, no chest pain. Have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\nNo, not really.\nOkay. And any temperatures or fevers?\nNo.\nOkay. And how about your appetite? Are you eating and drinking okay?\nYeah, that's fine.\nOkay. And your waterworks? Are you passing urine okay?\nYeah. Yeah, I usually pee a lot.\nYeah, sure. Okay. All right, fine. So moving on to your past medical history. You mentioned heart failure. Any other medical history I should be aware of?\nWell, I was told I had, like. They called it, like, a small heart attack about five years ago. I had. I had, like, some chest pain, and they took me to hospital.\nOkay.\nAnd.\nAnd they. But then I just got better.\nOkay, when you say small heart attack, did they give you a name for what happened and a name of a diagnosis?\nI can't remember. They just called it something like that. A small heart attack.\nSmall heart attack. Okay. Was it like angina or.\nNo, they said it was like, more than angina. Okay. But I didn't. But I only had to stay in hospital for a few days.\nOkay.\nYeah, I've been okay since then.\nYou've been okay since then. Okay. All right. So apart from the heart. The heart problems, the heart failure, any other problems I should be aware of?\nNo, I think I'm. Otherwise, I'm okay. Okay.\nDo you take any regular medications, apart from your diuretics that you're taking? Do you know which ones.\nYeah. I take something called Furosemide. And do you know which dose you're taking? I can't remember. I'm sorry, Doctor.\nI have\nto check.\nNo problems. Any other medications?\nYeah, I take Aspirin.\nOkay.\nAnd zoprolol. That\nMetoprolol was this. Sorry, the connection is not very good. Okay. Thank you. Yep. Simvastatin, Simonsatin. Okay. All right. Any allergies at all to any medications? No. No allergies. Okay. Is\nthere anything in the family\nthat's important for me to know? Any family history of medical problems? Heart problems, lung problems?\nMy father died of a heart attack.\nI'm sorry to hear that. How old was your father when he passed away?\nHe was early 60s. Okay.\nAnything else I should be aware of?\nMy mother had osteoporosis.\nOkay. Is your mother still with us? Yes, she's still living. Alright. And socially, sir? Just tell me a bit more about your situation at home. Who lives at home with you?\nI live on my own. Alright. Got two cats.\nYou got two cats? Okay, great.\nDo they have names? They're my family. They're called Polly and\nTim. Okay, so this is you and your cats. And in terms of day to day, are you working at the moment?\nI work part time as a lorry driver.\nOkay. And how is that? Is that\nquite stressful? Long hours? It's okay. Yeah. Like when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't. If I get more sick, then I won't be able to work properly.\nYeah. There's certainly a consideration, isn't there? So let's try and get you better soon. So it doesn't have any impact on your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\nOh, no, I only take shifts during the day. I don't like working at night.\nOkay. All right. And what about smoking and alcohol? Because they can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day.\nBack in the day. And how many years was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what about alcohol?\nI don't drink alcohol.\nOkay. Do you do much in the way of exercise, sir?\nI try and walk to the shops least once a day, but that's about it. Yeah. I don't go running like I used to when I was young.\nRight. And certainly now with your symptoms, you said you're getting more breakfast even walking to the shop. She said. Right. Based on your, based on your history and having listened to your story, I wonder whether you've had a flare up of your heart failure, sir, which can sometimes happen. What's going on.\nIt seems like your heart's not pumping as well as it should be. And obviously, having diagnosed with heart failure, there's obviously the first thing that comes to my mind. Now, there's a couple of options to move forward given that you otherwise well at the moment. And having examined you, your chest and your saturations and blood pressure all okay. I'm quite happy to increase your dose of Furosemide. Maybe rather than one tablet a day, we can give you two tablets a day for the first few days and see how you're getting on. Okay. Do you think that would be better? I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan. It's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good. Sorry.\nYeah, I remember now. Okay, fine. That's something I can organize for you today. And they may take a week or two weeks for that to be organized, but I think certainly in the Memantine let's get a blood test done. We can check your full blood, can look for signs of anemia, we can have a check your Codeine function, and we can definitely increase your Furosemide to one tablet twice a day. But I really would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable? I think that sounds like a good plan. And of course, in the Memantine if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, send. I want you to give me a call sooner than that and we can have a chat on the phone as well. Okay? I'll see how I get on. Okay. Do you have any questions for me? That's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day, okay? Thank you.","marks":[[83,94,".",false],[106,114,"Nice to see you",false],[161,161,"Are you the doctor Um",false],[382,382,"Um now",false],[431,431,"Uh I kind of",false],[553,557,"really",false],[750,750,"I've uh I've",false],[964,966,"you're",false],[991,995,"for",false],[1057,1060,"it's",false],[1135,1135,"minimal",false],[1322,1322,"coughing",false],[1499,1507,"run-down um",false],[1577,1584,"got a bit",true],[1640,1647,"it's",false],[1693,1712,"Kind of . Um",false],[1764,1768,"Both ankles OK. Uh",false],[1814,1814,"has this",false],[1882,1886,"Past",false],[2094,2097,"you're",false],[2185,2192,"",false],[2286,2301,"Um reporting",false],[2317,2317,"Um and and have you had any have you any",false],[2535,2535,"I I'm",false],[2637,2637,"ever since the drugs .",false],[2650,2665,"OK. Alright. Um",false],[2676,2688,"your uh",false],[2748,2748,"any",false],[2942,2944,"into",false],[3004,3008,"OK. And when",false],[3160,3160,"a uh something",false],[3194,3219,"It's more hard to say. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Note captures shortness of breath."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","Note captures gradual worsening over couple of weeks."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","Note captures worse in last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","'minimal exertion such as walking to the shops' but not previous normal tolerance or needing to sit down."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Note captures breathless around the house."],["The note captures: Concerned that his heart failure is getting worse.","no","Note does not document concern HF worsening."],["The note captures: No chest pain.","yes","Note captures no chest pain."],["The note captures: Has a mild dry cough that is not too troublesome.","partial","'dry cough' without noting it is mild/not troublesome."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","Note captures run-down, otherwise normal."],["The note captures: Swelling of both ankles.","yes","Note captures bilateral ankle swelling."],["The note captures: Ankle swelling noticed over the last few days.","yes","Note captures ankle swelling last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Note does not document ankles swelled in previous HF episode."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Note captures no palpitations."],["The note captures: No fevers or temperatures.","yes","Note captures no fever."],["The note captures: Eating and drinking normally (appetite fine).","yes","Note captures appetite normal."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","no","Note does not document urine OK, frequent since diuretic."],["The note captures: Known heart failure, diagnosed some time ago.","yes","Assessment 'acute decompensation of chronic heart failure' implies known HF."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Note does not document breathless at HF diagnosis, improved with meds."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Note does not document small heart attack ~5 years ago."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Note does not document presented with chest pain, admitted."],["The note captures: Has been well since the heart attack.","no","Note does not document well since heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Note does not document previous echo."],["The note captures: No other past medical history apart from the heart problems.","no","Note does not document no other PMH."],["The note captures: Takes furosemide (diuretic).","yes","Note captures takes furosemide."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'Furosemide (dose not recalled)' without current one-tablet-daily dose."],["The note captures: Takes aspirin.","yes","Note captures aspirin."],["The note captures: Takes bisoprolol.","no","Lists 'Metoprolol' instead of bisoprolol; wrong medication."],["The note captures: No known drug allergies.","no","Note does not document NKDA."],["The note captures: Father died of a heart attack.","no","Note does not document father died of heart attack."],["The note captures: Father was in his early sixties when he died.","no","Note does not document father early sixties."],["The note captures: Mother has osteoporosis.","no","Note does not document mother osteoporosis."],["The note captures: Lives alone.","no","Note does not document lives alone."],["The note captures: Works part-time as a lorry driver.","no","Note does not document part-time lorry driver."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Note does not document work exhausting, worried about work."],["The note captures: Ex-smoker.","no","Note does not document ex-smoker."],["The note captures: Smoked about a pack a day.","no","Note does not document pack a day."],["The note captures: Smoked for about 25 years.","no","Note does not document 25 years."],["The note captures: Does not drink alcohol.","no","Note does not document no alcohol."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Note does not document walks to shops daily."],["The note captures: Chest examination OK.","yes","Note captures chest exam OK."],["The note captures: Oxygen saturations OK.","yes","Note captures saturations OK."],["The note captures: Blood pressure OK.","yes","Note captures BP OK."],["The note captures: Otherwise well at the moment.","no","Note does not document otherwise well at moment."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","Note captures possible HF flare-up."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Note captures furosemide to two tablets/day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","Note captures for first few days then review."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'full blood count' without anaemia purpose."],["The note captures: Blood test: kidney function.","yes","Note captures kidney function."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","Note captures echo to assess pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo arranged but no 1-2 week timeframe."],["The note captures: Follow-up review in about one week.","yes","Note captures follow-up ~1 week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Note captures safety-net worse/more breathless."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Note captures safety-net chest pain/palpitations/dizziness."]],"claims":[["Metoprolol.","Patient confirmed bisoprolol, correcting the doctor's query about metoprolol."],["Simvastatin.","Simvastatin is never mentioned in the transcript."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports increased shortness of breath over the past few weeks, worsening in the last few days.\n\nHistory of Presenting Complaint::\n\nThe dyspnoea began gradually about two weeks ago and has become more troublesome over the last few days, occurring with minimal exertion such as walking to the shops or around the house. The patient also notes a dry cough and bilateral ankle swelling that started in the past few days. No chest pain, palpitations, fever, or change in appetite were reported.\n\nObjective\n\nChest examination was normal.\n\nOxygen saturation was within normal limits.\n\nBlood pressure was within normal range.\n\nNot discussed\n\nAssessment\n\nLikely acute decompensation of chronic heart failure.\n\nPlan\n\nMedications::\n\nFurosemide (dose not recalled).\n\nAspirin.\n\nMetoprolol.\n\nSimvastatin.\n\nIncrease Furosemide to two tablets daily for the first few days.\n\nArrange full blood count and renal function tests.\n\nArrange an echocardiogram to assess cardiac function.\n\nReview in approximately one week to assess response.\n\nPatient advised to contact the clinic sooner if symptoms worsen, such as increased breathlessness, chest pain, palpitations, or dizziness.","review":547.4473684210526,"saved":-61.4473684210526,"faster":-12.643491444661029,"clean":false,"effort":52.83018867924528,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","'minimal exertion such as walking to the shops' but not previous normal tolerance or needing to sit down."],["missing","Concerned that his heart failure is getting worse.","Note does not document concern HF worsening."],["partial","Has a mild dry cough that is not too troublesome.","'dry cough' without noting it is mild/not troublesome."],["missing","Ankles also swelled previously when his heart failure was a problem.","Note does not document ankles swelled in previous HF episode."],["missing","Passing urine OK, but urinates a lot since starting his medication (diuretic).","Note does not document urine OK, frequent since diuretic."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Note does not document breathless at HF diagnosis, improved with meds."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Note does not document small heart attack ~5 years ago."],["missing","That episode presented with chest pain and he was admitted to hospital.","Note does not document presented with chest pain, admitted."],["missing","Has been well since the heart attack.","Note does not document well since heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Note does not document previous echo."],["missing","No other past medical history apart from the heart problems.","Note does not document no other PMH."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'Furosemide (dose not recalled)' without current one-tablet-daily dose."],["missing","Takes bisoprolol.","Lists 'Metoprolol' instead of bisoprolol; wrong medication."],["missing","No known drug allergies.","Note does not document NKDA."],["missing","Father died of a heart attack.","Note does not document father died of heart attack."],["missing","Father was in his early sixties when he died.","Note does not document father early sixties."],["missing","Mother has osteoporosis.","Note does not document mother osteoporosis."],["missing","Lives alone.","Note does not document lives alone."],["missing","Works part-time as a lorry driver.","Note does not document part-time lorry driver."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Note does not document work exhausting, worried about work."],["missing","Ex-smoker.","Note does not document ex-smoker."],["missing","Smoked about a pack a day.","Note does not document pack a day."],["missing","Smoked for about 25 years.","Note does not document 25 years."],["missing","Does not drink alcohol.","Note does not document no alcohol."],["missing","Usual exercise is walking to the shops at least once a day.","Note does not document walks to shops daily."],["missing","Otherwise well at the moment.","Note does not document otherwise well at moment."],["partial","Blood test: full blood count to look for anaemia.","'full blood count' without anaemia purpose."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo arranged but no 1-2 week timeframe."],["fabrication","Metoprolol.","Patient confirmed bisoprolol, correcting the doctor's query about metoprolol."],["fabrication","Simvastatin.","Simvastatin is never mentioned in the transcript."]],"mb":29.701049,"latency":24.037,"finalised":571.4843684210526},{"label":"Run 3","wer":23.853211009174313,"text":"Hello?\nHello? Hello? Can you hear me okay?\nYes, I can hear you. Okay, great. I am. Yes, Dr. Stewd here. Oscar. How can I help you this afternoon?\nI'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about it? When did it all start?\nWell, it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome the last few days. Normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath, and I'm even starting to get a bit breathless just about the house, and it's got me kind of worried. Don't really know what's going on.\nOkay. Is there anything you're particularly worried about?\nWell, I've got heart failure. I was told that a while ago. And I got a bit breathless when I was first diagnosed and put on some medicine. That helped. But I'm a bit worried it's getting worse.\nRight. Okay. So you mentioned being short of breath for the last couple of weeks, but mainly the last couple of days has got a bit worse and you're now feeling more breathless on kind of minimal exertion. You mentioned, have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing at all?\nI've got a bit of a dry cough, but it's not too troublesome.\nOkay. And how's your general health otherwise? Are you feeling weak, lethargic,\nI'm feeling a little run down, but otherwise. Otherwise pretty normal. I've noticed my ankles have got a bit bigger.\nOkay, and what do you mean by that?\nIt's just like they've sort of swollen up a bit.\nOkay, is that both ankles? Both ankles?\nYeah, both ankles, yeah. It's a bit embarrassing.\nOkay, I can imagine. Yeah. And again over. How long have you noticed this for? I kind of\nnoticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nI think my ankles did swell up a bit last time. The heart failure was a problem.\nOkay. Okay, fine. Okay, so just to really recap, so really in the last couple of weeks you've been feeling breathless but worse in the last couple of days you mentioned you had a bit of a dry cough.\nAnd some swelling in your ankles, but importantly, no chest pain. And have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\nNo, not really.\nOkay. And any temperatures or fevers?\nNo.\nOkay. And how about your appetite? Are you eating and drinking okay?\nYeah, that's fine.\nOkay. And your waterworks? Are you passing urine okay?\nYeah. Yeah, I usually pee a lot. Yeah,\nsure. Okay. All right, fine. So moving on to your past medical history. You mentioned heart failure. Any other medical history I should be aware of?\nWell, I was told I had, like. They called it, like, a small heart attack about five years ago. I. I had. I had, like, chest pain, and they took me to hospital.\nOkay.\nAnd.\nBut then I just got better. Okay,\nwhen you say small heart attack, did they give you a name for what happened? A name of a diagnosis?\nI can't remember. I just called it something like that. A small heart attack.\nSmall heart attack. Okay. Was it like, angina or.\nNo, they said it seemed it was, like, more than angina. Okay. But I didn't. But I only had to stay in hospital for a few days.\nOkay. And,\nyeah, I've been okay since then.\nYou've been okay since then. Okay. All right. So apart from the heart. The heart problems, the heart failure, any other problems I should be aware of?\nNo, I think I'm. Otherwise, I'm okay. Okay. Do you\ntake any\nregular\nmedications, apart from your diuretics that you're taking? Do you know which ones.\nYeah. I take something called Furosemide\nand pino. Which dose you're taking?\nI can't remember. I'm sorry, Doctor.\nI have to check. No problems. Any other medications?\nYeah, I take Aspirin.\nOkay.\nAnd Zoprolol.\nThat. Metoprolol was Bisoprolol Sorry, the connection is not very good. Okay. Thank you. Yep. Simvastatinvastatin. Okay. All right. Any allergies at all? So any medications? No. No allergies. Okay. Anything in the family that's.\nThat's\nimportant for me to know. Any family history of medical problems? Heart problems, lung problems?\nMy father died of a heart attack.\nI'm sorry to hear that. How old was your father when he passed away?\nHe was early 60s.\nOkay. Anything else I should be aware of?\nMy mother had osteoporosis.\nOkay.\nIs\nyour mother still with us? Yes, she's still living.\nOkay.\nAll right. And socially, sir? Just tell me a bit more about your situation at home. Who lives at home with you?\nI live on my own. I got two cats.\nYou got two cats? Okay, great.\nDo they have names? They're my family. They're called Holly and\nTim. Okay, so this is you and your cats. And in terms of day to day, are you working at the moment?\nI work part time as a lorry driver. Okay.\nHow is that? Is that quite\nstressful? Long hours? It's okay. Yeah. Like when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't. If I get more sick, then I won't be able to work properly.\nYeah, there's certainly a consideration, isn't there? So let's try and get you better soon so it doesn't have any impact on your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\nOh, no, I only take shifts during the day. I don't like working at night.\nOkay. All right. And what about smoking and alcohol? Because they can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day.\nBack in the day. And how many years was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what about alcohol?\nI don't drink alcohol. Okay.\nDo you do much in the way of exercise, sir?\nI try and walk to the shops least once a day, but that's about it. Yeah. I don't go running like I used to when I was young.\nRight. And certainly now with your symptoms, you said you're getting more breakfast even walking to the shop. She said. Right. Based on your, based on your history and having listened to your story, I wonder whether you've had a flare up of your heart failure, sir, which can sometimes happen. What's going on? So.\nIt seems like your heart's not pumping as well as it should be. And obviously having diagnosed with heart failure, there's obviously the first thing that comes to my mind. Now there's a couple of options to move forward given that you otherwise are well at the moment. And having examined you, your chest and your saturations and blood pressure all. Okay. I'm quite happy to increase your dose of Furosemide. Maybe rather than a one tablet day, we can give you two tablets day for the first few days and see. And see how you're getting on. Okay. Do you think that would be best? I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan. It's a jelly scan of your heart. You may have had this done before when you're diagnosed and it's just to get a good. Sorry.\nYeah, I remember now. Okay, fine. That's something I can organize for you today. And they may take a week or two weeks for that to be organized, but I think certainly in the Memantine let's get blood tests done. We can check your full blood, can look for signs of anemia, we can have a check your Codeine function, and we can definitely increase your Furosemide to one tablet twice a day. But I really would like you to come back and see me in about a week's time, See how you're getting on. Does that sound reasonable? I think that sounds like a good plan. And of course, in the Memantine if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know sen, I want you to give me a call sooner than that and we can have a chat on the phone as well. Okay? I'll see how I get on. Okay. Do you have any questions for me? That's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best. Have a good day.\nOkay, thank you.","marks":[[12,12,"there. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'increasing shortness of breath'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'over the past couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'worsening in the last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","'minimal exertion (e.g., walking to shop)' - prior ability and needing to sit down omitted."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'now on minimal exertion'."],["The note captures: Concerned that his heart failure is getting worse.","no","Concern about heart failure worsening not documented."],["The note captures: No chest pain.","yes","'No chest pain'."],["The note captures: Has a mild dry cough that is not too troublesome.","yes","'Dry cough, not troublesome'."],["The note captures: Feels a little run-down; otherwise feels generally normal.","partial","'otherwise well' but feeling run-down not captured."],["The note captures: Swelling of both ankles.","yes","'Bilateral ankle swelling'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'noted past few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","'No ... palpitations'."],["The note captures: No fevers or temperatures.","yes","'No ... fever'."],["The note captures: Eating and drinking normally (appetite fine).","yes","'No ... appetite change'."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","partial","'Increased urinary frequency' but not linked to medication nor stated as otherwise normal."],["The note captures: Known heart failure, diagnosed some time ago.","yes","'chronic heart failure'."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","yes","'MI ~5 yrs ago'."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Chest pain and admission not mentioned."],["The note captures: Has been well since the heart attack.","no","Not mentioned."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Not stated."],["The note captures: Takes furosemide (diuretic).","yes","'on furosemide'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","no","Current dose not recorded."],["The note captures: Takes aspirin.","yes","'aspirin'."],["The note captures: Takes bisoprolol.","partial","'beta-blocker (metoprolol/bisoprolol)' - hedged, does not clearly state bisoprolol."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","no","Family history not documented."],["The note captures: Father was in his early sixties when he died.","no","Not documented."],["The note captures: Mother has osteoporosis.","no","Not documented."],["The note captures: Lives alone.","yes","'Lives alone with two cats'."],["The note captures: Works part-time as a lorry driver.","yes","'part-time lorry driver'."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Work exhaustion/worry not documented."],["The note captures: Ex-smoker.","yes","'ex-smoker'."],["The note captures: Smoked about a pack a day.","yes","'1 pack/day'."],["The note captures: Smoked for about 25 years.","yes","'x 25 yrs'."],["The note captures: Does not drink alcohol.","yes","'no alcohol'."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual exercise not documented."],["The note captures: Chest examination OK.","yes","'Chest examination ... no abnormal findings reported'."],["The note captures: Oxygen saturations OK.","yes","'oxygen saturation ... no abnormal findings'."],["The note captures: Blood pressure OK.","yes","'blood pressure ... no abnormal findings'."],["The note captures: Otherwise well at the moment.","yes","'otherwise well'."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Likely acute decompensation of chronic heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase furosemide to 1 tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for several days'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'full blood count' ordered but anaemia purpose not stated."],["The note captures: Blood test: kidney function.","yes","'renal function labs'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to assess cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","'Arrange echocardiogram' but 1-2 week timeframe omitted."],["The note captures: Follow-up review in about one week.","yes","'Review in ~1 week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'earlier if worsening dyspnoea'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations or dizziness'."]],"claims":[["on ... simvastatin / Patient reports taking simvastatin","Simvastatin is never mentioned in the transcript."],["Patient reports taking a beta-blocker (metoprolol/bisoprolol)","Patient clarified the drug is bisoprolol; metoprolol was only the doctor's mishearing."],["Advise to seek urgent care if severe symptoms develop","Doctor only advised calling him sooner; urgent care was never mentioned."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports increasing shortness of breath over the past couple of weeks, worsening in the last few days.\n\nHistory of Presenting Complaint::\n\nSOB progressive over 2 weeks, worsened last few days, now on minimal exertion (e.g., walking to shop).\n\nDry cough, not troublesome.\n\nBilateral ankle swelling noted past few days.\n\nNo chest pain, palpitations, fever, appetite change.\n\nIncreased urinary frequency but otherwise well.\n\nPast hx: chronic heart failure, MI ~5 yrs ago, on furosemide, aspirin, beta‑blocker, simvastatin.\n\nLives alone with two cats, part‑time lorry driver, ex‑smoker (1 pack/day × 25 yrs, quit), no alcohol.\n\nObjective\n\nChest examination, oxygen saturation and blood pressure assessed; no abnormal findings reported.\n\nNot discussed\n\nAssessment\n\nLikely acute decompensation of chronic heart failure.\n\nPlan\n\nMedications::\n\nPatient reports taking furosemide.\n\nPatient reports taking aspirin.\n\nPatient reports taking a beta‑blocker (metoprolol/bisoprolol).\n\nPatient reports taking simvastatin.\n\nIncrease furosemide to 1 tablet twice daily for several days.\n\nOrder full blood count and renal function labs.\n\nArrange echocardiogram to assess cardiac function.\n\nReview in ~1 week; earlier if worsening dyspnoea, chest pain, palpitations or dizziness.\n\nAdvise to seek urgent care if severe symptoms develop.","review":450.88157894736844,"saved":35.11842105263156,"faster":7.226012562269868,"clean":false,"effort":39.62264150943396,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","'minimal exertion (e.g., walking to shop)' - prior ability and needing to sit down omitted."],["missing","Concerned that his heart failure is getting worse.","Concern about heart failure worsening not documented."],["partial","Feels a little run-down; otherwise feels generally normal.","'otherwise well' but feeling run-down not captured."],["missing","Ankles also swelled previously when his heart failure was a problem.","Not mentioned."],["partial","Passing urine OK, but urinates a lot since starting his medication (diuretic).","'Increased urinary frequency' but not linked to medication nor stated as otherwise normal."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Not recorded."],["missing","That episode presented with chest pain and he was admitted to hospital.","Chest pain and admission not mentioned."],["missing","Has been well since the heart attack.","Not mentioned."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Not mentioned."],["missing","No other past medical history apart from the heart problems.","Not stated."],["missing","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","Current dose not recorded."],["partial","Takes bisoprolol.","'beta-blocker (metoprolol/bisoprolol)' - hedged, does not clearly state bisoprolol."],["missing","No known drug allergies.","Allergies not documented."],["missing","Father died of a heart attack.","Family history not documented."],["missing","Father was in his early sixties when he died.","Not documented."],["missing","Mother has osteoporosis.","Not documented."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Work exhaustion/worry not documented."],["missing","Usual exercise is walking to the shops at least once a day.","Usual exercise not documented."],["partial","Blood test: full blood count to look for anaemia.","'full blood count' ordered but anaemia purpose not stated."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","'Arrange echocardiogram' but 1-2 week timeframe omitted."],["fabrication","on ... simvastatin / Patient reports taking simvastatin","Simvastatin is never mentioned in the transcript."],["fabrication","Patient reports taking a beta-blocker (metoprolol/bisoprolol)","Patient clarified the drug is bisoprolol; metoprolol was only the doctor's mishearing."],["fabrication","Advise to seek urgent care if severe symptoms develop","Doctor only advised calling him sooner; urgent care was never mentioned."]],"mb":28.700374,"latency":26.055,"finalised":476.93657894736845},{"label":"Run 4","wer":23.691311386940097,"text":"Hello?\nHello there.\nHello? Can you hear me okay? Yes, I can hear you. Okay, great. Are you Dr. I am, yes. Dr. Sued here, Oscar. How can I help you this afternoon?\nI'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about it? When did it all start?\nWell, it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome in the last few days. Normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath. And I'm even starting to get a bit breathless just about the house. And it's got me kind of worried. Don't really know what's going on.\nOkay. Is there anything you're particularly worried about.\nWell, I've got heart failure. I was told that a while ago. And I got a bit breathless when I was first diagnosed and put on some medicine. That helped. But I'm a bit worried it's getting worse.\nRight. Okay. So you mentioned me feeling short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal exertion. You mentioned, have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing at all?\nI've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic,\nI'm feeling a little run down, but otherwise. Otherwise pretty normal.\nI've\nnoticed my ankles have got bigger.\nOkay, what do you mean by that?\nIt's just like they've sort of swollen up a bit.\nOkay, is that both ankles? Both ankles?\nYeah. Both ankles, yeah. It's a bit embarrassing.\nOkay, I can imagine. Yeah. And again over. How long have you noticed this for?\nI kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nI think my ankles did swell up a bit last time. The heart failure was a problem.\nOkay. Okay, fine. Okay, so just to really recap, so you really. The last couple of weeks you've been feeling breathless but worse. In the last couple. Couple of days you mentioned you had a bit of a dry cough.\nAnd some swelling in your ankles. But importantly, no chest pain. Have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\nNo, not really.\nOkay. And any temperatures or fevers?\nNo.\nOkay. And how about your appetite? Are you eating and drinking okay?\nYeah, that's fine.\nOkay. And your waterworks? Are you passing urine okay?\nYeah. Yeah, I usually pee a lot. Yeah,\nsure. Okay. All right, fine. So moving on to your past medical history. You mentioned heart failure. Any other medical history I should be aware of?\nWell, I was told I had, like. They called it, like, a small heart attack about five years ago. I had. I had, like, chest pain, and they took me to hospital.\nOkay.\nAnd.\nAnd they. But then I just got better.\nOkay, when you say small heart attack, did they give you a name for what happened? A name of a diagnosis?\nI can't remember. They just called it something like that. A small heart attack.\nSmall heart attack. Okay. Was it like angina or.\nNo, they said it was like, more than angina. Okay. But I didn't. But I only had to stay in hospital for a few days.\nOkay. And,\nyeah, I've been okay since then.\nYou've been okay since then. Okay. All right. So apart from the heart. The heart problems, the heart failure, any other problems I should be aware of?\nNo, I think I'm. Otherwise, I'm okay. Okay.\nDo you take any regular medications, apart from your diuretics that you're taking? Do you know which ones.\nYeah. I take something called Furosemide. And do you know which dose you're taking? I can't remember. I'm sorry, Doctor. I have to check.\nNo problems. Any other medications?\nYeah, I take Aspirin.\nOkay.\nAnd Metoprolol.\nMetoprolol. Sorry, the connection is not very good. Okay, thank you. Yep. Simvastatin, Simvastatin. Okay. All right. Any allergies at all? Any medications? No, no allergies. Okay. Anything\nin the family?\nThat's important for me to know. Any family history of medical problems? Heart problems, lung problems?\nMy father died of a heart attack.\nI'm sorry to hear that. How old was your father when he passed away?\nHe was early 60s. Okay.\nAnything else I should be aware of?\nMy mother had osteoporosis.\nOkay. Is your mother still with us? Yes, she's still living. Alright. And socially, sir? Just tell me a bit more about your situation at home. Who lives at home with you?\nI live on my own. I got two cats.\nYou got two cats? Okay,\ngreat. Do they have names? They're my family. They're called Polly and Tim.\nOkay, so this is you and your cats. And in terms of day to day, are you working at the moment?\nI work part time as a lorry driver.\nOkay. And how is that?\nQuite stressful. Long hours? It's okay. I. Yeah, like when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't. If I get more sick, then I won't be able to work properly.\nYeah, there's certainly a consideration, isn't there? So let's try and get you better soon. So it doesn't have any impact on your. On your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\nOh, no, I only take shifts during the day. I don't like working at night.\nOkay. All right. And what about smoking and alcohol? Because they can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day.\nBack in the day. And how many years was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what about alcohol?\nI don't drink alcohol. Okay.\nDo you do much in the way of exercise, sir?\nI try and walk to the shops least once a day, but that's about it. Yeah, I don't. I don't go running like I used to when I was young.\nRight. And certainly now with your symptoms, you said you're feeling more breathless even walking to the shop. She said. Right. Based on your. Based on your history and having listened to your story, I wonder whether you've had a flare up of your heart failure, sir, which can sometimes happen. What's going on.\nIt seems like your heart's not pumping as well as it should be. And obviously, having diagnosed with heart failure, there's obviously the first thing that comes to my mind. Now, there's a couple of options to move forward, given that you're otherwise well at the moment. And having examined you, your chest and your saturations and blood pressure all. Okay. I'm quite happy to increase your dose of Furosemide. Maybe rather than one tablet day, we can give you two tablets a day for the first few days and see. And see how you're getting on. Okay. Do you think that would be best? I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan. It's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good. Sorry.\nYeah, I remember now. Okay, fine. That's something I can organize for you today. And they may take a week or two weeks for that to be organized, but I think certainly in the Memantine let's get a blood test done. We can check your full blood, can look for signs of anemia, we can have a check your Codeine function and we can definitely increase your Furosemide to one tablet twice a day. But I really would like you to come back and see me in about weeks time to see how you're getting on. That sound reasonable? I think that sounds like a good plan. And of course, in the Memantine if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then you know sen, I want you to give me a call sooner than that and we can have a chat on the phone as well. Okay? I'll see how I get on. Okay. Do you have any questions for me? That's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day, okay? 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","'increased shortness of breath'."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'slowly getting worse over the last couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","'quite troublesome in the last few days'."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","'minimal exertion such as walking to the shops' - prior ability and needing to sit down omitted."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","'now occurring with minimal exertion'."],["The note captures: Concerned that his heart failure is getting worse.","no","Concern about heart failure worsening not documented."],["The note captures: No chest pain.","no","Absence of chest pain not documented."],["The note captures: Has a mild dry cough that is not too troublesome.","partial","'a dry cough' without noting it is mild/not troublesome."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'feeling a little run down'."],["The note captures: Swelling of both ankles.","yes","'swelling of both ankles'."],["The note captures: Ankle swelling noticed over the last few days.","yes","'started in the last few days'."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","no","Not documented."],["The note captures: No fevers or temperatures.","no","Not documented."],["The note captures: Eating and drinking normally (appetite fine).","no","Not documented."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","no","Not documented."],["The note captures: Known heart failure, diagnosed some time ago.","partial","Only implied by 'decompensation of chronic heart failure'; known history not stated."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Not recorded."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Previous heart attack not mentioned."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Not mentioned."],["The note captures: Has been well since the heart attack.","no","Not mentioned."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Not stated."],["The note captures: Takes furosemide (diuretic).","yes","'Furosemide'."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose not specified' but current one tablet a day not recorded."],["The note captures: Takes aspirin.","yes","'Aspirin'."],["The note captures: Takes bisoprolol.","no","Lists 'Metoprolol' instead of bisoprolol - wrong medication."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","no","Family history not documented."],["The note captures: Father was in his early sixties when he died.","no","Not documented."],["The note captures: Mother has osteoporosis.","no","Not documented."],["The note captures: Lives alone.","no","Social history not documented."],["The note captures: Works part-time as a lorry driver.","no","Not documented."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Not documented."],["The note captures: Ex-smoker.","no","Not documented."],["The note captures: Smoked about a pack a day.","no","Not documented."],["The note captures: Smoked for about 25 years.","no","Not documented."],["The note captures: Does not drink alcohol.","no","Not documented."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Not documented."],["The note captures: Chest examination OK.","partial","'Chest examined' but not recorded as OK."],["The note captures: Oxygen saturations OK.","partial","'oxygen saturation ... measured (values not documented)' - not recorded as OK."],["The note captures: Blood pressure OK.","partial","'blood pressure measured' - not recorded as OK."],["The note captures: Otherwise well at the moment.","no","Not stated."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'likely acute decompensation of chronic heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","'Increase Furosemide to one tablet twice daily'."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the first few days and reassess response'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","'full blood count' without anaemia purpose."],["The note captures: Blood test: kidney function.","yes","'renal function'."],["The note captures: Echocardiogram to assess how well the heart is pumping.","yes","'echocardiogram to evaluate cardiac function'."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","'Arrange ... echocardiogram' but 1-2 week timeframe omitted."],["The note captures: Follow-up review in about one week.","yes","'Follow up in about a week'."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","'contact the doctor sooner if breathlessness worsens'."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","'chest pain, palpitations or dizziness develop'."]],"claims":[["Metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["Simvastatin","Simvastatin is never mentioned in the transcript."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports increased shortness of breath over the past few weeks, worsening in the last few days.\n\nHistory of Presenting Complaint::\n\nThe shortness of breath has been slowly getting worse over the last couple of weeks and has become quite troublesome in the last few days, now occurring with minimal exertion such as walking to the shops. The patient also notes a dry cough, feeling a little run down, and swelling of both ankles that started in the last few days.\n\nObjective\n\nChest examined; oxygen saturation and blood pressure measured (values not documented).\n\nNot discussed\n\nAssessment\n\nAssessment: likely acute decompensation of chronic heart failure.\n\nPlan\n\nMedications::\n\nFurosemide (dose not specified)\n\nAspirin\n\nMetoprolol\n\nSimvastatin\n\nIncrease Furosemide to one tablet twice daily for the first few days and reassess response.\n\nArrange blood tests (full blood count, renal function) and an echocardiogram to evaluate cardiac function.\n\nFollow up in about a week to review symptoms and response to medication, with instructions to contact the doctor sooner if breathlessness worsens, chest pain, palpitations or dizziness develop.","review":628.2631578947369,"saved":-142.26315789473688,"faster":-29.272254710851207,"clean":false,"effort":64.15094339622641,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","'minimal exertion such as walking to the shops' - prior ability and needing to sit down omitted."],["missing","Concerned that his heart failure is getting worse.","Concern about heart failure worsening not documented."],["missing","No chest pain.","Absence of chest pain not documented."],["partial","Has a mild dry cough that is not too troublesome.","'a dry cough' without noting it is mild/not troublesome."],["missing","Ankles also swelled previously when his heart failure was a problem.","Not mentioned."],["missing","No palpitations or racing/skipped heartbeat.","Not documented."],["missing","No fevers or temperatures.","Not documented."],["missing","Eating and drinking normally (appetite fine).","Not documented."],["missing","Passing urine OK, but urinates a lot since starting his medication (diuretic).","Not documented."],["partial","Known heart failure, diagnosed some time ago.","Only implied by 'decompensation of chronic heart failure'; known history not stated."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Not recorded."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Previous heart attack not mentioned."],["missing","That episode presented with chest pain and he was admitted to hospital.","Not mentioned."],["missing","Has been well since the heart attack.","Not mentioned."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Not mentioned."],["missing","No other past medical history apart from the heart problems.","Not stated."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose not specified' but current one tablet a day not recorded."],["missing","Takes bisoprolol.","Lists 'Metoprolol' instead of bisoprolol - wrong medication."],["missing","No known drug allergies.","Allergies not documented."],["missing","Father died of a heart attack.","Family history not documented."],["missing","Father was in his early sixties when he died.","Not documented."],["missing","Mother has osteoporosis.","Not documented."],["missing","Lives alone.","Social history not documented."],["missing","Works part-time as a lorry driver.","Not documented."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Not documented."],["missing","Ex-smoker.","Not documented."],["missing","Smoked about a pack a day.","Not documented."],["missing","Smoked for about 25 years.","Not documented."],["missing","Does not drink alcohol.","Not documented."],["missing","Usual exercise is walking to the shops at least once a day.","Not documented."],["partial","Chest examination OK.","'Chest examined' but not recorded as OK."],["partial","Oxygen saturations OK.","'oxygen saturation ... measured (values not documented)' - not recorded as OK."],["partial","Blood pressure OK.","'blood pressure measured' - not recorded as OK."],["missing","Otherwise well at the moment.","Not stated."],["partial","Blood test: full blood count to look for anaemia.","'full blood count' without anaemia purpose."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","'Arrange ... echocardiogram' but 1-2 week timeframe omitted."],["fabrication","Metoprolol","Patient corrected the doctor and said bisoprolol, not metoprolol."],["fabrication","Simvastatin","Simvastatin is never mentioned in the transcript."]],"mb":34.698123,"latency":28.091,"finalised":656.3541578947369},{"label":"Run 5","wer":23.853211009174313,"text":"Hello?\nHello there.\nHello? Can you hear me okay? Yes, I can hear you. Okay, great. Are you Dr. I am, yes. Dr. Seed here, Oscar. How can I help you this afternoon?\nI'm contacting you because I've been quite short of breath lately.\nOkay. Do you want to tell me a bit more about it? When did it all start?\nWell, it seems to have been slowly getting worse over the last couple of weeks. It's become quite troublesome the last few days. Normally, I can walk to the shops without a problem, but now I'm having to sort of sit down and catch my breath. And I'm even starting to get a bit breathless just about the house. And it's got me kind of worried. Don't really know what's going on.\nOkay. Is there anything you're particularly worried about?\nWell, I've got heart failure. I was told that a while ago. And I got a bit breathless when I was first diagnosed and put on some medicine. That helped. But I'm a bit worried it's getting worse.\nRight. Okay. So you mentioned me feeling short of breath over the last couple of weeks, but mainly the last couple of days has got a bit worse. And you're now feeling more breathless on kind of minimal exertion. You mentioned, have you noticed any other symptoms at all with your breath? So, for example, any pain in your chest?\nNo pain in my chest.\nOkay. Have you found yourself coughing at all?\nI've got a bit of a dry cough, but it's not too troublesome.\nOkay. Okay. And how's your general health otherwise? Are you feeling weak, lethargic,\nI'm feeling a little run down, but otherwise. Otherwise pretty normal.\nI've\nnoticed my ankles have Codeine bigger.\nOkay, what do you mean by that?\nIt's just like they've sort of swollen up a bit.\nOkay, is that both ankles? Both ankles?\nYeah, both ankles, yeah. It's a bit embarrassing.\nOkay, I can imagine. Yeah. And again over how long have you noticed this for?\nI kind of noticed it the last few days.\nLast few days. Okay. And is this something that you've had before in the past?\nI think my ankles did swell up a bit last time. The heart failure was a problem.\nOkay. Okay, fine. Okay, so just to really recap, so you really. The last couple of weeks you've been feeling breathless but worse. In the last couple. Couple of days you mentioned you had a bit of a dry cough.\nAnd some swelling in your ankles. But importantly, no chest pain. Have you noticed your heartbeat racing at all? So, palpitations or skipped heartbeat?\nNo, not really.\nOkay. And any temperatures or fevers?\nNo.\nOkay. And how about your appetite? Are you eating and drinking okay?\nYeah, that's fine.\nOkay. And your waterworks? Are you passing urine okay?\nYeah. Yeah, I usually pee a lot.\nYeah, sure. Okay. All right, fine. So moving on to your past medical history. You mentioned heart failure. Any other medical history I should be aware of?\nWell, I was told I had, like. They called it, like, a small heart attack about five years ago. I. I had. I had, like, chest pain, and they took me to hospital.\nOkay.\nAnd.\nAnd they. But then I just got better.\nOkay, when you say small heart attack, did they give you a name for what happened and a name of a diagnosis?\nI can't remember. They just called it something like that. A small heart attack.\nSmall heart attack. Okay. Was it like angina or.\nNo, they said it was like, more than angina. Okay. But I didn't. But I only had to stay in hospital for a few days.\nOkay.\nYeah, I've been okay since then.\nYou've been okay since then. Okay. All right. So apart from the heart. The heart problems, the heart failure, any other problems I should be aware of?\nNo, I think I'm. Otherwise, I'm okay. Okay.\nDo you take any regular medications, apart from your diuretics that you're taking? Do you know which ones.\nYeah. I take something called Furosemide. And do you know which dose you're taking? I can't remember. I'm sorry, Doctor.\nI have\nto check.\nNo problems. Any other medications?\nYeah, I take Aspirin.\nOkay.\nAnd zoprolol. That\nMetoprolol was this. Sorry, the connection is not very good. Okay. Thank you. Yep. Simvastatin, Simonsatin. Okay. All right. Any allergies at all to any medications? No. No allergies. Okay. Is\nthere anything in the family\nthat's important for me to know? Any family history of medical problems? Heart problems, lung problems?\nMy father died of a heart attack.\nI'm sorry to hear that. How old was your father when he passed away?\nHe was early 60s. Okay.\nAnything else I should be aware of?\nMy mother had osteoporosis.\nOkay. Is your mother still with us? Yes, she's still living. Alright. And socially, sir? Just tell me a bit more about your situation at home. Who lives at home with you?\nI live on my own. Alright. I got two cats.\nYou got two cats? Okay, great.\nDo they have names? They're my family. They're called Polly and\nTim. Okay, so this is you and your cats. And in terms of day to day, are you working at the moment?\nI work part time as a lorry driver.\nOkay. And how is that? Is that quite\nstressful? Long hours? It's okay. Yeah. Like when I'm working, it's pretty exhausting. I guess I'm a bit worried that if I get sick, I won't. If I get more sick, then I won't be able to work properly.\nYeah. There's certainly a consideration, isn't there? So let's try and get you better soon. So it doesn't have any impact on your job. And do you find yourself doing a lot of antisocial hours? Do you do a lot of night driving, weekend driving?\nOh, no, I only take shifts during the day. I don't like working at night.\nOkay. All right. And what about smoking and alcohol? Because they can sometimes be very important when it comes to heart problems. Do you smoke at all? Not anymore. So you used to smoke? Yeah. How many did you smoke a day on average? Oh, it was about a pack a day.\nBack in the day. And how many years was that for? Oh, that was a good 25 years. Okay. Well done for stopping. It must be very difficult for you, but well done for stopping. And what about alcohol?\nI don't drink alcohol.\nOkay. Do you do much in the way of exercise, sir?\nI try and walk to the shops least once a day, but that's about it. Yeah. I don't go running like I used to when I was young.\nRight. And certainly now with your symptoms, you said you're getting more breakfast even walking to the shop. She said. Right. Based on your, based on your history and having listened to your story, I wonder whether you've had a flare up of your heart failure, sir, which can sometimes happen. What's going on.\nIt seems like your heart's not pumping as well as it should be. And obviously, having diagnosed with heart failure, there's obviously the first thing that comes to my mind. Now, there's a couple of options to move forward given that you otherwise well at the moment. And having examined you, your chest and your saturations and blood pressure all okay. I'm quite happy to increase your dose of Furosemide. Maybe rather than one tablet a day, we can give you two tablets a day for the first few days and see how you're getting on. Okay. Do you think that would be better? I think it's definitely worth treating your symptoms, but what we should also think about is maybe doing a couple of other tests, like a blood test and maybe an echocardiogram of your heart, see how well your heart's pumping. Okay. Is that something you've had? Yeah. So an echo scan. It's a jelly scan of your heart. You may have had this done before when you're diagnosed, and it's just to get a good. Sorry.\nYeah, I remember now. Okay, fine. That's something I can organize for you today. And they may take a week or two weeks for that to be organized, but I think certainly in the Memantine let's get a blood test done. We can check your full blood, can look for signs of anemia, we can have a check your Codeine function, and we can definitely increase your Furosemide to one tablet twice a day. But I really would like you to come back and see me in about a week's time, see how you're getting on. That sound reasonable? I think that sounds like a good plan. And of course, in the Memantine if you are getting more unwell, so if you're getting more breathless or you're having any other symptoms like chest pain or palpitations or dizziness, then, you know, send. I want you to give me a call sooner than that and we can have a chat on the phone as well. Okay? I'll see how I get on. Okay. Do you have any questions for me? That's all pretty clear. Thank you very much, doctor. Great. No, I wish you all the best.\nHave a good day, okay? Thank you.","marks":[[83,94,".",false],[106,114,"Nice to see you",false],[161,161,"Are you the doctor Um",false],[382,382,"Um now",false],[431,431,"Uh I kind of",false],[553,557,"really",false],[750,750,"I've uh I've",false],[964,966,"you're",false],[991,995,"for",false],[1057,1060,"it's",false],[1135,1135,"minimal",false],[1322,1322,"coughing",false],[1499,1507,"run-down um",false],[1577,1584,"got a bit",true],[1640,1647,"it's",false],[1693,1712,"Kind of . Um",false],[1764,1768,"Both ankles OK. Uh",false],[1814,1814,"has this",false],[1882,1886,"Past",false],[2094,2097,"you're",false],[2185,2192,"",false],[2286,2301,"Um reporting",false],[2317,2317,"Um and and have you had any have you any",false],[2535,2535,"I I'm",false],[2637,2637,"ever since the drugs .",false],[2650,2665,"OK. Alright. Um",false],[2676,2688,"your uh",false],[2748,2748,"any",false],[2909,2909,"some",false],[2940,2942,"into",false],[3002,3006,"OK. 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See you soon.",false]],"facts":[["The note captures: Presents with shortness of breath.","yes","Shortness of breath documented as the presenting complaint."],["The note captures: Breathlessness has been gradually worsening over the last couple of weeks.","yes","'SOB started gradually over the last couple of weeks'."],["The note captures: Breathlessness has become much more troublesome in the last few days.","yes","States marked worsening over the last few days."],["The note captures: Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","partial","Walking to shops cited as exertion but not previous normal tolerance or needing to sit down."],["The note captures: Now breathless just moving about the house (breathless on minimal exertion).","yes","Documents breathlessness around the house/minimal exertion."],["The note captures: Concerned that his heart failure is getting worse.","no","Concern about worsening heart failure not documented."],["The note captures: No chest pain.","yes","Chest pain denied."],["The note captures: Has a mild dry cough that is not too troublesome.","partial","'dry cough' without noting it is mild/not troublesome."],["The note captures: Feels a little run-down; otherwise feels generally normal.","yes","'feeling a little run down but otherwise normal'."],["The note captures: Swelling of both ankles.","yes","Bilateral ankle swelling documented."],["The note captures: Ankle swelling noticed over the last few days.","yes","Ankle swelling noted over last few days."],["The note captures: Ankles also swelled previously when his heart failure was a problem.","no","Previous ankle swelling not mentioned."],["The note captures: No palpitations or racing/skipped heartbeat.","yes","Palpitations denied."],["The note captures: No fevers or temperatures.","yes","Fever denied."],["The note captures: Eating and drinking normally (appetite fine).","no","Appetite not documented."],["The note captures: Passing urine OK, but urinates a lot since starting his medication (diuretic).","no","Urination not documented."],["The note captures: Known heart failure, diagnosed some time ago.","partial","Only implied via 'exacerbation of chronic heart failure'; no history documented."],["The note captures: Was breathless when heart failure was first diagnosed and this improved with medication.","no","Not documented."],["The note captures: Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","no","Previous heart attack not documented."],["The note captures: That episode presented with chest pain and he was admitted to hospital.","no","Not documented."],["The note captures: Has been well since the heart attack.","no","Does not record that he has been well since the heart attack."],["The note captures: Has had an echocardiogram before (around the time of heart failure diagnosis).","no","Previous echocardiogram not mentioned."],["The note captures: No other past medical history apart from the heart problems.","no","Does not state absence of other past medical history."],["The note captures: Takes furosemide (diuretic).","yes","Furosemide listed."],["The note captures: Current furosemide dose is one tablet a day; patient does not know the dose in mg.","partial","'dose unspecified' but baseline one tablet daily not stated."],["The note captures: Takes aspirin.","yes","Aspirin listed."],["The note captures: Takes bisoprolol.","no","Lists metoprolol instead of bisoprolol."],["The note captures: No known drug allergies.","no","Allergies not documented."],["The note captures: Father died of a heart attack.","no","Family history not documented."],["The note captures: Father was in his early sixties when he died.","no","Family history not documented."],["The note captures: Mother has osteoporosis.","no","Family history not documented."],["The note captures: Lives alone.","no","Social history not documented."],["The note captures: Works part-time as a lorry driver.","no","Occupation not documented."],["The note captures: Finds work exhausting and is worried that worsening illness will stop him working properly.","no","Not documented."],["The note captures: Ex-smoker.","no","Smoking history not documented."],["The note captures: Smoked about a pack a day.","no","Smoking history not documented."],["The note captures: Smoked for about 25 years.","no","Smoking history not documented."],["The note captures: Does not drink alcohol.","no","Alcohol not documented."],["The note captures: Usual exercise is walking to the shops at least once a day.","no","Usual exercise not documented."],["The note captures: Chest examination OK.","yes","'Chest examination unremarkable'."],["The note captures: Oxygen saturations OK.","yes","'Oxygen saturation within normal limits'."],["The note captures: Blood pressure OK.","yes","'Blood pressure within normal limits'."],["The note captures: Otherwise well at the moment.","yes","'otherwise normal'."],["The note captures: Possible flare-up (exacerbation) of heart failure, with the heart not pumping as well as it should.","yes","'Possible exacerbation of chronic heart failure'."],["The note captures: Increase furosemide from one tablet a day to two tablets a day (one tablet twice a day).","yes","Furosemide increased to one tablet twice daily / two tablets a day."],["The note captures: Increased furosemide dose for the first few days, then see how he gets on.","yes","'for the initial few days'."],["The note captures: Blood test: full blood count to look for anaemia.","partial","Full blood count ordered but anaemia purpose omitted."],["The note captures: Blood test: kidney function.","yes","Renal/kidney function blood test planned."],["The note captures: Echocardiogram to assess how well the heart is pumping.","partial","'Arrange echocardiogram of the heart' without purpose of assessing pumping."],["The note captures: Echocardiogram to be requested today; may take one to two weeks to be arranged.","partial","Echo arranged but 1-2 week timing not stated."],["The note captures: Follow-up review in about one week.","yes","Review in about one week."],["The note captures: Safety-net: call sooner if more unwell or more breathless.","yes","Advised to call sooner if breathlessness worsens/symptoms worsen."],["The note captures: Safety-net: call sooner if chest pain, palpitations or dizziness develop.","yes","Safety-net lists chest pain, palpitations and dizziness."]],"claims":[["increased shortness of breath over the past few weeks","Patient said it has been worsening over the last couple of weeks."],["Metoprolol.","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["Simvastatin.","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports increased shortness of breath over the past few weeks, worsening in the last few days.\n\nHistory of Presenting Complaint::\n\nSOB started gradually over the last couple of weeks, now occurs with minimal exertion (e.g., walking to shops, around house).\n\nAssociated dry cough and bilateral ankle swelling noted in the last few days.\n\nDenies chest pain, palpitations, fever, or temperature changes.\n\nReports feeling a little run down but otherwise normal.\n\nObjective\n\nChest examination unremarkable.\n\nOxygen saturation within normal limits.\n\nBlood pressure within normal limits.\n\nNot discussed\n\nAssessment\n\nPossible exacerbation of chronic heart failure.\n\nPlan\n\nMedications::\n\nFurosemide (dose unspecified).\n\nAspirin.\n\nMetoprolol.\n\nSimvastatin.\n\nIncrease furosemide to two tablets daily for the initial few days.\n\nOrder full blood count and renal function tests.\n\nArrange echocardiogram of the heart.\n\nReview in one week, or sooner if symptoms worsen (increased breathlessness, chest pain, palpitations, dizziness).","review":573.7894736842105,"saved":-87.78947368421052,"faster":-18.06367771280052,"clean":false,"effort":57.54716981132076,"sig":[["partial","Previously walked to the shops without difficulty; now has to sit down to catch his breath on the way.","Walking to shops cited as exertion but not previous normal tolerance or needing to sit down."],["missing","Concerned that his heart failure is getting worse.","Concern about worsening heart failure not documented."],["partial","Has a mild dry cough that is not too troublesome.","'dry cough' without noting it is mild/not troublesome."],["missing","Ankles also swelled previously when his heart failure was a problem.","Previous ankle swelling not mentioned."],["missing","Eating and drinking normally (appetite fine).","Appetite not documented."],["missing","Passing urine OK, but urinates a lot since starting his medication (diuretic).","Urination not documented."],["partial","Known heart failure, diagnosed some time ago.","Only implied via 'exacerbation of chronic heart failure'; no history documented."],["missing","Was breathless when heart failure was first diagnosed and this improved with medication.","Not documented."],["missing","Had a 'small heart attack' about five years ago (told it was more than angina; exact diagnosis not recalled).","Previous heart attack not documented."],["missing","That episode presented with chest pain and he was admitted to hospital.","Not documented."],["missing","Has been well since the heart attack.","Does not record that he has been well since the heart attack."],["missing","Has had an echocardiogram before (around the time of heart failure diagnosis).","Previous echocardiogram not mentioned."],["missing","No other past medical history apart from the heart problems.","Does not state absence of other past medical history."],["partial","Current furosemide dose is one tablet a day; patient does not know the dose in mg.","'dose unspecified' but baseline one tablet daily not stated."],["missing","Takes bisoprolol.","Lists metoprolol instead of bisoprolol."],["missing","No known drug allergies.","Allergies not documented."],["missing","Father died of a heart attack.","Family history not documented."],["missing","Father was in his early sixties when he died.","Family history not documented."],["missing","Mother has osteoporosis.","Family history not documented."],["missing","Lives alone.","Social history not documented."],["missing","Works part-time as a lorry driver.","Occupation not documented."],["missing","Finds work exhausting and is worried that worsening illness will stop him working properly.","Not documented."],["missing","Ex-smoker.","Smoking history not documented."],["missing","Smoked about a pack a day.","Smoking history not documented."],["missing","Smoked for about 25 years.","Smoking history not documented."],["missing","Does not drink alcohol.","Alcohol not documented."],["missing","Usual exercise is walking to the shops at least once a day.","Usual exercise not documented."],["partial","Blood test: full blood count to look for anaemia.","Full blood count ordered but anaemia purpose omitted."],["partial","Echocardiogram to assess how well the heart is pumping.","'Arrange echocardiogram of the heart' without purpose of assessing pumping."],["partial","Echocardiogram to be requested today; may take one to two weeks to be arranged.","Echo arranged but 1-2 week timing not stated."],["fabrication","increased shortness of breath over the past few weeks","Patient said it has been worsening over the last couple of weeks."],["fabrication","Metoprolol.","Patient corrected the doctor's 'Metoprolol?' and confirmed he takes bisoprolol."],["fabrication","Simvastatin.","Simvastatin is never mentioned in the transcript; patient lists only furosemide, aspirin and bisoprolol."]],"mb":28.734345,"latency":23.099,"finalised":596.8884736842106}]}}