{"reference":"Hi there. Good morning. I'm Doctor from GP at Hand. Nice to see you.\n\n Hi.\n\n OK. So, um, before we start your appointment. Could I confirm your full name and date of birth please?\n\n Yeah, it's John Smith, and I am thirty two years old.\n\n Sorry, I didn't catch your date of birth.\n\n I'm thirty two years old.\n\n Thirty two years old, OK. Could you tell me the first line of your address, and your postcode please?\n\n It's four Park Avenue, and it's AB one CB two.\n\n That's great, thank you so much for that. Are you in a private place where you're OK to speak at the moment?\n\n Yes.\n\n OK. So how can I help you today? You've been having some problems with your asthma. Is that right?\n\n Sorry, say that .\n\n How can I help you today?\n\n So, um, I've been experiencing very weird symptoms, over the past month or so.\n\n And I don't know what's causing them. I have googled it and, um, nothing's coming up, so I thought I'd come and speak to you about it.\n\n OK.\n\n OK. So, tell me a bit more about these weird symptoms you've been having.\n\n So, it started with, feeling very tired, but for a couple of days, and then I get back to normal.\n\n And then I started losing feeling, in my hands and arms. I get a weird sensation like, uh, I guess, pins and needles.\n\n Right again, the connection's not so great. You've been getting pins and needles in the hand. Is that right?\n\n And.\n\n Yeah, that's correct.\n\n OK. Is that the right or left hand?\n\n My right hand.\n\n Is it always the right?\n\n Yes.\n\n OK. Um, we've lost video now, maybe is there a, a, a button you can press?\n\n OK.\n\n Are you happy for us to carry on without the video? I can't see you at the moment.\n\n Yes, that's fine.\n\n All right. Um, so, you've been having these pins and needles, and episodes of numbness, in the right hand. Is it just the hand, or does it go up the arm as well?\n\n Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts few days and then goes back to normal. So, it's very weird.\n\n Right, OK. Um, is there any involvement of your leg at all?\n\n Uh, my, colleague said, I'm walking slightly differently to normal.\n\n And again, it's only for three days, or three or four days.\n\n OK. You, you said you've been having weird symptoms for about a month.\n\n Yes.\n\n , so, what has been happening from the beginning of the month? What else has been happening?\n\n Um, I generally feel tired, and weak.\n\n And, sometimes I feel nauseous, and I don't feel like I want to do anything.\n\n Right, OK.\n\n Um, and, um.\n\n You know, , your colleague said you've, you've not been walking normally.\n\n Yes.\n\n Do you feel anything different, on either side, in terms of your legs? Can , have you noticed anything different?\n\n Yeah, so, at the same time I get my arm symptoms, my leg feels weaker.\n\n Right, OK.\n\n And.\n\n You know you, the abnormal gait. Has that been present, outside of these episodes?\n\n No, it has not. So normally, I'm, fit and well actually.\n\n Right, .\n\n All right, OK. Um, and, these, these episodes. How often have they been happening?\n\n They have been getting more regular. So at the start, it would be maybe once a week, uh, to every once , once a month, but now it's getting uh, uh, a couple of times a day.\n\n Right, OK. And, how long have these episodes been going on for? When, when did it all start? Was it a month ago?\n\n , probably a month and a half, maybe two months.\n\n Right, OK.\n\n OK. And, along with these symptoms, of the weakness and numbness. Do you have any other symptoms at the same time? Like swallowing, or difficulty speaking, or vision problems?\n\n So, recently I've noticed, I can't hold my cup of coffee.\n\n And when I, do drink coffee, it's slightly harder to drink.\n\n And that's only been in the last couple of days, I guess.\n\n Right. Is that during these episodes, or outside of these episodes?\n\n Only during the episodes.\n\n OK.\n\n Do you have any difficulty swallowing at all?\n\n Not currently, no.\n\n . During the episodes, do you have any difficulty swallowing?\n\n I, I, I feel like there's something in my throat.\n\n OK. What about, um, difficulty speaking during these episodes? Any, any issues with that at all?\n\n No, I can speak fine.\n\n OK. And any visual problems during these episodes?\n\n I, I don't think so, but I wear glasses.\n\n OK, all right. Now um, can I just ask? , has, uh, is there any history of stroke, or mini-strokes in your family?\n\n Uh, yes. My, father has had a, operation to the side of his neck, to reduce the risk of stroke.\n\n Right, OK.\n\n Um, and, uh, how about yourself? Have you had any history of, mini-strokes or anything like that, along those lines? I know you're quite young.\n\n No, so after my, dad had his operation, I was required to be checked, and my cholesterol , was fine.\n\n Good, excellent. So you had a, a blood test done. And did they check for diabetes as well?\n\n Yeah.\n\n They checked my diabetes, my blood pressure and my, cholesterol, and the doctor said it was all OK.\n\n Fantastic, OK. Now, do you have any other illnesses at all?\n\n No.\n\n No. Are you on any medication?\n\n I take an aspirin, seventy five milligrams, once a day, but that's, because of something I read on the internet.\n\n OK. So, so, why is that? Why do you take that?\n\n I think it's, meant to reduce your risk of stroke and heart attack.\n\n OK. Do, have you ever told a doctor before, your GP, that you're on Aspirin?\n\n Yes I took, I started to , taking it after my, father had his operation, but that wasn't the doctor telling me.\n\n OK. Uh, and, has any GP ever spoken to you about, the risks of Aspirin, and whether you should be on it? Or have you not , told the , the GP in the past?\n\n No, I haven't.\n\n You haven't, OK. Um, all right. Um. Now, um, in terms of your uh, your kind of social situation. Um, are you working at the moment?\n\n Yes, I am.\n\n , what do you work as?\n\n Uh, I'm, uh, I'm actually a doctor.\n\n You're a , a, a medical doctor?\n\n Yes.\n\n OK. Uh, which, specialty are you in?\n\n I work in, uh, plastic surgery.\n\n Plastic surgery, OK, great. And, um, do you, have any, um, allergies to any medication at all?\n\n I'm allergic to penicillin only.\n\n OK. And, um, are you, um, living alone?\n\n No, I live with my wife.\n\n Right, OK. Um, fantastic. Uh , do you smoke at all?\n\n No, I don't.\n\n Right, OK. Um, that's fine. Now, obviously you're a, you're a medic yourself. Did you have any thoughts as to what might be going on?\n\n Uh, I've actually, got no idea.\n\n Right, OK. Um, well the, the way you're describing these episodes. They make me concerned about, mini-strokes or TIAs, , transient ischemic attacks. Um.\n\n OK.\n\n And so, that's something quite urgent. And given that you've got a family history of um, stroke.\n\n Um, even though you're quite young, I think um, it's something that we need to exclude. So, what I'm probably going to do, uh, in fact what I am going to do, is I'm going to, refer you to a stroke, a TIA clinic.\n\n Um, now just to double-check. Do you have the symptoms right now?\n\n No, I'm perfectly fine at the moment.\n\n OK. So, so, what I'm gonna do, is I'm uh, I'm gonna refer you to a, a mini-stroke clinic, or a TIA clinic.\n\n Um, I send that referral off now, and then you can attend them, they, they'll usually, call you in within the next one to two days, OK.\n\n Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days , before the weekend. So, um, uh, basically the deadline should be, Thursday, Friday.\n\n We're expecting you to be seen by the time, that's the kind of turnaround we're, we're looking at.\n\n And in that clinic, they'll be doing a number of things. Um, they'll be checking, they'll be doing a ultrasound of the, carotid arteries, like your, your father had. Um, and, they'll be doing a, maybe a, they might do a scan of your brain as well, to check if there's any signs of a bleed there.\n\n But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether, you have um, any illness. OK, whether you have got any kind of stroke or, mini-stroke.\n\n Sure.\n\n Now, if your symptoms return and they persist, they're prolonged. Then um, you may need to attend A and E.\n\n OK, because um, our presumptive, working diagnosis is, mini-stroke or TIA, OK.\n\n And if, a mini-stroke is prolonged then uh, then we end up thinking that this might be a stroke and in that case, that becomes even more of an emergency. So, we're not talking about waiting one or two days, we want you to go to hospital in that instance, as soon as possible, OK.\n\n Sure.\n\n Now if , things happen again, feel free to contact us, we can assess you over the phone, we can give you direction and guidance over the phone. That's, that's, that's not a problem, you know, you, you've got easy access to us.\n\n OK. So, um, this is the plan going forward. Um, I'm going to, um, do that referral.\n\n You should hear back from the hospital, relatively soon.\n\n The hospital, you can actually ring them, on um, uh, the PALS number, and then there's also the TIA clinic number.\n\n I'm going to leave that number in the notes for this consultation, OK. So you'll have all the information you need, to chase this appointment.\n\n OK.\n\n And um, if you want, you can ring them, either today or tomorrow morning.\n\n , today in the afternoon, wait uh, one or two hours. Or tomorrow morning just to find out when they got time to slot you in. And, just to make sure they've got you in the system, that they've got in the books, and they're going to be calling you in, OK.\n\n , this isn't, a, an immediate emergency that you need to rush down to A and E. But it's something quite urgent we need to, deal with in a short space of time, OK.\n\n So if there's, if there's any delay that, transpires for example, you can't make the appointment or, you know, they, you don't get called. , you, you get, get in contact back, back with us, OK.\n\n All right. Did you have any questions at all?\n\n No, I think that covers, most of it.\n\n OK, great. So just bear with me a few minutes, and then I'll send that uh, all through and then you should, um, you should be able to help, you should have the information at your hands to, in order to take things further, OK.\n\n , thank you.\n\n All the best. Take care now. Bye bye.","products":{"hanah":[{"label":"Run 1","wer":9.163135593220339,"text":"Hi there, good morning. I'm Dr. Glynn Miller from QPM, nice to see you.\n\n  Thanks.\n\n  Okay, so, um, before we start your appointment, could I confirm your full name and date of birth, please?\n\n  Yes, it's John Smith, and I am 32 years old.\n\n  Sorry, I didn't catch your date of birth.\n\n  I'm 32 years old.\n\n  32 years old, okay. Could you tell me the first line of your address and your postcode, please?\n\n  It's 4 Park Avenue, and it's AB1 CB2.\n\n  That's great, thank you so much for that. Are you in a private place where you're okay to speak at the moment?\n\n  Yes.\n\n  Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n\n  Sorry, say that again.\n\n  How can I help you today?\n\n  So, um, I've been experien over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it.\n\n  Okay. So tell me a bit more about these weird symptoms you've been having.\n\n  So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I get pins and needles, and—\n\n  Right. So what—so just to get the connection's not so great. You've been getting pins and needles in the hand, is that right?\n\n  Yeah, that's correct.\n\n  Okay. Is that the right or left hand?\n\n  My right hand.\n\n  Is it always the right?\n\n  Yes.\n\n  Okay. Um, with lots of video now, maybe is a, a, a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\n\n  Yes, that's fine.\n\n  All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\n\n  Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts 3 days, and then goes back to normal. So it's very weird.\n\n  Right, okay. And is it any involvement of your leg at all?\n\n  Uh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n\n  Okay. You, you said you've been having weird symptoms for about a month.\n\n  Yes.\n\n  So, so what has been happening from the beginning of the month? What else has been happening?\n\n  Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\n\n  Right. Okay. Um, and, um, you. Know, your colleague said you've, you've not been walking normally.\n\n  Yes.\n\n  Do you feel anything different on either side in terms of your legs? Can you—have you noticed anything different?\n\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker, And, you know, you—the abnormal gait, has that been present outside of these episodes? No. It has not.\n\n  Right.\n\n  So normally I'm fit and well, actually.\n\n  All right, okay. Um, and these, these episodes, how often have they been happening?\n\n  They have been getting more regular. So at the start it would be maybe once a week, uh, to every once at once a month, but now it's getting a couple of times a day.\n\n  Right, okay. And how long have these episodes been going on for? When, when did it all start? Is it—\n\n  It might be a month and a half, maybe 2 months.\n\n  Right, okay. Okay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems?\n\n  So, recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink, and that's only been in the last couple of days, I guess.\n\n  Right. Is that during these episodes or outside of these episodes?\n\n  Only during the episodes.\n\n  Okay. Do you have any difficulty swallowing at all?\n\n  Not currently, no.\n\n  Okay. During the episodes, do you have any difficulty swallowing?\n\n  I, I, I feel like there's something in my throat.\n\n  Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all?\n\n  No, I can speak fine.\n\n  Okay. And any visual problems during these episodes?\n\n  I don't think so, but I wear glasses.\n\n  Okay, all right. Now, um, can I just ask, has—is there any history of stroke or mini-strokes in your family?\n\n  Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n\n  Right, okay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n\n  No, so after my dad had his operation, I was required to be checked, and my cholesterol was fine, So you had a, a blood test done, and did they check for diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay.\n\n  Fantastic, okay. Now, do you have any other illnesses at all?\n\n  No.\n\n  No. Are you on any medication?\n\n  I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\n\n  Okay. So, so why is that? Why did you take that?\n\n  I think it's meant to reduce your risk of stroke and heart attack.\n\n  Okay. Do you—have you ever told a doctor before your GP that you're on aspirin?\n\n  Yes, I took—I started taking it after my father had his operation.\n\n  Okay.\n\n  But that wasn't the doctor telling me.\n\n  Okay. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the, the GP in the past?\n\n  No.\n\n  I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment?\n\n  Yes, I am.\n\n  What do you work as?\n\n  Uh, I'm, I'm actually a doctor.\n\n  You're a med—a medical doctor?\n\n  Yes.\n\n  Okay. Uh, which specialty are you in?\n\n  I work in, uh, plastic surgery.\n\n  Plastic surgery. Okay, great. And, um, do you have any, um, allergies to any medication at all?\n\n  I'm allergic to penicillin only.\n\n  Okay. And, um, are you, um, living alone?\n\n  No, I live with my wife.\n\n  Wife. Okay. Um, fantastic. Uh, do you smoke at all?\n\n  No, I don't.\n\n  Right, okay. Um, that's fine. Now, obviously you're, you're a medic yourself, did you have any thoughts as to what might be going on?\n\n  Uh, I've absolutely got no idea.\n\n  Right, okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient transient ischemic attacks. Um, and so that's something quite urgent and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, and in fact what I am going to do is I'm going to refer you to a stroke TIA clinic. Um, now just to double-check, do you have the symptoms right now?\n\n  No, I'm perfectly fine at the moment.\n\n  Okay. So, so what I'm going to do is I'm going—I'm going to refer you to a, a mini-stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next 1 to 2 days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so, um, uh, basically the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking—they'll be doing the ultrasound of the carotid arteries like your, your father had, um, and they'll be doing maybe—they might do a scan of the brain as well to see if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short timeframe in order to exclude whether you have, um, any illness.\n\n  Sure.\n\n  You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E, okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke, and in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to the hospital in that instance as soon as possible, okay?\n\n  Sure.\n\n  Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's, that's, that's not a problem. You know, you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital—you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to need that number in the notes for this consultation.\n\n  Okay.\n\n  Okay? So you'll have all the information you need to chase this appointment, and, um, if you want, you can ring them either today or tomorrow morning to—today in the afternoon, wait 1 or 2 hours, or tomorrow morning just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got them booked and they're going to be calling you in, okay?\n\n  Great.\n\n  So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's—if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, something needs to be done. You need to be getting in contact b-back with us, okay?\n\n  Great.\n\n  All right. Did you have any questions at all?\n\n  No, I think that covers most of it.\n\n  Okay, great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should, um, you should be able to have—you should have the information at your hands to, in order to take things further, okay?\n\n  Great, thank you.\n\n  All the best. Take care then. Bye-bye.\n\n  Bye-bye.","marks":[[28,44,"Doctor",false],[50,53,"GP at Hand.",false],[75,90,"Hi. OK.",false],[437,445,"AB one CB two.",false],[691,697,".",false],[748,756,"experiencing very weird symptoms",false],[1184,1187,"guess",false],[1221,1243,"again",false],[1472,1484,"we've lost",false],[1504,1504,"there",false],[1908,1909,"few",false],[1989,1991,"there",false],[2897,2897,"Right .",false],[3260,3271,"a month ago probably",false],[3859,3864,".",false],[4667,4667,"Good excellent.",false],[5089,5092,"do",false],[5772,5775,"a",false],[6089,6100,"Right OK.",false],[6306,6316,"actually",false],[6459,6468,"",false],[6926,6934,"gonna",false],[6945,6950,"uh",false],[6955,6963,"gonna",false],[7643,7646,"your",false],[7664,7667,"check",false],[7761,7770,"time frame",false],[7829,7834,"OK whether",false],[7842,7849,"have",true],[7888,7888,"Sure.",false],[7936,7940,"they're",false],[8746,8751,"can",false],[8787,8792,"PALS",false],[8859,8863,"leave",false],[9167,9171,"got time",false],[9258,9269,"in the books",false],[9310,9335,"OK.",false],[9638,9665,"",false],[9670,9688,"you get get",false],[9700,9706,"back back",false],[9716,9731,"OK.",false],[9961,9965,"help",false],[10049,10063,"OK.",false],[10103,10129,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"Episodic sx x ~1.5–2 months\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","\"Initial intermittent fatigue\" before ongoing symptoms."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"pins/needles and numbness in R hand\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"pins/needles ... in R hand; associated perceived R arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"Episodes last ~3–4 days, then return to normal.\""],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"During same episodes, leg feels weak\"."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"colleague has noted altered gait\"."],["The note captures: Gait is normal outside the episodes.","yes","\"gait normal outside episodes\"."],["The note captures: Generally feels tired and weak.","yes","\"ongoing fatigue/weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"occasional nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"reduced motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"from ~weekly/monthly initially\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"to a couple of times/day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding cup\"."],["The note captures: Drinking is slightly harder during episodes.","yes","\"and drinking coffee\"."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"Recent episodic ... onset last few days\"."],["The note captures: No difficulty swallowing currently.","yes","\"No current dysphagia\"."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"during episodes feels sensation in throat\"."],["The note captures: No difficulty speaking during episodes.","yes","\"No speech difficulty.\""],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"No definite visual disturbance; wears glasses.\""],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"Currently asymptomatic.\""],["The note captures: No personal history of stroke or mini-stroke (TIA).","partial","\"PMH: none reported\" implies but does not specifically state no prior stroke/TIA."],["The note captures: Cholesterol previously checked and normal.","yes","\"cholesterol ... reportedly normal\"."],["The note captures: Previously screened for diabetes; normal.","yes","\"diabetes checks reportedly normal\"."],["The note captures: Blood pressure previously checked; normal.","yes","\"Previous BP ... normal\"."],["The note captures: No other illnesses; normally fit and well.","yes","\"PMH: none reported.\""],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75 mg OD\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","\"self-initiated after reading it may reduce stroke/MI risk\"."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","\"GP not aware/discussed risks\"."],["The note captures: Allergic to penicillin.","yes","\"Allergy: penicillin.\""],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father had neck operation to reduce stroke risk\"."],["The note captures: Non-smoker.","yes","\"Non-smoker.\""],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","\"consultation continued audio-only. No physical examination findings\"."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"possible TIA/“mini-stroke”\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","\"given recurrent focal sx and FHx ...; urgent exclusion required\"."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to TIA/stroke clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"within 1–2 days, anticipated Thurs/Fri\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"carotid ultrasound\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","\"possibly brain scan\" captured but purpose (check for bleed) omitted."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"If sx recur and persist/prolong → attend A&E urgently\"."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","\"not considered immediate A&E presentation at time of consultation\"."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","\"May contact service by phone if sx recur\"."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","\"Provided hospital PALS and TIA clinic contact details\"."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","\"advised to chase appointment later today/tomorrow and confirm referral received\"."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"Contact service if unable to attend, not contacted, or any delay\"."]],"claims":[],"note":"Subjective\nEpisodic sx x ~1.5–2 months; increasing frequency from ~weekly/monthly initially to a couple of times/day.\nEpisodes last ~3–4 days, then return to normal.\nInitial intermittent fatigue; ongoing fatigue/weakness, occasional nausea and reduced motivation.\nEpisodic pins/needles and numbness in R hand; associated perceived R arm weakness.\nDuring same episodes, leg feels weak and colleague has noted altered gait; gait normal outside episodes.\nRecent episodic difficulty holding cup and drinking coffee, onset last few days.\nNo current dysphagia; during episodes feels sensation in throat.\nNo speech difficulty. No definite visual disturbance; wears glasses.\nCurrently asymptomatic.\nFHx: father had neck operation to reduce stroke risk.\nPrevious BP, cholesterol and diabetes checks reportedly normal.\nPMH: none reported.\nMeds: aspirin 75 mg OD, self-initiated after reading it may reduce stroke/MI risk; GP not aware/discussed risks.\nAllergy: penicillin.\nNon-smoker. Lives with wife. Works as doctor in plastic surgery.\nUnsure of cause; had searched symptoms online without explanation.\nObjective\nVideo connection poor; consultation continued audio-only.\nNo physical examination findings documented.\nAssessment\nRecurrent transient focal neurological sx: R hand paraesthesia/numbness, perceived R arm/leg weakness and episodic gait change, with recent episodic impaired cup holding/drinking.\nClinician concern for possible TIA/“mini-stroke” given recurrent focal sx and FHx of stroke-related disease; urgent exclusion required.\nNo current sx; not considered immediate A&E presentation at time of consultation.\nPlan\nUrgent referral to TIA/stroke clinic planned; expected contact/assessment within 1–2 days, anticipated Thurs/Fri.\nExplained clinic may arrange carotid ultrasound and possibly brain scan, alongside other investigations.\nIf sx recur and persist/prolong → attend A&E urgently due concern for possible stroke.\nMay contact service by phone if sx recur for assessment/guidance.\nProvided hospital PALS and TIA clinic contact details; advised to chase appointment later today/tomorrow and confirm referral received.\nContact service if unable to attend, not contacted, or any delay with appointment.","review":128.06578947368422,"saved":357.9342105263158,"faster":73.64901451158761,"clean":false,"effort":2.1739130434782608,"sig":[["partial","No personal history of stroke or mini-stroke (TIA).","\"PMH: none reported\" implies but does not specifically state no prior stroke/TIA."],["partial","TIA clinic may do a brain scan to check for a bleed.","\"possibly brain scan\" captured but purpose (check for bleed) omitted."]]},{"label":"Run 2","wer":8.792372881355933,"text":"Hi there, good morning. I'm Dr. Glynn Miller from QPM, nice to see you.\n\n  Thanks.\n\n  Okay, so, um, before we start your appointment, could I confirm your full name and date of birth, please?\n\n  Yeah, it's John Smith, and I am 32 years old.\n\n  Sorry, I didn't catch your date of birth.\n\n  I'm 32 years old.\n\n  32 years old, okay. Could you tell me the first line of your address and your postcode, please?\n\n  It's 4 Park Avenue, and it's AB1 CB2.\n\n  That's great, thank you so much for that. Are you in a private place where you're okay to speak at the moment?\n\n  Yeah.\n\n  Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n\n  Sorry, say that again.\n\n  How can I help you today?\n\n  So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it.\n\n  Okay. So tell me a bit more about these weird symptoms you've been having.\n\n  So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I get pins and needles, and—\n\n  Right. So what—so just to get the connection's not so great. You've been getting pins and needles in the hand, is that right?\n\n  Yeah, that's correct.\n\n  Okay. Is that the right or left hand?\n\n  My right hand.\n\n  Is it always the right?\n\n  Yes.\n\n  Okay. Um, with lots of video now, maybe is a, a, a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\n\n  Yes, that's fine.\n\n  All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\n\n  Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts 3 days, and then goes back to normal. So it's very weird.\n\n  Right, okay. And is it any involvement of your leg at all?\n\n  Uh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n\n  Okay. You, you said you've been having weird symptoms for about a month.\n\n  Yes.\n\n  So, so what has been happening from the beginning of the month? What else has been happening?\n\n  Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\n\n  Right. Okay. Um, and, um, you. Know, your colleague said you've, you've not been walking normally.\n\n  Yes.\n\n  Do you feel anything different on either side in terms of your legs? Can you—have you noticed anything different?\n\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker, And, you know, you—the abnormal gait, has that been present outside of these episodes? No. It has not.\n\n  Right.\n\n  So normally I'm fit and well, actually.\n\n  All right, okay. Um, and these, these episodes, how often have they been happening?\n\n  They have been getting more regular. So at the start it would be maybe once a week, uh, to every once at once a month, but now it's getting a couple of times a day.\n\n  Right, okay. And how long have these episodes been going on for? When, when did it all start? Is it—\n\n  It might be a month and a half, maybe 2 months.\n\n  Right, okay. Okay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems?\n\n  So, recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink, and that's only been in the last couple of days, I guess.\n\n  Right. Is that during these episodes or outside of these episodes?\n\n  Only during the episodes.\n\n  Okay. Do you have any difficulty swallowing at all?\n\n  Not currently, no.\n\n  Okay. During the episodes, do you have any difficulty swallowing?\n\n  I, I, I feel like there's something in my throat.\n\n  Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all?\n\n  No, I can speak fine.\n\n  Okay. And any visual problems during these episodes?\n\n  I don't think so, but I wear glasses.\n\n  Okay, all right. Now, um, can I just ask, has—is there any history of stroke or mini-strokes in your family?\n\n  Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n\n  Right, okay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n\n  No, so after my dad had his operation, I was required to be checked, and my cholesterol was fine, So you had a, a blood test done, and did they check for diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay.\n\n  Fantastic, okay. Now, do you have any other illnesses at all?\n\n  No.\n\n  No. Are you on any medication?\n\n  I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\n\n  Okay. So, so why is that? Why did you take that?\n\n  I think it's meant to reduce your risk of stroke and heart attack.\n\n  Okay. Do you—have you ever told a doctor before your GP that you're on aspirin?\n\n  Yes, I took—I started taking it after my father had his operation.\n\n  Okay.\n\n  But that wasn't the doctor telling me.\n\n  Okay. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the, the GP in the past?\n\n  No.\n\n  I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment?\n\n  Yes, I am.\n\n  What do you work as?\n\n  Uh, I'm, I'm actually a doctor.\n\n  You're a med—a medical doctor?\n\n  Yes.\n\n  Okay. Uh, which specialty are you in?\n\n  I work in, uh, plastic surgery.\n\n  Plastic surgery. Okay, great. And, um, do you have any, um, allergies to any medication at all?\n\n  I'm allergic to penicillin only.\n\n  Okay. And, um, are you, um, living alone?\n\n  No, I live with my wife.\n\n  Wife. Okay. Um, fantastic. Uh, do you smoke at all?\n\n  No, I don't.\n\n  Right, okay. Um, that's fine. Now, obviously you're, you're a medic yourself, did you have any thoughts as to what might be going on?\n\n  Uh, I've absolutely got no idea.\n\n  Right, okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient transient ischemic attacks. Um, and so that's something quite urgent and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, and in fact what I am going to do is I'm going to refer you to a stroke TIA clinic. Um, now just to double-check, do you have the symptoms right now?\n\n  No, I'm perfectly fine at the moment.\n\n  Okay. So, so what I'm going to do is I'm going—I'm going to refer you to a, a mini-stroke clinic or a TIA clinic, um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next 1 to 2 days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so, um, uh, basically the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things, um, they'll be checking—they'll be doing the ultrasound of the carotid arteries like your, your father had, um, and they'll be doing maybe—they might do a scan of the brain as well to check if there's any signs of a bleed there, but, um, they'll be doing a range of tests in a short time frame in order to exclude whether you have, um, any illness.\n\n  Sure.\n\n  You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E, okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke, and in that case that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days, we want you to go to the hospital in that instance as soon as possible, okay?\n\n  Sure.\n\n  Now, if things happen again, feel free to contact us, we can assess you over the phone, we can give you direction and guidance over the phone, that's, that's, that's not a problem. You know, you've got easy access to us. Okay, so, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital—you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to need that number in the notes for this consultation.\n\n  Okay.\n\n  Okay? So you'll have all the information you need to chase this appointment, and, um, if you want, you can ring them either today or tomorrow morning to today in the afternoon, wait 1 or 2 hours, or tomorrow morning just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got them booked and they're going to be calling you in, okay?\n\n  Great.\n\n  So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's—if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, something needs to be done, you need to be getting in contact back with us, okay?\n\n  Great.\n\n  All right. Did you have any questions at all?\n\n  No, I think that covers most of it.\n\n  Okay, great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should, um, you should be able to have—you should have the information at your hands to, in order to take things further, okay?\n\n  Great, thank you.\n\n  All the best. Take care then. Bye-bye.\n\n  Bye-bye.","marks":[[28,44,"Doctor",false],[50,53,"GP at Hand.",false],[75,90,"Hi. OK.",false],[438,446,"AB one CB two.",false],[693,699,".",false],[1210,1213,"guess",false],[1247,1269,"again",false],[1498,1510,"we've lost",false],[1530,1530,"there",false],[1934,1935,"few",false],[2015,2017,"there",false],[2923,2923,"Right .",false],[3286,3297,"a month ago probably",false],[3885,3890,".",false],[4693,4693,"Good excellent.",false],[5115,5118,"do",false],[5798,5801,"a",false],[6115,6126,"Right OK.",false],[6332,6342,"actually",false],[6485,6494,"",false],[6952,6960,"gonna",false],[6971,6976,"uh",false],[6981,6989,"gonna",false],[7669,7672,"your",false],[7858,7863,"OK whether",false],[7871,7878,"have",true],[7917,7917,"Sure.",false],[7965,7969,"they're",false],[8774,8779,"can",false],[8815,8820,"PALS",false],[8887,8891,"leave",false],[9195,9199,"got time",false],[9286,9297,"in the books",false],[9338,9363,"OK.",false],[9666,9692,"",false],[9698,9716,"you get get",false],[9732,9732,"back",false],[9742,9757,"OK.",false],[9987,9991,"help",false],[10075,10089,"OK.",false],[10129,10155,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'~1.5–2-month hx' of episodic symptoms."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'initially transient fatigue x few days then resolved'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins/needles and numbness in R hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","'R hand only'."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Paraesthesia in R hand 'with perceived R arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Symptoms last ~3 days then resolve'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Concurrent intermittent leg weakness'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'abnormal gait noted by colleague'."],["The note captures: Gait is normal outside the episodes.","yes","Gait change 'occurs only during episodes'."],["The note captures: Generally feels tired and weak.","yes","'episodic fatigue, general weakness'."],["The note captures: Sometimes feels nauseous.","yes","Nausea documented."],["The note captures: Low motivation; does not feel like doing anything.","yes","'↓ motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially ~weekly to monthly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now a couple of times/day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding cup'."],["The note captures: Drinking is slightly harder during episodes.","yes","'difficulty ... drinking coffee'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'During recent episodes' captures recency and episode-only timing."],["The note captures: No difficulty swallowing currently.","yes","'No current dysphagia'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'sensation of something in throat'."],["The note captures: No difficulty speaking during episodes.","partial","'No current ... speech difficulty' does not clearly state no speech difficulty during episodes."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No definite visual sx; wears glasses'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Asymptomatic during consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","partial","Only 'PMH: none reported'; no explicit statement of no prior stroke/TIA."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol check reportedly normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes check reportedly normal."],["The note captures: Blood pressure previously checked; normal.","yes","BP check reportedly normal."],["The note captures: No other illnesses; normally fit and well.","yes","'PMH: none reported'; 'normally fit/well'."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75 mg OD'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-initiated after reading about stroke/MI prevention'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'GP ... has not discussed risks/appropriateness'."],["The note captures: Allergic to penicillin.","yes","'Allergy: penicillin'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father had neck operation to reduce stroke risk'."],["The note captures: Non-smoker.","yes","'non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","'video connection lost ... no visual assessment/examination performed'."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'TIA/minor stroke considered'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","'urgent exclusion required' with FHx cited."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA/stroke clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected assessment within 1–2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid artery ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'possible brain scan' noted but not the purpose of checking for a bleed."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E urgently if sx recur and persist/prolong'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","'no immediate emergency transfer advised'."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'contact service for telephone assessment/guidance if sx recur'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","no","No mention of TIA clinic/PALS numbers being left in the notes."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Says contact clinic to confirm referral but omits this afternoon/tomorrow morning timing."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact clinician/service if not contacted or if unable to attend'."]],"claims":[["GP not aware [of aspirin use]","Asked if he had told a doctor he was on aspirin, patient answered 'Yes'; only that no GP discussed its risks is supported."],["perceived R arm/leg weakness","Patient said his leg feels weaker during episodes; the side of the leg was never stated."]],"note":"Subjective\n~1.5–2-month hx episodic fatigue, general weakness, nausea and ↓ motivation; initially transient fatigue x few days then resolved.\nRecurrent pins/needles and numbness in R hand only, with perceived R arm weakness. Symptoms last ~3 days then resolve.\nConcurrent intermittent leg weakness and abnormal gait noted by colleague; occurs only during episodes.\nEpisodes increasing in frequency: initially ~weekly to monthly; now a couple of times/day.\nDuring recent episodes, difficulty holding cup and drinking coffee; sensation of something in throat. No current dysphagia or speech difficulty. No definite visual sx; wears glasses.\nAsymptomatic during consultation; normally fit/well outside episodes.\nFHx: father had neck operation to reduce stroke risk.\nPrevious BP, cholesterol and diabetes checks reportedly normal.\nPMH: none reported.\nMeds: aspirin 75 mg OD, self-initiated after reading about stroke/MI prevention; GP not aware and has not discussed risks/appropriateness.\nAllergy: penicillin.\nSocial: plastic surgery doctor; lives with wife; non-smoker.\nPt unsure of cause; sought assessment due to unusual, escalating sx.\nObjective\nRemote consultation; video connection lost/discontinued, so no visual assessment/examination performed.\nPt stated currently symptom-free.\nAssessment\nRecurrent transient focal neurological sx: R hand paraesthesia/numbness, perceived R arm/leg weakness and episodic gait change, with recent functional difficulty holding/drinking from cup.\nTIA/minor stroke considered due to recurrent transient focal unilateral sx, increasing frequency and FHx of stroke risk; urgent exclusion required.\nCurrent absence of sx means no immediate emergency transfer advised during consultation.\nPlan\nUrgent referral to TIA/stroke clinic to be sent; expected assessment within 1–2 days.\nDiscussed likely clinic investigations, including carotid artery ultrasound and possible brain scan, to assess for stroke/TIA.\nAdvised attend A&E urgently if sx recur and persist/prolong, due to concern for possible stroke.\nAdvised contact service for telephone assessment/guidance if sx recur.\nPt to contact hospital/TIA clinic if needed to confirm referral/appointment; contact clinician/service if not contacted or if unable to attend.","review":206.57894736842104,"saved":279.42105263157896,"faster":57.49404375135369,"clean":false,"effort":13.043478260869565,"sig":[["partial","No difficulty speaking during episodes.","'No current ... speech difficulty' does not clearly state no speech difficulty during episodes."],["partial","No personal history of stroke or mini-stroke (TIA).","Only 'PMH: none reported'; no explicit statement of no prior stroke/TIA."],["partial","TIA clinic may do a brain scan to check for a bleed.","'possible brain scan' noted but not the purpose of checking for a bleed."],["missing","TIA clinic and PALS contact numbers to be left in the consultation notes.","No mention of TIA clinic/PALS numbers being left in the notes."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Says contact clinic to confirm referral but omits this afternoon/tomorrow morning timing."],["fabrication","GP not aware [of aspirin use]","Asked if he had told a doctor he was on aspirin, patient answered 'Yes'; only that no GP discussed its risks is supported."],["fabrication","perceived R arm/leg weakness","Patient said his leg feels weaker during episodes; the side of the leg was never stated."]],"mb":10.96194,"latency":21.559,"finalised":228.13794736842104},{"label":"Run 3","wer":9.004237288135593,"text":"All right, good morning. I'm Dr. Ginger from QPRN; nice to see you.\n\n  Thanks.\n\n  Okay, so, um, before we start, your appointment—could I confirm your full name and date of birth, please?\n\n  Yes, it's John Smith, and I am 32 years old.\n\n  Sorry, I didn't catch your date of birth.\n\n  I'm 32 years old.\n\n  32 years old, okay. Could you tell me the first line of your address and your postcode, please?\n\n  It's 4 Park Avenue, and it's AB1 CB2.\n\n  That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment?\n\n  Yes.\n\n  Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n\n  Sorry, say that again.\n\n  How can I help you today?\n\n  So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it.\n\n  Okay. So tell me a bit more about these weird symptoms you've been having.\n\n  So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I guess pins and needles, and—\n\n  Right. So what—so just tell me again, the connection's not so great. You've been getting pins and needles in the hand, is that right?\n\n  Yeah, that's correct.\n\n  Okay. Is that the right or left hand?\n\n  My right hand.\n\n  Is it always the right?\n\n  Yes.\n\n  Okay. Um, with lots of video now, maybe is a, a, a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\n\n  Yes, that's fine.\n\n  All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\n\n  Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts 3 days, and then goes back to normal. So it's very weird.\n\n  Right. Okay. And is it any involvement of your leg at all?\n\n  Uh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n\n  Okay. You—you said you've been having weird symptoms for about a month.\n\n  Yes.\n\n  So—so what has been happening from the beginning of the month? What else has been happening?\n\n  Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\n\n  Right. Okay. Um, and, um, you. Know, your colleague said you've—you've not been walking normally.\n\n  Yes.\n\n  Do you feel anything different on either side in terms of your legs? Can you—have you noticed anything different?\n\n  Yes. So at the same time I get my arm symptoms, my leg feels weaker, And, you know, you—the abnormal gait, has that been present outside of these episodes? No. It has not.\n\n  Right.\n\n  So normally I'm fit and well, actually.\n\n  All right. Okay. Um, and these—these episodes, how often have they been happening?\n\n  They have been getting more regular. So at the start it would be maybe once a week, uh, to every once a—once a month, but now it's getting a couple of times a day.\n\n  Right. Okay. And how long have these episodes been going on for? When—when did it all start? Is it—\n\n  It might be a month and a half, maybe 2 months.\n\n  Right. Okay. Okay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems?\n\n  So, recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink, and that's only been in the last couple of days, I guess.\n\n  Right. Is that during these episodes or outside of these episodes?\n\n  Only during the episodes.\n\n  Okay. Do you have any difficulty swallowing at all?\n\n  Not currently, no.\n\n  Okay. During the episodes, do you have any difficulty swallowing?\n\n  I—I feel like there's something in my throat.\n\n  Okay. What about, um, difficulty speaking during these episodes? Any—any issues with that at all?\n\n  No, I can speak fine.\n\n  Okay. And any visual problems during these episodes?\n\n  I don't think so, but I wear glasses.\n\n  Okay. All right. Now, um, can I just ask, has—is there any history of stroke or mini-strokes in your family?\n\n  Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n\n  Right. Okay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n\n  No. So after my dad had his operation, I was required to be checked, and my cholesterol, uh, was fine.\n\n  Good. Excellent. So you had a—a blood test done, and did they check what diabetes as well?\n\n  They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay.\n\n  Fantastic. Okay. Now, do you have any other illnesses at all?\n\n  No.\n\n  No. Are you on any medication?\n\n  I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\n\n  Okay. So—so why is that? Why did you take that?\n\n  I think it's meant to reduce your risk of stroke and heart attack.\n\n  Okay. Do you—have you ever told a doctor before your GP that you're on aspirin?\n\n  Yes, I took—I started taking it after my father had his operation.\n\n  Okay.\n\n  But that wasn't the doctor telling me.\n\n  Okay. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the—the GP in the past?\n\n  No. I haven't.\n\n  You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment?\n\n  Yes, I am.\n\n  What do you work as?\n\n  Uh, I'm—I'm actually a doctor.\n\n  You're a med—a medical doctor?\n\n  Yes.\n\n  Okay. Uh, which specialty are you in?\n\n  I work in, uh, plastic surgery.\n\n  Plastic surgery. Okay. Great. And, um, do you have any, um, allergies to any medication at all?\n\n  I'm allergic to penicillin only.\n\n  Okay. And, um, are you, um, living alone?\n\n  No, I live with my wife.\n\n  Wife. Okay. Um, fantastic. Uh, do you smoke at all?\n\n  No, I don't.\n\n  Right. Okay. Um, that's fine. Now, obviously you're—you're a medic yourself, did you have any thoughts as to what might be going on?\n\n  Uh, I've absolutely got no idea.\n\n  Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient—transient ischemic attacks. Um, and so that's something quite urgent and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, and in fact what I am going to do is I'm going to refer you to a stroke TIA clinic. Um, now just to double-check, do you have the symptoms right now?\n\n  No, I'm perfectly fine at the moment.\n\n  Okay. So—so what I'm going to do is I'm—I'm going to refer you to a—a mini-stroke clinic or a TIA clinic, um, I send that referral off now, and then you can attend them. They—they'll usually call you in within the next 1 to 2 days.\n\n  Okay.\n\n  Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so, um, uh, basically the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're—we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking—they'll be doing that ultrasound of the carotid arteries like your—your father had, um, and they'll be doing maybe a—they might do a scan of the brain as well to see if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether you have, um, any illness.\n\n  Sure.\n\n  You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E, okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke, and in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to the hospital in that instance, as soon as possible.\n\n  Okay.\n\n  Okay?\n\n  Sure.\n\n  Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's—that's—that's not a problem. You know, we—you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital—you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to use that number in the notes for this consultation.\n\n  Okay.\n\n  Okay? So you'll have all the information you need to chase this appointment, and, um, if you want, you can ring them either today or tomorrow morning to—today in the afternoon, wait 1 or 2 hours, or tomorrow morning just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got them booked and they're going to be calling you in. Okay?\n\n  Great.\n\n  So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's—if there's any delay that transpires, for example, you can't make the appointment, or, you know, that you don't get called, something needs to be done. You need to be ge-get in contact b-back with us. Okay?\n\n  Great.\n\n  All right. Did you have any questions at all?\n\n  No, I think that covers most of it.\n\n  Okay. Great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should, um, you should be able to have—you should have the information at your hands to, in order to take things further. Okay?\n\n  Great. Thank you.\n\n  All the best. Take care then. Bye-bye.\n\n  Bye-bye.","marks":[[0,9,"Hi there.",false],[29,39,"Doctor",false],[45,49,"GP at Hand.",false],[71,86,"Hi. OK.",false],[433,441,"AB one CB two.",false],[687,693,".",false],[1243,1266,"",false],[1502,1514,"we've lost",false],[1534,1534,"there",false],[1938,1939,"few",false],[2019,2021,"there",false],[2924,2924,"Right .",false],[3284,3295,"a month ago probably",false],[3883,3888,".",false],[4764,4768,"for",false],[5135,5138,"do",false],[5816,5819,"a",false],[6133,6144,"Right OK.",false],[6349,6359,"actually",false],[6502,6511,"",false],[6968,6976,"gonna",false],[6991,6999,"gonna",false],[7690,7693,"your",false],[7711,7714,"check",false],[7878,7883,"OK whether",false],[7891,7898,"have",true],[7937,7937,"Sure.",false],[7985,7989,"they're",false],[8809,8814,"can",false],[8850,8855,"PALS",false],[8922,8925,"leave",false],[9229,9233,"got time",false],[9320,9331,"in the books",false],[9372,9397,"OK.",false],[9701,9728,"",false],[9733,9750,"you get get",false],[9762,9768,"back back",false],[9778,9793,"OK.",false],[10023,10027,"help",false],[10111,10126,"OK.",false],[10165,10191,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"episodic neurological sx x ~6–8 weeks\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","\"Initial fatigue for several days, then return to baseline.\""],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"pins and needles/numbness in R hand\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","\"R hand only\"."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"R hand only; associated subjective R arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"Episodes last ~3 days then resolve.\""],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"Concurrent leg weakness\"."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"colleague has noted altered walking\"."],["The note captures: Gait is normal outside the episodes.","yes","\"No gait abnormality between episodes.\""],["The note captures: Generally feels tired and weak.","yes","\"Ongoing fatigue, generalised weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"intermittent nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"↓ motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"initially described as ~weekly to monthly\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"now occurring a couple of times/day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding cup of coffee\"."],["The note captures: Drinking is slightly harder during episodes.","yes","\"and drinking coffee during episodes\"."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"during episodes, onset last few days\"."],["The note captures: No difficulty swallowing currently.","yes","\"No current dysphagia.\""],["The note captures: During episodes, feels as if something is in his throat.","yes","\"Sensation of something in throat during episodes.\""],["The note captures: No difficulty speaking during episodes.","yes","\"No speech difficulty during episodes.\""],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"No definite visual disturbance; wears glasses.\""],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"Asymptomatic at time of consultation.\""],["The note captures: No personal history of stroke or mini-stroke (TIA).","partial","\"No other PMH reported\" implies but does not specifically state no prior stroke/TIA."],["The note captures: Cholesterol previously checked and normal.","yes","\"cholesterol ... reportedly normal\"."],["The note captures: Previously screened for diabetes; normal.","yes","\"diabetes checks reportedly normal\"."],["The note captures: Blood pressure previously checked; normal.","yes","\"Previous BP ... normal\"."],["The note captures: No other illnesses; normally fit and well.","yes","\"Normally fit and well. No other PMH reported.\""],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75 mg OD\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","\"self-initiated following father’s operation/internet research\"."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","partial","\"GP unaware\" implies but does not state that no GP discussed aspirin risks."],["The note captures: Allergic to penicillin.","yes","\"Allergy: penicillin.\""],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father had neck operation to reduce stroke risk\"."],["The note captures: Non-smoker.","yes","\"Non-smoker.\""],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","\"video unavailable due connection issues. No physical/neurological examination\"."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"concern for possible TIA/minor stroke\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","\"given focal episodic neurological sx and FHx; urgent exclusion required\"."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to TIA/stroke clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"anticipated assessment within 1–2 days\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"carotid artery ultrasound\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","\"brain scan\" captured but purpose (check for bleed) omitted."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"If sx recur and persist/prolong, attend A&E urgently\"."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","\"May contact service by phone if sx recur for assessment/guidance.\""],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","\"TIA clinic and PALS contact details to be included in consultation notes\"."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","\"contact/chase TIA clinic later today or tomorrow morning to confirm referral\"."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"re-contact service if appointment delayed, not received or unable to attend\"."]],"claims":[],"note":"SOAP Notes\n\nDate: 27 September 2026\n\nClinician: Ahmed Hakeem, Physiotherapist\n\nSubjective\n32-year-old male with episodic neurological sx x ~6–8 weeks.\nInitial fatigue for several days, then return to baseline. Ongoing fatigue, generalised weakness, intermittent nausea and ↓ motivation.\nRecurrent pins and needles/numbness in R hand only; associated subjective R arm weakness. Episodes last ~3 days then resolve.\nConcurrent leg weakness and abnormal gait during episodes; colleague has noted altered walking. No gait abnormality between episodes.\nFrequency initially described as ~weekly to monthly; now occurring a couple of times/day.\nRecent difficulty holding cup of coffee and drinking coffee during episodes, onset last few days.\nSensation of something in throat during episodes. No current dysphagia.\nNo speech difficulty during episodes. No definite visual disturbance; wears glasses.\nAsymptomatic at time of consultation.\nNormally fit and well. No other PMH reported.\nFHx: father had neck operation to reduce stroke risk.\nPrevious BP, cholesterol and diabetes checks reportedly normal.\nMeds: aspirin 75 mg OD, self-initiated following father’s operation/internet research; GP unaware.\nAllergy: penicillin.\nNon-smoker. Lives with wife. Works as a doctor in plastic surgery.\nUnsure of cause; sought assessment due unusual recurrent sx.\nObjective\nRemote consultation; video unavailable due connection issues.\nNo physical/neurological examination documented.\nAssessment\nRecurrent episodic R hand paraesthesia with subjective R arm weakness, concurrent leg weakness/altered gait, and recent impaired cup grip/drinking difficulty.\nEpisodes resolve between attacks but are reportedly increasing in frequency.\nClinician concern for possible TIA/minor stroke given focal episodic neurological sx and FHx; urgent exclusion required.\nPlan\nUrgent referral to TIA/stroke clinic to be sent; anticipated assessment within 1–2 days.\nExplained clinic may arrange carotid artery ultrasound, brain scan and other investigations as indicated.\nIf sx recur and persist/prolong, attend A&E urgently due concern for possible stroke.\nMay contact service by phone if sx recur for assessment/guidance.\nAdvised to contact/chase TIA clinic later today or tomorrow morning to confirm referral/appointment; TIA clinic and PALS contact details to be included in consultation notes.\nAdvised to re-contact service if appointment delayed, not received or unable to attend.","review":174.42105263157896,"saved":311.57894736842104,"faster":64.11089452025124,"clean":false,"effort":5.434782608695652,"sig":[["partial","No personal history of stroke or mini-stroke (TIA).","\"No other PMH reported\" implies but does not specifically state no prior stroke/TIA."],["partial","No GP has discussed the risks of aspirin or whether he should be on it.","\"GP unaware\" implies but does not state that no GP discussed aspirin risks."],["partial","TIA clinic may do a brain scan to check for a bleed.","\"brain scan\" captured but purpose (check for bleed) omitted."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not an immediate emergency."]],"mb":10.983379,"latency":23.507,"finalised":197.92805263157896},{"label":"Run 4","wer":9.322033898305085,"text":"All right, good morning. I'm Dr. Gideon Miller from QC Ahmed; nice to see you.\n\n  Thanks.\n\n  Okay, so, um, before we start your appointment, could I confirm your full name and date of birth, please?\n\n  Yeah, it's John Smith, and I— I'm searching for 2 years old.\n\n  Sorry, I didn't catch your date of birth.\n\n  I'm 32 years old.\n\n  32 years old, okay. Could you tell me the first line of your address and your postcode, please?\n\n  It's 4 Park Avenue, and it's AB1 CB2.\n\n  That's great, thank you so much for that. Are you in a private place where you're okay to speak at the moment?\n\n  Yes.\n\n  Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n\n  Sorry, say that again.\n\n  How can I help you today?\n\n  So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it.\n\n  Okay. So tell me a bit more about these weird symptoms you've been having.\n\n  So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I get pins and needles, and—\n\n  Right. So what— so just to say it again, the connection's not so great. You've been getting pins and needles in the hand, is that right?\n\n  Yeah, that's correct.\n\n  Okay. Is that the right or left hand?\n\n  My right hand.\n\n  Is it always the right?\n\n  Yes.\n\n  Okay. Um, with lots of video now, maybe is a, a, a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\n\n  Yes, that's fine.\n\n  All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\n\n  Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts 3 days, and then goes back to normal. So it's very weird.\n\n  Right, okay. And is it any involvement of your leg at all?\n\n  Uh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days or 3 or 4 days.\n\n  Okay. You— you said you've been having weird symptoms for about a month.\n\n  Yes.\n\n  So— so what has been happening from the beginning of the month? What else has been happening?\n\n  Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\n\n  Right. Okay. Um, and, um, you. Know, your colleague said you've— you've not been walking normally.\n\n  Yes.\n\n  Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker, And, you know, you— the abnormal gait, has that been present outside of these episodes? No. It has not.\n\n  Right.\n\n  So normally I'm fit and well, actually.\n\n  All right. Okay. Um, and these— these episodes, how often have they been happening?\n\n  They have been getting more regular. So at the start it would be maybe once a week, uh, to every once— once a month, but now it's getting a couple of times a day.\n\n  Right, okay. And how long have these episodes been going on for? When— when did it all start? Is it—\n\n  It might be a month and a half, maybe 2 months.\n\n  Right, okay. Okay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems?\n\n  So, recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink, and that's only been in the last couple of days, I guess.\n\n  Right. Is that— during these episodes, or outside of these episodes?\n\n  Only during the episodes.\n\n  Okay. Do you have any difficulty swallowing at all?\n\n  Not currently, no.\n\n  Okay. During the episodes, do you have any difficulty swallowing?\n\n  I— I— I feel like there's something in my throat.\n\n  Okay. What about, um, difficulty speaking during these episodes? Any— any issues with that at all?\n\n  No, I can speak fine.\n\n  Okay. And any visual problems during these episodes?\n\n  I don't think so, but I wear glasses.\n\n  Okay. All right. Now, um, can I just ask, has— is there any history of stroke or mini-strokes in your family?\n\n  Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n\n  Right, okay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n\n  No, so after my dad had his operation, I was required to be checked, and my cholesterol was fine, So you had a— a blood test done. And did they check for diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay.\n\n  Fantastic. Okay. Now, do you have any other illnesses at all?\n\n  No.\n\n  No. Are you on any medication?\n\n  I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\n\n  Okay. So— so why is that? Why did you take that?\n\n  I think it's meant to reduce your risk of stroke and heart attack.\n\n  Okay. Do you— have you ever told a doctor before your GP that you're on aspirin?\n\n  Yes, I took— I started taking it after my father had his operation.\n\n  Okay.\n\n  But that wasn't the doctor telling me.\n\n  Okay. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the— the GP in the past?\n\n  No.\n\n  I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment?\n\n  Yes, I am.\n\n  What do you work as?\n\n  Uh, I'm— I'm actually a doctor.\n\n  You're a med— a medical doctor?\n\n  Yes.\n\n  Okay. Uh, which specialty are you in?\n\n  I work in, uh, plastic surgery.\n\n  Plastic surgery. Okay, great. And, um, do you have any, um, allergies to any medication at all?\n\n  I'm allergic to penicillin only.\n\n  Okay. And, um, are you, um, living alone?\n\n  No, I live with my wife.\n\n  Wife. Okay. Um, fantastic. Uh, do you smoke at all?\n\n  No, I don't.\n\n  Right, okay. Um, that's fine. Now, obviously you're— you're a medic yourself, did you have any thoughts as to what might be going on?\n\n  Uh, I've absolutely got no idea.\n\n  Right, okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient— transient ischemic attacks. Um, and so that's something quite urgent and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, and in fact what I am going to do is I'm going to refer you to a stroke— a TIA clinic. Um, now just to double-check, do you have the symptoms right now?\n\n  No, I'm perfectly fine at the moment.\n\n  Okay. So— so what I'm going to do is I'm going— I'm going to refer you to a mini-stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They— they'll usually call you in within the next 1 to 2 days.\n\n  Okay.\n\n  Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so, um, uh, basically the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're— we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking— they'll be doing the ultrasound of the carotid arteries, like your— your father had, um, and they'll be doing maybe— they might do a scan of the brain as well, to see if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short timeframe, in order to exclude whether you have, um, any illness.\n\n  Sure.\n\n  You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E, okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke, and in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to the hospital in that instance, as soon as possible, okay?\n\n  Sure.\n\n  Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's— that's— that's not a problem. You know, you've got easy access to us.\n\n  Okay.\n\n  Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital, relatively soon. The hospital— you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to need that number in the notes for this consultation.\n\n  Okay.\n\n  Okay? So you'll have all the information you need to chase this appointment, and, um, if you want, you can ring them either today or tomorrow morning to— today in the afternoon, wait 1 or 2 hours, or tomorrow morning just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got them booked and they're going to be calling you in, okay?\n\n  Great.\n\n  So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's— if there's any delay that transpires, for example, you can't make the appointment, or, you know, that you don't get called, something needs to be done. You need to be get— getting in contact back with us, okay?\n\n  Great.\n\n  All right. Did you have any questions at all?\n\n  No, I think that covers most of it.\n\n  Okay, great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should— um, you should be able to have— you should have the information at your hands to, in order to take things further, okay?\n\n  Great, thank you.\n\n  All the best. Take care then. Bye-bye.\n\n  Bye-bye.","marks":[[0,9,"Hi there.",false],[29,46,"Doctor",false],[52,60,"GP at Hand.",false],[82,97,"Hi. OK.",false],[232,249,"am thirty",true],[460,468,"AB one CB two.",false],[714,720,".",false],[1231,1234,"guess",false],[1268,1294,"",false],[1530,1542,"we've lost",false],[1562,1562,"there",false],[1966,1967,"few",false],[2047,2049,"there",false],[2680,2680,"Can",false],[2947,2947,"Right .",false],[3308,3319,"a month ago probably",false],[3909,3914,".",false],[4718,4718,"Good excellent.",false],[5140,5143,"do",false],[5825,5828,"a",false],[6143,6154,"Right OK.",false],[6360,6370,"actually",false],[6514,6523,"",false],[6984,6992,"gonna",false],[7003,7008,"uh",false],[7014,7022,"gonna",false],[7714,7717,"your",false],[7736,7739,"check",false],[7833,7842,"time frame",false],[7902,7907,"OK whether",false],[7915,7922,"have",true],[7961,7961,"Sure.",false],[8009,8013,"they're",false],[8834,8839,"can",false],[8875,8880,"PALS",false],[8947,8951,"leave",false],[9256,9260,"got time",false],[9347,9358,"in the books",false],[9399,9424,"OK.",false],[9729,9756,"",false],[9761,9771,"you",false],[9777,9784,"get",false],[9800,9800,"back",false],[9810,9825,"OK.",false],[10055,10059,"help",false],[10144,10158,"OK.",false],[10198,10224,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"~1–2 months episodic ... initially described as ~1 month\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","\"episodic fatigue\" noted but not that it began with a couple of days of tiredness then normal."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"R hand pins/needles and numbness\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"R hand pins/needles ... associated perceived R arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"Episodes last ~3 days, then resolve.\""],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"During same episodes, leg feels weaker\"."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"colleague has noted altered gait\"."],["The note captures: Gait is normal outside the episodes.","yes","\"gait normal between episodes\"."],["The note captures: Generally feels tired and weak.","yes","\"fatigue, general weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"↓ motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"initially ~weekly/monthly\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"now several times/day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding coffee cup\"."],["The note captures: Drinking is slightly harder during episodes.","yes","\"and drinking coffee\"."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"Last few days: during episodes\"."],["The note captures: No difficulty swallowing currently.","yes","\"No current dysphagia\"."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"sensation of something in throat\"."],["The note captures: No difficulty speaking during episodes.","yes","\"no speech difficulty\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"No clear visual sx; wears glasses.\""],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"Currently asymptomatic\"."],["The note captures: No personal history of stroke or mini-stroke (TIA).","partial","\"No PMH\" implies but does not specifically state no prior stroke/TIA."],["The note captures: Cholesterol previously checked and normal.","yes","\"cholesterol ... checks reportedly normal\"."],["The note captures: Previously screened for diabetes; normal.","yes","\"diabetes checks reportedly normal\"."],["The note captures: Blood pressure previously checked; normal.","yes","\"Previous BP ... normal\"."],["The note captures: No other illnesses; normally fit and well.","yes","\"normally fit/well\"; \"No PMH\"."],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75 mg OD\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","\"self-initiated after father's operation for perceived stroke/MI prevention\"."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","\"GP not aware/discussed risks\"."],["The note captures: Allergic to penicillin.","yes","\"Allergy: penicillin.\""],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father had neck operation to reduce stroke risk\"."],["The note captures: Non-smoker.","yes","\"Non-smoker.\""],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","\"video connection poor/unavailable ... No in-person/visual neurological examination\"."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"Clinician concern for TIA/“mini-stroke”\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","\"urgent exclusion required given ... FHx of stroke-related vascular disease\"."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to TIA/stroke clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"within 1–2 days/Thu–Fri\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"carotid ultrasound\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","\"possibly brain scan\" captured but purpose (check for bleed) omitted."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"If sx recur and persist/prolong, attend A&E urgently\"."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","\"May contact service by phone if sx recur for assessment/advice.\""],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","partial","\"via provided contact details\" – TIA clinic/PALS numbers in notes not specified."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Chasing clinic mentioned only if not contacted/delayed; this afternoon/tomorrow confirmation call not captured."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"if not contacted or if appointment delayed/unable to attend\"."]],"claims":[["Advised to chase hospital/TIA clinic appointment via provided contact details if not contacted or if appointment delayed/unable to attend.","Clinician said to contact the practice (not the clinic) if there is a delay, not called, or unable to attend; ringing the clinic was to confirm the referral today/tomorrow."]],"note":"Subjective\n~1–2 months episodic fatigue, general weakness, nausea and ↓ motivation; initially described as ~1 month.\nEpisodic R hand pins/needles and numbness; associated perceived R arm weakness. Episodes last ~3 days, then resolve.\nDuring same episodes, leg feels weaker and colleague has noted altered gait; gait normal between episodes.\nEpisodes increasing in frequency: initially ~weekly/monthly, now several times/day.\nLast few days: during episodes, difficulty holding coffee cup and drinking coffee; sensation of something in throat. No current dysphagia; no speech difficulty. No clear visual sx; wears glasses.\nCurrently asymptomatic; normally fit/well.\nConcerned by unexplained sx; internet search unhelpful. No personal ideas re cause.\nFHx: father had neck operation to reduce stroke risk.\nPrevious BP, cholesterol and diabetes checks reportedly normal. No PMH.\nMeds: aspirin 75 mg OD, self-initiated after father’s operation for perceived stroke/MI prevention; GP not aware/discussed risks.\nAllergy: penicillin.\nNon-smoker. Lives with wife. Works as doctor in plastic surgery.\nObjective\nRemote consultation; video connection poor/unavailable. Pt agreed to continue by audio.\nNo in-person/visual neurological examination documented.\nAssessment\nRecurrent transient focal neurological sx involving R hand/arm and leg, with reported gait change and recent episodic difficulty holding/drinking from cup.\nClinician concern for TIA/“mini-stroke”; urgent exclusion required given focal episodic sx and FHx of stroke-related vascular disease.\nCurrently symptom-free; no current dysphagia or speech difficulty reported.\nPlan\nUrgent referral to TIA/stroke clinic to be sent; expected assessment within 1–2 days/Thu–Fri.\nExplained clinic may perform carotid ultrasound and possibly brain scan, alongside other tests to exclude stroke/TIA.\nIf sx recur and persist/prolong, attend A&E urgently due concern for possible stroke.\nMay contact service by phone if sx recur for assessment/advice.\nAdvised to chase hospital/TIA clinic appointment via provided contact details if not contacted or if appointment delayed/unable to attend.","review":207.78947368421052,"saved":278.2105263157895,"faster":57.24496426250813,"clean":false,"effort":10.869565217391305,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","\"episodic fatigue\" noted but not that it began with a couple of days of tiredness then normal."],["partial","No personal history of stroke or mini-stroke (TIA).","\"No PMH\" implies but does not specifically state no prior stroke/TIA."],["partial","TIA clinic may do a brain scan to check for a bleed.","\"possibly brain scan\" captured but purpose (check for bleed) omitted."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not an immediate emergency."],["partial","TIA clinic and PALS contact numbers to be left in the consultation notes.","\"via provided contact details\" – TIA clinic/PALS numbers in notes not specified."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Chasing clinic mentioned only if not contacted/delayed; this afternoon/tomorrow confirmation call not captured."],["fabrication","Advised to chase hospital/TIA clinic appointment via provided contact details if not contacted or if appointment delayed/unable to attend.","Clinician said to contact the practice (not the clinic) if there is a delay, not called, or unable to attend; ringing the clinic was to confirm the referral today/tomorrow."]],"mb":11.025064,"latency":23.243,"finalised":231.03247368421052},{"label":"Run 5","wer":9.322033898305085,"text":"All right, good morning. I'm Dr. Gideon Miller from QPM; nice to see you.\n\n  Thanks.\n\n  Okay, so, um, before we start your appointment, could I confirm your full name and date of birth, please?\n\n  Yeah, it's John Smith, and I— I'm 32 years old.\n\n  Sorry, I didn't catch your date of birth.\n\n  I'm 32 years old.\n\n  32 years old, okay. Could you tell me the first line of your address and your postcode, please?\n\n  Uh, it's 4 Park Avenue, and it's AB1 CB2.\n\n  That's great, thank you so much for that. Are you in a private place where you're okay to speak at the moment?\n\n  Yeah.\n\n  Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n\n  Sorry, say that again.\n\n  How can I help you today?\n\n  So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it.\n\n  Okay. So tell me a bit more about these weird symptoms you've been having.\n\n  So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I get pins and needles, and—\n\n  Right. So what— so just to say it again, the connection's not so great. You've been getting pins and needles in the hand, is that right?\n\n  Yeah, that's correct.\n\n  Okay. Is that the right or left hand?\n\n  My right hand.\n\n  Is it always the right?\n\n  Yes.\n\n  Okay. Um, with lots of video now, maybe is a, a, a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\n\n  Yes, that's fine.\n\n  All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\n\n  Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts 3 days, and then goes back to normal. So it's very weird.\n\n  Right, okay. And is it any involvement of your leg at all?\n\n  Uh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days or 3 or 4 days.\n\n  Okay. You— you said you've been having weird symptoms for about a month.\n\n  Yes.\n\n  So— so what has been happening from the beginning of the month? What else has been happening?\n\n  Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\n\n  Right. Okay. Um, and, um, you. Know, your colleague said you've— you've not been walking normally.\n\n  Yes.\n\n  Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker, And, you know, you— the abnormal gait, has that been present outside of these episodes? No. It has not.\n\n  Right.\n\n  So normally I'm fit and well, actually.\n\n  All right. Okay. Um, and these— these episodes, how often have they been happening?\n\n  They have been getting more regular. So at the start it would be maybe once a week, uh, to every once— once a month, but now it's getting a couple of times a day.\n\n  Right, okay. And how long have these episodes been going on for? When— when did it all start? Is it—\n\n  It might be a month and a half, maybe 2 months.\n\n  Right, okay. Okay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems?\n\n  So, recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink, and that's only been in the last couple of days, I guess.\n\n  Right. Is that— during these episodes, or outside of these episodes?\n\n  Only during the episodes.\n\n  Okay. Do you have any difficulty swallowing at all?\n\n  Not currently, no.\n\n  Okay. During the episodes, do you have any difficulty swallowing?\n\n  I— I— I feel like there's something in my throat.\n\n  Okay. What about, um, difficulty speaking during these episodes? Any— any issues with that at all?\n\n  No, I can speak fine.\n\n  Okay. And any visual problems during these episodes?\n\n  I don't think so, but I wear glasses.\n\n  Okay. All right. Now, um, can I just ask, has— is there any history of stroke or mini-strokes in your family?\n\n  Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n\n  Right, okay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n\n  No, so after my dad had his operation, I was required to be checked, and my cholesterol was fine, So you had a— a blood test done. And did they check for diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay.\n\n  Fantastic. Okay. Now, do you have any other illnesses at all?\n\n  No.\n\n  No. Are you on any medication?\n\n  I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\n\n  Okay. So— so why is that? Why did you take that?\n\n  I think it's meant to reduce your risk of stroke and heart attack.\n\n  Okay. Do you— have you ever told a doctor before your GP that you're on aspirin?\n\n  Yes, I took— I started taking it after my father had his operation.\n\n  Okay.\n\n  But that wasn't the doctor telling me.\n\n  Okay. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the— the GP in the past?\n\n  No.\n\n  I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment?\n\n  Yes, I am.\n\n  What do you work as?\n\n  Uh, I'm— I'm actually a doctor.\n\n  You're a med— a medical doctor?\n\n  Yes.\n\n  Okay. Uh, which specialty are you in?\n\n  I work in, uh, plastic surgery.\n\n  Plastic surgery. Okay, great. And, um, do you have any, um, allergies to any medication at all?\n\n  I'm allergic to penicillin only.\n\n  Okay. And, um, are you, um, living alone?\n\n  No, I live with my wife.\n\n  Wife. Okay. Um, fantastic. Uh, do you smoke at all?\n\n  No, I don't.\n\n  Right, okay. Um, that's fine. Now, obviously you're— you're a medic yourself, did you have any thoughts as to what might be going on?\n\n  Uh, I've absolutely got no idea.\n\n  Right, okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient— transient ischemic attacks. Um, and so that's something quite urgent, and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, and in fact what I am going to do is I'm going to refer you to a stroke— a TIA clinic. Um, now just to double-check, do you have the symptoms right now?\n\n  No, I'm perfectly fine at the moment.\n\n  Okay. So— so what I'm going to do is I'm going— I'm going to refer you to a mini-stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They— they'll usually call you in within the next 1 to 2 days.\n\n  Okay.\n\n  Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so, um, uh, basically the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're— we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking— they'll be doing the ultrasound of the carotid arteries, like your— your father had, um, and they'll be doing maybe a— they might do a scan of the brain as well, to see if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short timeframe, in order to exclude whether you have, um, any illness.\n\n  Sure.\n\n  You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E, okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke, and in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to the hospital in that instance, as soon as possible, okay?\n\n  Sure.\n\n  Now, if th— things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's— that's— that's not a problem. You know, you've got— you've got easy access to us.\n\n  Okay.\n\n  Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital, relatively soon. The hospital— you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to need that number in the notes for this consultation.\n\n  Okay.\n\n  Okay? So you'll have all the information you need to chase this appointment, and, um, if you want, you can ring them either today or tomorrow morning to— today in the afternoon, wait 1 or 2 hours, or tomorrow morning just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got them booked, and they're going to be calling you in, okay?\n\n  Great.\n\n  So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's— if there's any delay that transpires, for example, you can't make the appointment, or, you know, that you don't get called, something needs to be done. You need to be get— getting in contact back with us, okay?\n\n  Great.\n\n  All right. Did you have any questions at all?\n\n  No, I think that covers most of it.\n\n  Okay, great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should— um, you should be able to have— you should have the information at your hands to, in order to take things further, okay?\n\n  Great, thank you.\n\n  All the best. Take care then. Bye-bye.\n\n  Bye-bye.","marks":[[0,9,"Hi there.",false],[29,46,"Doctor",false],[52,55,"GP at Hand.",false],[77,92,"Hi. OK.",false],[227,233,"am thirty two",false],[446,454,"AB one CB two.",false],[701,707,".",false],[1218,1221,"guess",false],[1255,1281,"",false],[1517,1529,"we've lost",false],[1549,1549,"there",false],[1953,1954,"few",false],[2034,2036,"there",false],[2667,2667,"Can",false],[2934,2934,"Right .",false],[3295,3306,"a month ago probably",false],[3896,3901,".",false],[4705,4705,"Good excellent.",false],[5127,5130,"do",false],[5812,5815,"a",false],[6130,6141,"Right OK.",false],[6347,6357,"actually",false],[6501,6510,"",false],[6972,6980,"gonna",false],[6991,6996,"uh",false],[7002,7010,"gonna",false],[7704,7707,"your",false],[7726,7729,"check",false],[7823,7832,"time frame",false],[7892,7897,"OK whether",false],[7905,7912,"have",true],[7951,7951,"Sure.",false],[7999,8003,"they're",false],[8438,8440,"",false],[8625,8635,"you",false],[8840,8845,"can",false],[8881,8886,"PALS",false],[8953,8957,"leave",false],[9262,9266,"got time",false],[9353,9364,"in the books",false],[9406,9431,"OK.",false],[9736,9763,"",false],[9768,9778,"you",false],[9784,9791,"get",false],[9807,9807,"back",false],[9817,9832,"OK.",false],[10062,10066,"help",false],[10151,10165,"OK.",false],[10205,10231,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"~1.5–2/12 episodic\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","\"episodic fatigue\" noted but not that it began with a couple of days of tiredness then normal."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"right-hand pins/needles/numbness\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"right-hand pins/needles/numbness with subjective right arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"lasting ~3 days then resolving\"."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"Concurrent subjective leg weakness\"."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"abnormal gait noted by colleague\"."],["The note captures: Gait is normal outside the episodes.","yes","\"absent between episodes\"."],["The note captures: Generally feels tired and weak.","yes","\"fatigue, generalised weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"↓ motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"initially ~weekly to monthly\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"now several times/day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding coffee cup\"."],["The note captures: Drinking is slightly harder during episodes.","yes","\"and drinking\"."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"During recent episodes\"."],["The note captures: No difficulty swallowing currently.","yes","\"No dysphagia currently\"."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"throat sensation\" during recent episodes."],["The note captures: No difficulty speaking during episodes.","yes","\"no speech difficulty\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"No definite visual sx; wears glasses.\""],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"Asymptomatic at time of consultation.\""],["The note captures: No personal history of stroke or mini-stroke (TIA).","partial","\"PMH: none reported\" implies but does not specifically state no prior stroke/TIA."],["The note captures: Cholesterol previously checked and normal.","yes","\"cholesterol ... reportedly normal\"."],["The note captures: Previously screened for diabetes; normal.","yes","\"diabetes checks reportedly normal\"."],["The note captures: Blood pressure previously checked; normal.","yes","\"Previous BP ... normal\"."],["The note captures: No other illnesses; normally fit and well.","yes","\"normally fit/well\"; \"PMH: none reported\"."],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75 mg OD\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","\"self-initiated ... following father’s operation/internet reading; not GP-advised\"."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","\"not GP-advised/discussed\"."],["The note captures: Allergic to penicillin.","yes","\"Allergy: penicillin.\""],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father had neck operation to reduce stroke risk\"."],["The note captures: Non-smoker.","yes","\"Non-smoker.\""],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","\"video connection lost, continued without video ... No examination findings\"."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"TIA/mini-stroke considered\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","\"urgent exclusion required despite young age\" given FHx."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to TIA/stroke clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"within 1–2 days/Thursday–Friday\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"carotid artery ultrasound\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","\"brain scan\" captured but purpose (check for bleed) omitted."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"If sx recur and persist/prolong → attend A&E urgently.\""],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","\"May contact service by phone if sx recur for assessment/guidance.\""],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","no","Contact numbers left in notes not mentioned."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Chasing clinic mentioned only if not contacted/delayed; this afternoon/tomorrow confirmation call not captured."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"if not contacted, unable to attend, or delays occur\"."]],"claims":[["Advised to contact/chase hospital/TIA clinic if not contacted, unable to attend, or delays occur.","Clinician said to contact the practice (not the clinic) if there is a delay, not called, or unable to attend."]],"note":"Subjective\n~1.5–2/12 episodic fatigue, generalised weakness, nausea and ↓ motivation; normally fit/well.\nRecurrent right-hand pins/needles/numbness with subjective right arm weakness, lasting ~3 days then resolving.\nConcurrent subjective leg weakness and abnormal gait noted by colleague; absent between episodes.\nEpisodes initially ~weekly to monthly; now several times/day.\nDuring recent episodes: difficulty holding coffee cup and drinking; throat sensation. No dysphagia currently; no speech difficulty. No definite visual sx; wears glasses.\nConcerned by unexplained sx; no personal idea re cause.\nFHx: father had neck operation to reduce stroke risk.\nPrevious BP, cholesterol and diabetes checks reportedly normal.\nPMH: none reported. Meds: self-initiated aspirin 75 mg OD following father’s operation/internet reading; not GP-advised/discussed.\nAllergy: penicillin.\nNon-smoker. Lives with wife. Working as doctor in plastic surgery.\nObjective\nTelephone/video consultation; video connection lost, continued without video.\nAsymptomatic at time of consultation.\nNo examination findings documented.\nAssessment\nRecurrent transient focal neurological sx: right-hand sensory disturbance, subjective right arm/leg weakness and intermittent gait change, with recent difficulty holding/drinking from cup and throat sensation.\nTIA/mini-stroke considered due to transient focal unilateral sx and FHx; urgent exclusion required despite young age and reportedly normal vascular risk screening.\nIf sx persist/prolong, concern for stroke requiring emergency assessment.\nPlan\nUrgent referral to TIA/stroke clinic planned; expected assessment within 1–2 days/Thursday–Friday.\nExplained clinic may arrange carotid artery ultrasound, brain scan and other investigations to exclude stroke/TIA.\nIf sx recur and persist/prolong → attend A&E urgently.\nMay contact service by phone if sx recur for assessment/guidance.\nAdvised to contact/chase hospital/TIA clinic if not contacted, unable to attend, or delays occur.","review":208.06578947368422,"saved":277.9342105263158,"faster":57.18810916179336,"clean":false,"effort":11.956521739130435,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","\"episodic fatigue\" noted but not that it began with a couple of days of tiredness then normal."],["partial","No personal history of stroke or mini-stroke (TIA).","\"PMH: none reported\" implies but does not specifically state no prior stroke/TIA."],["partial","TIA clinic may do a brain scan to check for a bleed.","\"brain scan\" captured but purpose (check for bleed) omitted."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not an immediate emergency."],["missing","TIA clinic and PALS contact numbers to be left in the consultation notes.","Contact numbers left in notes not mentioned."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Chasing clinic mentioned only if not contacted/delayed; this afternoon/tomorrow confirmation call not captured."],["fabrication","Advised to contact/chase hospital/TIA clinic if not contacted, unable to attend, or delays occur.","Clinician said to contact the practice (not the clinic) if there is a delay, not called, or unable to attend."]],"mb":10.925409,"latency":17.244,"finalised":225.30978947368422}],"heidi":[{"label":"Run 1","wer":11.069915254237287,"text":"I'm Dr. Goodman Han. Nice to see you. Okay. So, um, before we start your appointment, could I confirm your full name and date of birth, please? Yes, John Smith, and I am thirty-two years old.\n\nSo I did that's your date of birth? I'm thirty-two years old. Thirty-two years old. Okay. Could you tell me the first line of your address and your postcode, please? It's Four Park Avenue, and it's AB1, CB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've been having some problems with your action, is that right?\n\nSorry. Say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I just know what's causing them. I have Googled it, and, um, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling like hands and arms. I get a weird sensation like, uh, I get pins and needles. Right. And so you're just telling again, the connection is not so great. You've been getting pins and needles in the hand. Is that right?\n\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yeah. Okay. Um, we've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yeah, that's fine. All right. Um, so you've been having these pins and needles, episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts a few days and then goes back to normal. So it's very weird.\n\nRight. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You you said you've been having weird symptoms for about a month? Yeah. So so what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes.\n\nDo you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time I get my arm symptoms, my leg feels weaker. Right. Okay. And, you know, you the abnormal gait. Has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They've been getting more regular. So at the start, it would be maybe once a week to every once a once a month.\n\nBut now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When when did it all start? Is that maybe a month and a half, maybe two months? Right. Okay. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes.\n\nOkay. Do you have any difficulty swallowing at all? Not currently, no. Okay. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about difficulty speaking during these episodes? Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck.\n\nTo reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication?\n\nI take an aspirin seventy-five milligrams once a day, but that's because of something I read on the internet. Okay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do, have you ever told a doctor before your GP that you're on aspirin? Yes, I took-- I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. A- and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G- the GP in the past? No, I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh-\n\nYour kind of social situation. Are you working at the moment? Yes, I am. What do you work as? I'm I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Wife. Okay. Fantastic. Do you smoke at all? No. I don't.\n\nRight. Okay. Um, that's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? Uh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient, transient ischemic attacks. Um, and so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, in fact, what I am going to do, is I'm going to refer you to a stroke, a TIA clinic.\n\nUm, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm gonna do is I'm gonna, I'm gonna refer you to a, a mini-stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next one to two days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically the deadline should be Thursday, Friday. We're expecting you to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking-- they'll be doing that ultrasound of the carotid arteries like what your father had. Um, and they'll be doing, maybe a-- they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame.\n\nIn order to exclude whether you have any illness or you haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they're prolonged, then you may need to attend to A ⁇ E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. Okay? And if a mini stroke is prolonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to the hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the floor. We can give you direction and guidance over the time. That's not the problem. You know, you've you've got easy access to us. Okay. So this is the plan going forward. I'm going to\n\nDo that referral. You should hear back from the hospital relatively soon. The hospital, you could actually ring them on, um, uh, the PALS number, and then there's also the GIA clinic number. I'm going to put that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning, tomorrow, today in the afternoon. Wait one or two hours or tomorrow morning, just to find out one day of plan to slot you in and just to make sure they've got you in the system that they've got in the books and they're going to be calling you in. Okay? Great. So, um, this isn't an immediate emergency that you need to rush down to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to be getting in contact back with us. Okay. Great. All right. Did you have any questions at all?\n\nNo, I think that covers most of it. Okay, great. So just bear with me a few minutes, and then I'll send that all through, and then you should, um, you should be able to have-- you should have the information at your hands to, in order to take things further, okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye.","marks":[[0,0,"Hi there. Good morning.",false],[4,20,"Doctor from GP at Hand.",false],[38,43,"Hi. OK.",false],[144,147,"Yeah it's",false],[193,195,"Sorry",false],[198,208,"didn't catch",false],[391,400,"AB one CB two.",false],[596,602,"asthma.",false],[636,642,".",false],[753,757,"don't",true],[1079,1083,"in my",false],[1136,1139,"guess",false],[1165,1191,"",false],[1203,1216,"connection's",false],[2526,2526,"Can",false],[2799,2813,"Right . All right OK. Um",false],[2876,2883,"They have",false],[3128,3141,"Was it a month ago probably",false],[3706,3711,".",false],[4026,4040,"OK all right.",false],[4531,4535,"for",false],[5163,5171,"OK. Uh",false],[5291,5293,"",false],[5787,5798,"Right OK. Um",false],[5988,5998,"actually",false],[6128,6137,"",false],[6620,6625,"uh",false],[7249,7253,"your",false],[7331,7334,"your",false],[7513,7515,"OK whether",false],[7520,7527,"have",true],[7554,7566,"mini-stroke. Sure.",false],[8114,8120,"phone",false],[8169,8174,"phone. That's that's",false],[8209,8215,"you",false],[8393,8398,"can",false],[8473,8476,"TIA",false],[8505,8508,"leave",false],[8708,8716,"",false],[8802,8817,"when they got time",false],[8955,8974,"OK.",false],[9040,9043,"A and E.",false],[9267,9294,"",false],[9299,9317,"you get get",false],[9333,9333,"back",false],[9343,9355,"OK.",false],[9572,9578,"help",false],[9662,9674,"OK.",false],[9710,9724,"now.",false],[9729,9729,"bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'Onset approx 1.5–2 months ago'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'Initially tiredness for a few days, then resolved'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles and numbness in right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Hand paraesthesia with 'right arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'lasting a few days then normalising'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'concurrent leg weakness'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'abnormal gait noted by colleague'."],["The note captures: Gait is normal outside the episodes.","yes","'present only during episodes'."],["The note captures: Generally feels tired and weak.","yes","'General tiredness, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'reduced desire for activity'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially once weekly to monthly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now a couple of times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'Difficulty holding cup'."],["The note captures: Drinking is slightly harder during episodes.","yes","'slight difficulty drinking coffee'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'over last couple of days, only during episodes'."],["The note captures: No difficulty swallowing currently.","no","Current swallowing status not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","'something in throat' during episodes."],["The note captures: No difficulty speaking during episodes.","yes","'no difficulty speaking'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'no visual problems (wears glasses)'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Currently asymptomatic'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","Not documented."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","BP normal."],["The note captures: No other illnesses; normally fit and well.","no","No statement of no other illnesses."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-prescribed for stroke/heart attack risk reduction'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'not previously discussed with GP'."],["The note captures: Allergic to penicillin.","yes","Penicillin."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father had carotid artery surgery to reduce stroke risk'."],["The note captures: Non-smoker.","yes","Non-smoker."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Video loss/no examination not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Transient Ischaemic Attack (TIA) / mini-stroke'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","'Urgent referral' but no rationale about FHx/young age."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'contacts within 1–2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid artery ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'possible brain scan' without bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E immediately if symptoms return, persist or are prolonged'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not documented."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Phone assessment by practice on recurrence not documented."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'PALS or TIA clinic number provided in notes'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","Follow up with clinic 'by today afternoon or tomorrow morning'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","partial","'re-contact clinic' refers to the TIA clinic rather than the practice."]],"claims":[["Advised to re-contact clinic if any delays or issues with appointment.","Doctor said to get back in contact with the practice (us) if there is any delay, not the TIA clinic."]],"note":"Subjective:\n\n- 32yo male, plastic surgery doctor, presents with \"weird symptoms\" over past month, worsening.\n\n- Initially tiredness for a few days, then resolved.\n\n- Subsequent episodes: pins and needles and numbness in right hand; right arm weakness lasting a few days then normalising; concurrent leg weakness; abnormal gait noted by colleague, present only during episodes.\n\n- General tiredness, weakness, nausea, reduced desire for activity.\n\n- Difficulty holding cup and slight difficulty drinking coffee over last couple of days, only during episodes.\n\n- Sensation of \"something in throat\" during episodes; no difficulty speaking; no visual problems (wears glasses).\n\n- Episodes initially once weekly to monthly, now a couple of times daily.\n\n- Onset approx 1.5–2 months ago.\n\n- Currently asymptomatic.\n\n- PMHx: previous bloods (diabetes, BP, cholesterol) reported normal.\n\n- FHx: father had carotid artery surgery to reduce stroke risk.\n\n- Meds: aspirin 75mg daily (self-prescribed for stroke/heart attack risk reduction, not previously discussed with GP).\n\n- Allergies: penicillin.\n\n- Social: lives with wife; non-smoker.\n\n\n\n\nObjective:\n\n- Asymptomatic at time of consultation.\n\n\n\n\nAssessment:\n\n- Transient Ischaemic Attack (TIA) / mini-stroke.\n\n\n\n\nPlan:\n\n- Urgent referral to TIA clinic, to be sent today.\n\n- Advised clinic usually contacts within 1–2 days.\n\n- Anticipated carotid artery ultrasound and possible brain scan at clinic.\n\n- Advised to attend A&E immediately if symptoms return, persist or are prolonged (possible stroke).\n\n- Advised to contact clinic (PALS or TIA clinic number provided in notes) to follow up appointment if no contact by today afternoon or tomorrow morning.\n\n- Advised to re-contact clinic if any delays or issues with appointment.\n\n- No current symptoms.\n\n- No questions.","review":257.2105263157895,"saved":228.78947368421052,"faster":47.07602339181287,"clean":false,"effort":18.478260869565215,"sig":[["missing","No difficulty swallowing currently.","Current swallowing status not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","Not documented."],["missing","No other illnesses; normally fit and well.","No statement of no other illnesses."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Video loss/no examination not documented."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","'Urgent referral' but no rationale about FHx/young age."],["partial","TIA clinic may do a brain scan to check for a bleed.","'possible brain scan' without bleed purpose."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not documented."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Phone assessment by practice on recurrence not documented."],["partial","If there is any delay (not called or cannot make the appointment), contact the practice again.","'re-contact clinic' refers to the TIA clinic rather than the practice."],["fabrication","Advised to re-contact clinic if any delays or issues with appointment.","Doctor said to get back in contact with the practice (us) if there is any delay, not the TIA clinic."]],"mb":40.240346,"latency":29.729,"finalised":286.93952631578946},{"label":"Run 2","wer":10.434322033898304,"text":"Hi there. Good morning. I'm Dr. Good Miller from PTSD. Nice to see you. Okay. So, um, before we start your appointment, can I confirm your full name and Dr. Bird, please? Yes, John Smith, and I am thirty-fifty-two years old.\n\nSo I did that date of birth? I'm thirty-two years old. Thirty-two years old. Okay. Could you tell me the first line of your address and your postcode, please? It's Four Park Avenue, and it's AB1, CB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've been having some problems with your action, is that right?\n\nSorry. Say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it. Okay, so tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling hands and arms. I get a weird sensation like, uh, I get pins and needles. Right. And just tell me again, the connection is not so great. You've been getting pins and needles in the hand. Is that right?\n\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yeah. Okay. Um, we've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yeah, that's fine. All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts a few days and then goes back to normal. So it's very weird.\n\nRight. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You you said you've been having weird symptoms for about a month? Yeah. So so what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally? Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n\nYes. So at the same time I get my arm symptoms, my leg feels weaker. Right. Okay. And, you know, you the abnormal gait. Has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week to every once a once a month, but now it's getting a couple of times a day.\n\nRight. Okay. And how long have these episodes been going on for? When when did it all start? Is that from a month and a half, maybe two months? Right. Okay. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes.\n\nOkay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about difficulty speaking during these episodes? Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck.\n\nTo reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication?\n\nI take an aspirin seventy-five milligrams once a day, but that's because of something I read on the internet. Okay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do, have you ever told a doctor before your GP that you're on aspirin? Yes, I took-- I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. A- and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G- the GP in the past? No, I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh-\n\nYour kind of social situation. Are you working at the moment? Yes, I am. What do you work as? I'm I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Wife. Okay. Fantastic. Do you smoke at all? No. I don't.\n\nRight. Okay. Um, that's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? Uh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient, transient ischemic attacks. Um, and so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, in fact, what I am going to do, is I'm going to refer you to a stroke, a TIA clinic.\n\nUm, now just to double check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm gonna do is I'm gonna, I'm gonna refer you to a, a mini stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next one to two days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically the deadline should be Thursday, Friday. We're expecting you to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking-- they'll be doing the ultrasound of the carotid arteries like your, your father had, um, and they'll be doing, uh, maybe a-- they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame.\n\nIn order to exclude whether you have any illness or you haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they're prolonged, then you may need to attend A ⁇ E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. Okay? And if a mini stroke is prolonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to the hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's that's that's not the problem. You know, you've you've got easy access to us. Okay? So this is the plan going forward. I'm going to\n\nDo that referral. You should hear back from the hospital relatively soon. The hospital, you could actually ring them on, um, uh, the PALS number, and then there's also the PIA clinic number. I'm going to put that number in the notes for this consultation. Okay, so you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning, tomorrow today in the afternoon, wait one or two hours, or tomorrow morning, just to find out when they have time to slot you in and just to make sure they've got you in the system that they've got in the books and they're going to be recording you in. Okay. Great. So, um, this isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called.\n\nSomething you know, you need to be get getting in contact back with us. Okay? Great. Alright. Did you have any questions at all? No. I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that all through, and then you should you should be able to have you should have the information at your hands in order to take things further. Okay? Great. Thank you. All the best. Take care then. Bye bye. Bye.","marks":[[28,43,"Doctor",false],[49,54,"GP at Hand.",false],[72,77,"Hi. OK.",false],[120,123,"Could",false],[153,161,"date of birth",false],[171,174,"Yeah it's",false],[197,213,"thirty two",true],[226,228,"Sorry",false],[231,239,"didn't catch your",false],[417,426,"AB one CB two.",false],[622,628,"asthma.",false],[662,668,".",false],[1108,1108,"in my",false],[1161,1164,"guess",false],[1190,1206,"",false],[1218,1231,"connection's",false],[2539,2539,"Can",false],[2813,2827,"Right . All right OK. Um",false],[3144,3156,"Was it a month ago probably",false],[4035,4049,"OK all right.",false],[4540,4544,"for",false],[5172,5180,"OK. Uh",false],[5300,5302,"",false],[5796,5807,"Right OK. Um",false],[5997,6007,"actually",false],[6137,6146,"",false],[6628,6633,"uh",false],[7343,7346,"your",false],[7525,7527,"OK whether",false],[7532,7539,"have",true],[7566,7578,"mini-stroke. Sure.",false],[8233,8239,"you",false],[8417,8422,"can",false],[8497,8500,"TIA",false],[8529,8532,"leave",false],[8732,8740,"",false],[8836,8840,"got",false],[8967,8976,"calling",false],[8985,9004,"OK.",false],[9070,9073,"A and E.",false],[9298,9307,"",false],[9312,9316,"",false],[9322,9332,"",false],[9337,9344,"get",false],[9360,9360,"back",false],[9370,9391,"OK. All right.",false],[9591,9595,"help",false],[9675,9687,"OK.",false],[9723,9728,"now.",false],[9738,9742,"",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past month' and 'Ongoing ~1.5-2 months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'Initially fatigue for a couple of days, then resolved'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'numbness and pins and needles in right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Hand paraesthesia and 'Right arm feels weaker during episodes'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","partial","Only gait described as 'lasting 3-4 days'; transient duration of episodes overall not clearly stated."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Leg weakness coinciding with arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Colleague noted abnormal gait'."],["The note captures: Gait is normal outside the episodes.","partial","Gait 'lasting 3-4 days' implies transience but normal gait outside episodes not stated."],["The note captures: Generally feels tired and weak.","yes","'General tiredness and weakness'."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'disinterest in activities'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially once weekly to monthly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now a couple of times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'slight difficulty drinking coffee'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recent ... during episodes only'."],["The note captures: No difficulty swallowing currently.","yes","'no current dysphagia'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'Sensation of something in throat during episodes'."],["The note captures: No difficulty speaking during episodes.","yes","'Denies dysarthria ... during episodes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'visual problems during episodes; wears glasses' denied."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Asymptomatic at time of consult'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","Not documented."],["The note captures: Cholesterol previously checked and normal.","no","Not documented."],["The note captures: Previously screened for diabetes; normal.","no","Not documented."],["The note captures: Blood pressure previously checked; normal.","no","Not documented."],["The note captures: No other illnesses; normally fit and well.","no","Not documented."],["The note captures: Takes aspirin 75 mg once daily.","no","Aspirin not documented."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","no","Not documented."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Not documented."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'family history of stroke' (accepted rendering)."],["The note captures: Non-smoker.","no","Smoking status not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'No examination performed (telehealth consult)' but loss of video not mentioned."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Concerned about TIA'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","TIA concern 'given ... family history of stroke' with urgent referral."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days (by Thursday/Friday)'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid artery ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'potentially brain scan' without bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend ED if symptoms return, persist or are prolonged'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","'No immediate emergency requiring ED attendance at present'."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'contact practice ... if symptoms recur for telephone assessment'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'Provided hospital PALS number and TIA clinic number'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'contact clinic today or tomorrow morning to confirm appointment'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact practice if any delay with TIA clinic appointment'."]],"claims":[],"note":"Subjective\n\n- Reports \"weird\" symptoms over past month\n\n- Initially fatigue for a couple of days, then resolved\n\n- Subsequently numbness and pins and needles in right hand\n\n- Right arm feels weaker during episodes\n\n- Colleague noted abnormal gait, lasting 3-4 days\n\n- General tiredness and weakness, occasional nausea, disinterest in activities\n\n- Leg weakness coinciding with arm symptoms\n\n- Episodes initially once weekly to monthly, now a couple of times daily\n\n- Ongoing ~1.5-2 months\n\n- Recent difficulty holding cup of coffee and slight difficulty drinking coffee, during episodes only\n\n- Sensation of something in throat during episodes; no current dysphagia\n\n- Denies dysarthria or visual problems during episodes; wears glasses\n\n- Asymptomatic at time of consult\n\n\n\n\nObjective\n\n- No examination performed (telehealth consult)\n\n\n\n\nAssessment\n\n- Concerned about TIA given episodic neurological symptoms and family history of stroke\n\n\n\n\nPlan\n\n- Urgent referral to TIA clinic\n\n- TIA clinic to conduct carotid artery ultrasound and potentially brain scan\n\n- Advised to attend within 1-2 days (by Thursday/Friday)\n\n- Counselled to attend ED if symptoms return, persist or are prolonged, as this could indicate a stroke\n\n- Provided hospital PALS number and TIA clinic number\n\n- Advised to contact clinic today or tomorrow morning to confirm appointment\n\n- Instructed to contact practice if any delay with TIA clinic appointment or if symptoms recur for telephone assessment and guidance\n\n- No immediate emergency requiring ED attendance at present","review":295.1578947368421,"saved":190.84210526315792,"faster":39.267922893653896,"clean":false,"effort":26.08695652173913,"sig":[["partial","Episodes are transient, lasting a few days (three or four days), then return to normal.","Only gait described as 'lasting 3-4 days'; transient duration of episodes overall not clearly stated."],["partial","Gait is normal outside the episodes.","Gait 'lasting 3-4 days' implies transience but normal gait outside episodes not stated."],["missing","No personal history of stroke or mini-stroke (TIA).","Not documented."],["missing","Cholesterol previously checked and normal.","Not documented."],["missing","Previously screened for diabetes; normal.","Not documented."],["missing","Blood pressure previously checked; normal.","Not documented."],["missing","No other illnesses; normally fit and well.","Not documented."],["missing","Takes aspirin 75 mg once daily.","Aspirin not documented."],["missing","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","Not documented."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Not documented."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Non-smoker.","Smoking status not documented."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'No examination performed (telehealth consult)' but loss of video not mentioned."],["partial","TIA clinic may do a brain scan to check for a bleed.","'potentially brain scan' without bleed purpose."]],"mb":40.443565,"latency":29.722,"finalised":324.87989473684206},{"label":"Run 3","wer":11.175847457627118,"text":"Hi there. Good morning. I'm Dr. Goodman from PTSD. Nice to see you. Okay. So, um, before we start your appointment, could I confirm your full name is Dr. Berkeley? Yeah, John Smith, and I am thirty-two years old.\n\nSo I do actually date of birth. I'm thirty two years old. Thirty two years old. Okay. Could you tell me the first line of your address and your postcode please? Four Park Avenue, and it's AB1, CB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've been having some problems with your action. Is that right?\n\nSorry. Say that in- How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feelings in my hands and arms. I get a weird sensation like, uh, I get pins and needles. Right. And- You-- So what, so you just tell the, the connection is not so great. You've been getting pins and needles in the hand, is that right?\n\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yeah. Okay. Um, we've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yeah, that's fine. All right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts a few days and then goes back to normal. So it's very weird.\n\nRight. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n\nYes. So at the same time I get my arm symptoms, my leg feels weaker. Right. Okay. And, you know, you the abnormal gait. Has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They've been getting more regular. So at the start, it would be maybe once a week to every once a once a month, but now it's getting a couple of times a day.\n\nRight. Okay. And how long have these episodes been going on for? When when did it all start? Is that a month and a half, maybe two months. Right. Okay. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes.\n\nOkay. Do you have any difficulty swallowing at all? Not currently, no. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about difficulty speaking during these episodes? Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your hominy? Yes. My father has had a operation to the side of his neck.\n\nTo reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check the diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication?\n\nI take an aspirin seventy-five milligrams once a day, but that's because of something I read on the internet. Okay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do- have you ever told a doctor before your GP that you're on aspirin? Yes, I took-- I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. A- and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G- the GP in the past? No, I haven't. You haven't? Okay. Um, all right. Um, now, um, in terms of your, uh-\n\nYour kind of social situation. Are you working at the moment? Yes, I am. What do you work as? I'm I'm actually a doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Wife. Okay. Fantastic. Do you smoke at all? No. I don't.\n\nRight. Okay. Um, that's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? Uh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transit, transient ischemic attacks. Um, and so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, in fact, what I am going to do, is I'm going to refer you to a stroke, a TIA clinic.\n\nUm, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm gonna do is I'm gonna, I'm gonna refer you to a, a mini-stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next one to two days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically, the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking-- they'll be doing the ultrasound of the carotid arteries like your, your father had, um, and they'll be doing, maybe they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame.\n\nIn order to exclude whether you have any illness or you have got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they're prolonged, then you may need to attend to A ⁇ E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. Okay? And if a mini stroke is prolonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the floor. We can give you direction and guidance over the time that's that's not the problem. You know, you've you've got easy access to us. Okay? So this is the plan going forward. I'm going to\n\nDo that referral. You should hear back from the hospital relatively soon. The hospital, you could actually ring them on, um, uh, the Pound's number, and then there's also the GIA clinic number. I'm going to put that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning, tomorrow, today in the afternoon, wait one or two hours, or tomorrow morning, just to find out one day at time to slot you in and just to make sure they've got you in the system that they've got in the books and they're going to be calling you in. Okay? Great. So, uh, this isn't an immediate emergency that you need to rush down to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to be get get in contact back with us. Okay? Great. All right. Did you have any questions at all?\n\nNo, I think that covers most of it. Okay, great. So just bear with me a few minutes, and then I'll send that all through, and then you should, uh, you should be able to have-- you should have the information at your hands to, in order to take things further, okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye-bye.","marks":[[28,39,"Doctor",false],[45,50,"GP at Hand.",false],[68,73,"Hi. OK.",false],[147,162,"and date of birth please",false],[168,168,"it's",false],[214,216,"Sorry",false],[219,230,"didn't catch your",false],[373,373,"It's",false],[402,411,"AB one CB two.",false],[607,614,"asthma.",false],[647,650,".",false],[1083,1091,"feeling",false],[1150,1153,"guess",false],[1179,1215,"again",false],[1221,1238,"connection's",false],[2546,2546,"Can",false],[2820,2834,"Right . All right OK. Um",false],[2897,2904,"They have",false],[3149,3156,"Was it a month ago probably",false],[3721,3724,".",false],[4039,4053,"OK all right.",false],[4133,4139,"family Uh",false],[4990,4999,"OK. Do",false],[5175,5183,"OK. Uh",false],[5303,5305,"",false],[5801,5812,"Right OK. Um",false],[6002,6012,"actually",false],[6142,6149,"",false],[6632,6637,"uh",false],[7336,7339,"your",false],[7518,7520,"OK whether",false],[7556,7568,"mini-stroke. Sure.",false],[8112,8118,"phone",false],[8167,8171,"phone. That's",false],[8213,8219,"you",false],[8397,8402,"can",false],[8438,8445,"PALS",false],[8480,8483,"TIA",false],[8512,8515,"leave",false],[8715,8723,"",false],[8810,8820,"when they got",false],[8963,8982,"OK.",false],[9048,9051,"A and E.",false],[9275,9302,"",false],[9307,9317,"you",false],[9341,9341,"back",false],[9351,9363,"OK.",false],[9580,9586,"help",false],[9670,9682,"OK.",false],[9718,9741,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"past month\" and \"Symptoms present for 1.5-2 months\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","\"Initial fatigue for a couple of days, then resolution\"."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"pins and needles in right hand\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"pins and needles in right hand\"; \"Right arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"lasting a few days, then returning to normal\"."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"Concurrent leg weakness with arm symptoms\"."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"Colleague observed altered gait\"."],["The note captures: Gait is normal outside the episodes.","yes","\"Abnormal gait confined to episodes\"."],["The note captures: Generally feels tired and weak.","yes","\"fatigue and weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"intermittent nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"lack of motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"initially once a week to once a month\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"now several times a day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding coffee cup\"."],["The note captures: Drinking is slightly harder during episodes.","yes","\"slight difficulty drinking\"."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"Recent onset (last couple of days) ... during episodes\"."],["The note captures: No difficulty swallowing currently.","no","Absence of current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"Sensation of something in throat during episodes\"."],["The note captures: No difficulty speaking during episodes.","yes","\"No difficulty speaking\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"No ... visual problems during episodes; wears glasses\"."],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"Asymptomatic at time of consult\"."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","\"no history of TIA/stroke\"."],["The note captures: Cholesterol previously checked and normal.","yes","\"cholesterol - all reported normal\"."],["The note captures: Previously screened for diabetes; normal.","yes","\"previously screened for diabetes ... normal\"."],["The note captures: Blood pressure previously checked; normal.","yes","\"BP ... normal\"."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / normally fit and well not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75mg daily\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","\"self-prescribed based on internet information to reduce stroke/heart attack risk\"."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","\"not previously discussed with GP\"."],["The note captures: Allergic to penicillin.","yes","\"Allergies: penicillin\"."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father had neck surgery to reduce stroke risk\"."],["The note captures: Non-smoker.","yes","\"non-smoker\"."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Lost video / remote consult with no examination not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"Concern for transient ischaemic attacks (TIAs)\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","Concern tied to \"family history of stroke\" with urgent referral/investigation."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to stroke/TIA clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"expected appointment within 1-2 days\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"carotid artery ultrasound\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","yes","\"potentially brain scan to exclude stroke or bleed\"."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"attend A&E immediately if symptoms return and persist/prolong\"."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","\"not an immediate emergency requiring A&E attendance but require urgent investigation\"."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","partial","\"contact practice if ... worsening of symptoms\" but phone assessment on recurrence not specified."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","partial","\"Provided clinic phone number\" – PALS number and leaving in notes omitted."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Phone number \"to confirm appointment details\" but this afternoon/tomorrow timing not captured."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"contact practice if any delays in appointment\"."]],"claims":[],"note":"Subjective:\n\n- 32yo male, medical doctor (plastic surgery), presents with unusual symptoms over past month, intensifying recently\n\n- Initial fatigue for a couple of days, then resolution\n\n- Subsequent pins and needles in right hand\n\n- Right arm weakness, lasting a few days, then returning to normal\n\n- Colleague observed altered gait, lasting 3-4 days\n\n- Concurrent leg weakness with arm symptoms\n\n- Episodes of fatigue and weakness; intermittent nausea and lack of motivation\n\n- Abnormal gait confined to episodes\n\n- Episodes increasing in frequency; initially once a week to once a month, now several times a day\n\n- Symptoms present for 1.5-2 months\n\n- Recent onset (last couple of days) difficulty holding coffee cup and slight difficulty drinking during episodes\n\n- Sensation of something in throat during episodes\n\n- No difficulty speaking or visual problems during episodes; wears glasses\n\n- Asymptomatic at time of consult\n\n- PMHx: previously screened for diabetes, BP and cholesterol - all reported normal; no history of TIA/stroke\n\n- Meds: aspirin 75mg daily (self-prescribed based on internet information to reduce stroke/heart attack risk; not previously discussed with GP)\n\n- Allergies: penicillin\n\n- FHx: father had neck surgery to reduce stroke risk\n\n- Social: lives with wife; non-smoker\n\n\n\n\nObjective:\n\n- Asymptomatic at time of consult\n\n\n\n\nAssessment:\n\n- Concern for transient ischaemic attacks (TIAs) given episodic neurological symptoms and family history of stroke\n\n\n\n\nPlan:\n\n- Urgent referral to stroke/TIA clinic (expected appointment within 1-2 days)\n\n- Investigations at clinic to include carotid artery ultrasound and potentially brain scan to exclude stroke or bleed\n\n- Counselled to attend A&E immediately if symptoms return and persist/prolong, as this could indicate a stroke (medical emergency)\n\n- Provided clinic phone number for follow-up and to confirm appointment details\n\n- Advised to contact practice if any delays in appointment or worsening of symptoms\n\n- Advised current symptoms are not an immediate emergency requiring A&E attendance but require urgent investigation","review":201.1184210526316,"saved":284.88157894736844,"faster":58.61760883690709,"clean":false,"effort":9.782608695652174,"sig":[["missing","No difficulty swallowing currently.","Absence of current swallowing difficulty not documented."],["missing","No other illnesses; normally fit and well.","No other illnesses / normally fit and well not stated."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Lost video / remote consult with no examination not documented."],["partial","If symptoms recur, can contact the practice for phone assessment and advice.","\"contact practice if ... worsening of symptoms\" but phone assessment on recurrence not specified."],["partial","TIA clinic and PALS contact numbers to be left in the consultation notes.","\"Provided clinic phone number\" – PALS number and leaving in notes omitted."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Phone number \"to confirm appointment details\" but this afternoon/tomorrow timing not captured."]],"mb":41.238939,"latency":29.37,"finalised":230.4884210526316},{"label":"Run 4","wer":10.752118644067798,"text":"Hi, Brian. Good morning. I'm Dr. Gen Miller from PTSD. Nice to see you. Okay, so, um, before we start your appointment, could I confirm your full name and direct birth, please? Yes, John Smith, and I am thirty-five-two years old.\n\nSo I do that's a date of birth. I'm thirty two years old. Thirty two years old. Okay. Could you tell me the first line of your address and your postcode? Four Park Avenue, and it's AB1, CB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak in a second? Yeah. Okay. So how can I help you today? You've been having some problems with your action. Is that right?\n\nSorry. Say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it. Okay. So tell me a little bit about these weird symptoms you've been having. So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling hands and arms. I get a weird sensation like, uh, I get pins and needles. Right. And again, the connection is not so great. You've been getting pins and needles in the hand. Is that right?\n\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yeah. Okay. Um, we've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yeah, that's fine. All right. Um, so you've been having these pins and needles and episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts a few days and then goes back to normal. So it's very weird.\n\nRight. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You you said you've been having weird symptoms for about a month? Yeah. So so what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n\nYes. So at the same time I get my arm symptoms, my leg feels weaker. Right. Okay. And, you know, you the abnormal gait. Has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They've been getting more regular. So at the start, it would be maybe once a week to every once a once a month, but now it's getting a couple of times a day.\n\nRight. Okay. And how long have these episodes been going on for? When when did it all start? Is that a month? A month and a half, maybe two months. Right. Okay. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes.\n\nOkay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about difficulty speaking during these episodes? Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck.\n\nTo reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check the diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication?\n\nI take an aspirin seventy-five milligrams once a day, but that's because of something I read on the internet. Okay. So, so why is that? Why did you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do- have you ever told a doctor before your GP that you're on aspirin? Yes, I took-- I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. A- and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G- the GP in the past? No, I haven't. You haven't? Okay. Um, all right. Um, now, um, in terms of your, uh-\n\nYour kind of social situation. Are you working at the moment? Yes, I am. What do you work as? I'm I'm actually a doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Wow. Okay. Fantastic. Do you smoke at all? No. I don't.\n\nRight. Okay. Um, that's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? Uh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient, transient ischemic attacks. Um, and so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, in fact, what I am going to do, is I'm going to refer you to a stroke, a TIA clinic.\n\nUm, now just to double check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm gonna do is I'm gonna, I'm gonna refer you to a, a mini stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next one to two days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking-- they'll be doing the ultrasound of the carotid arteries that your, your father had, um, and they'll be doing, maybe they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame.\n\nIn order to exclude whether you have any illness or you haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they're prolonged, then you may need to attend to A ⁇ E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. Okay? And if a mini stroke is prolonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to the hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the time, we can give you direction and guidance over the time. That's that's not the problem. You know, you've you've got easy access to us. Okay? So this is the plan going forward. I'm going to\n\nDo that referral. You should hear back from the hospital relatively soon. The hospital, you could actually ring them on, um, uh, the PALS number, and then there's also the GIA clinic number. I'm going to leave that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning, tomorrow, today in the afternoon, wait one or two hours, or tomorrow morning, just to find out one day of time to slot you in and just to make sure they've got you in the system, that they've got in the books and they're going to be calling you in. Okay? Great. So, um, this isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something you know, you need to be get get in contact back with us, okay? Great. All right. Did you have any questions at all?\n\nNo, I think that covers most of it. Okay, great. So just bear with me a few minutes, and then I'll send that all through, and then you should, um, you should be able to have-- you should have the information at your hands to, in order to take things further, okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye-bye.","marks":[[4,10,"there.",false],[29,43,"Doctor",false],[49,54,"GP at Hand.",false],[72,76,"Hi. OK.",false],[155,161,"date of",false],[177,180,"Yeah it's",false],[203,218,"thirty two",true],[231,233,"Sorry",false],[236,247,"didn't catch your",false],[383,383,"please It's",false],[412,421,"AB one CB two.",false],[518,542,"at the moment Yes. OK.",false],[615,622,"asthma.",false],[655,661,".",false],[921,927,"",false],[931,931,"more",false],[1103,1103,"in my",false],[1156,1159,"guess",false],[1200,1213,"connection's",false],[2525,2525,"Can",false],[2799,2813,"Right . All right OK. Um",false],[2876,2883,"They have",false],[3143,3143,"ago probably",false],[4022,4036,"OK all right.",false],[4888,4891,"do",false],[4974,4983,"OK. Do",false],[5159,5167,"OK. Uh",false],[5287,5289,"",false],[5785,5795,"Right OK. Um",false],[5985,5995,"actually",false],[6125,6134,"",false],[6616,6621,"uh",false],[7319,7322,"your",false],[7501,7503,"OK whether",false],[7508,7515,"have",true],[7542,7554,"mini-stroke. Sure.",false],[8102,8106,"phone",false],[8156,8161,"phone. That's",false],[8203,8209,"you",false],[8387,8392,"can",false],[8467,8470,"TIA",false],[8704,8712,"",false],[8799,8809,"when they got",false],[8953,8972,"OK.",false],[9038,9041,"A and E.",false],[9265,9274,"",false],[9279,9283,"",false],[9289,9299,"",false],[9323,9323,"back",false],[9333,9345,"OK.",false],[9562,9568,"help",false],[9652,9664,"OK.",false],[9700,9723,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over past 1.5-2 months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","'Initially fatigue for several days' but return to normal not stated and 'couple' became 'several'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'numbness and pins and needles in right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Pins and needles in right hand; 'Right arm feels weaker during episodes'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'lasts a few days then resolves'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","no","Leg weakness not mentioned."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Colleague noted abnormal gait'."],["The note captures: Gait is normal outside the episodes.","partial","'intermittent for 3-4 days' implies but does not state normal gait between episodes."],["The note captures: Generally feels tired and weak.","yes","'General fatigue, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'reduced motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'monthly -> weekly' - reasonable rendering of less-frequent start."],["The note captures: Episodes now occur a couple of times a day.","yes","'now a couple of times a day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding coffee cup'."],["The note captures: Drinking is slightly harder during episodes.","yes","'some difficulty drinking coffee'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recently ... during episodes only'."],["The note captures: No difficulty swallowing currently.","no","No current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","'something in my throat' during episodes."],["The note captures: No difficulty speaking during episodes.","yes","'Denies difficulty speaking'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'Denies ... visual problems'; 'Wears glasses'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Asymptomatic at time of consult'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not stated."],["The note captures: Cholesterol previously checked and normal.","no","Cholesterol check not documented."],["The note captures: Previously screened for diabetes; normal.","no","Diabetes check not documented."],["The note captures: Blood pressure previously checked; normal.","no","Blood pressure check not documented."],["The note captures: No other illnesses; normally fit and well.","no","Not documented."],["The note captures: Takes aspirin 75 mg once daily.","no","Aspirin not documented."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","no","Aspirin not documented."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Not documented."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'strong family history of stroke' (accepted)."],["The note captures: Non-smoker.","no","Smoking status not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'No examination performed (telehealth)' but video loss not noted."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Concerned re: TIA/mini stroke'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Family history and urgency present; young age not noted."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA/stroke clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days, ideally by Thursday/Friday'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid artery ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'possible brain scan' but bleed purpose not specified."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'If symptoms return and persist, attend A&E immediately'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","'urgent but not immediate emergency'."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Practice phone assessment if symptoms recur not captured."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'Provided PALS number and TIA clinic number'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'contact clinic later today or tomorrow morning to confirm'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","partial","'re-contact clinic if any delay' - unclear it means the practice."]],"claims":[["Advised to re-contact clinic if any delay in appointment or unable to attend","Clinician said to get back in contact with the practice ('with us'), not the TIA clinic."]],"note":"Subjective:\n\n- Intermittent unusual symptoms over past 1.5-2 months\n\n- Initially fatigue for several days, then episodes of numbness and pins and needles in right hand\n\n- Right arm feels weaker during episodes; lasts a few days then resolves\n\n- Colleague noted abnormal gait, intermittent for 3-4 days\n\n- General fatigue, weakness, occasional nausea, reduced motivation\n\n- Episodes increasing in frequency: monthly → weekly → now a couple of times a day\n\n- Recently difficulty holding coffee cup and some difficulty drinking coffee, during episodes only\n\n- Sensation of \"something in my throat\" during episodes\n\n- Denies difficulty speaking or visual problems during episodes\n\n- Wears glasses\n\n- Asymptomatic at time of consult\n\n\n\n\nObjective:\n\n- No examination performed (telehealth consultation)\n\n\n\n\nAssessment:\n\n- Concerned re: TIA/mini stroke given intermittent neurological symptoms and strong family history of stroke\n\n\n\n\nPlan:\n\n- Urgent referral to TIA/stroke clinic, sent today\n\n- Anticipate appointment within 1-2 days, ideally by Thursday/Friday\n\n- Clinic likely to perform carotid artery ultrasound and possible brain scan to exclude cerebrovascular event\n\n- If symptoms return and persist, attend A&E immediately as prolonged symptoms may indicate stroke\n\n- Provided PALS number and TIA clinic number for follow-up/chasing appointment\n\n- Advised to contact clinic later today or tomorrow morning to confirm referral received and appointment scheduled\n\n- Emphasised urgent but not immediate emergency; attend A&E only if symptoms persist/worsen\n\n- Advised to re-contact clinic if any delay in appointment or unable to attend","review":397.88157894736844,"saved":88.11842105263156,"faster":18.13136235650855,"clean":false,"effort":36.95652173913043,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","'Initially fatigue for several days' but return to normal not stated and 'couple' became 'several'."],["missing","Leg feels weaker at the same time as the arm symptoms.","Leg weakness not mentioned."],["partial","Gait is normal outside the episodes.","'intermittent for 3-4 days' implies but does not state normal gait between episodes."],["missing","No difficulty swallowing currently.","No current swallowing difficulty not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not stated."],["missing","Cholesterol previously checked and normal.","Cholesterol check not documented."],["missing","Previously screened for diabetes; normal.","Diabetes check not documented."],["missing","Blood pressure previously checked; normal.","Blood pressure check not documented."],["missing","No other illnesses; normally fit and well.","Not documented."],["missing","Takes aspirin 75 mg once daily.","Aspirin not documented."],["missing","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","Aspirin not documented."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Not documented."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Non-smoker.","Smoking status not documented."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'No examination performed (telehealth)' but video loss not noted."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Family history and urgency present; young age not noted."],["partial","TIA clinic may do a brain scan to check for a bleed.","'possible brain scan' but bleed purpose not specified."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Practice phone assessment if symptoms recur not captured."],["partial","If there is any delay (not called or cannot make the appointment), contact the practice again.","'re-contact clinic if any delay' - unclear it means the practice."],["fabrication","Advised to re-contact clinic if any delay in appointment or unable to attend","Clinician said to get back in contact with the practice ('with us'), not the TIA clinic."]],"mb":40.640469,"latency":29.381,"finalised":427.2625789473684},{"label":"Run 5","wer":10.805084745762713,"text":"Hi, Brian. Good morning. I'm Dr. Good Miller from PTSD. Nice to see you. Okay. So, um, before we start your appointment, could I confirm your full name and doctor, please? Yeah, John Smith, and I am thirty-five two years old.\n\nSo I do that's a date of birth? I'm thirty-two years old. Thirty-two years old. Okay. Could you tell me the first line of your address and your postcode, please? It's Four Park Avenue, and it's AB1, CB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak in a please? Yeah. Okay. So how can I help you today? You've been having some problems with your action, is that right?\n\nSorry. Say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I just know what's causing them. I have Googled it, and, um, nothing's coming up, so I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling in my hands and arms. I get a weird sensation like, uh, I get pins and needles. Right. And what so just here again? The connection is not so great. You've been getting pins and needles in the hand. Is that right?\n\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yeah. Okay. Um, we've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yeah, that's fine. All right. Um, so you've been having these pins and needles and episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? Uh, the pins and needles are in the hand, but I feel like my arm is getting weaker, but it only lasts three days and then goes back to normal. So it's very weird.\n\nRight. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n\nYes. So at the same time I get my arm symptoms, my leg feels weaker. Right. Okay. And, you know, you the abnormal gait. Has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They've been getting more regular. So at the start, it would be maybe once a week to every once a once a month, but now it's getting a couple of times a day.\n\nRight. Okay. And how long have these episodes been going on for? When when did it all start? Is that maybe a month and a half, maybe two months? Right. Okay. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes.\n\nOkay. Do you have any difficulty swallowing at all? Not currently, no. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about difficulty speaking during these episodes? Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck.\n\nTo reduce the risk of stroke? Right. Okay. Um, and, uh, how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a blood test done. And did they check the diabetes as well? They checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Now, do you have any other illnesses at all? No. No. Are you on any medication?\n\nI take an aspirin seventy-five milligrams once a day, but that's because of something I read on the internet. Okay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do- have you ever told a doctor before your GP that you're on aspirin? Yes, I took-- I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. A- and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G- the GP in the past? No, I haven't. You haven't? Okay. Um, all right. Um, now, um, in terms of your, uh-\n\nYour kind of social situation. Are you working at the moment? Yes, I am. What do you work as? I'm I'm actually a doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Wife. Okay. Fantastic. Do you smoke at all? No. I don't.\n\nRight. Okay. Um, that's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? Uh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient, transient ischemic attacks. Um, and so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do, in fact, what I am going to do is I'm going to refer you to a stroke, a TIA clinic.\n\nUm, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm gonna do is I'm gonna, I'm gonna refer you to a, a mini stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They, they'll usually call you in within the next one to two days, okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking-- they'll be doing the ultrasound of the carotid arteries like your, your father had, um, and they'll be doing, maybe they might do a scan of the brain as well to check if there's any signs of a bleed there. Okay. But, um, they'll be doing a range of tests in a short time frame.\n\nIn order to exclude whether you have any illness or you haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they're prolonged, then you may need to attend A ⁇ E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. Okay? And if a mini stroke is prolonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the floor. We can give you direction and guidance over the floor. That's that's not a problem. You know, you've you've got easy access to us. Okay? So this is the plan going forward. I'm going to\n\nDo that referral. You should hear back from the hospital relatively soon. The hospital, you could actually ring them on, um, uh, the PALS number, and then there's also the GIA clinic number. I'm going to leave that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning, tomorrow, today in the afternoon, wait one or two hours, or tomorrow morning, just to find out one day of time to slot you in and just to make sure they've got you in the system that they've got in the books and they're going to be calling you in. Okay? Great. So, um, this isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to be getting in contact back with us. Okay? Great. All right. Did you have any questions at all?\n\nNo, I think that covers most of it. Okay, great. So just bear with me a few minutes, and then I'll send that all through, and then you should, um, you should be able to have-- you should have the information at your hands to, in order to get things further, okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye.","marks":[[4,10,"there.",false],[29,44,"Doctor",false],[50,55,"GP at Hand.",false],[73,78,"Hi. OK.",false],[156,162,"date of birth",false],[176,176,"it's",false],[199,210,"thirty",true],[227,229,"Sorry",false],[232,243,"didn't catch your",false],[421,430,"AB one CB two.",false],[527,551,"at the moment Yes. OK.",false],[624,630,"asthma.",false],[664,670,".",false],[781,785,"don't",true],[1168,1171,"guess",false],[1197,1218,"",false],[1230,1243,"connection's",false],[1869,1874,"few",false],[2555,2555,"Can",false],[2829,2843,"Right . All right OK. Um",false],[2906,2913,"They have",false],[3158,3171,"Was it a month ago probably",false],[3736,3739,".",false],[4054,4068,"OK all right.",false],[5013,5022,"OK. Do",false],[5198,5206,"OK. Uh",false],[5326,5328,"",false],[5824,5835,"Right OK. Um",false],[6025,6035,"actually",false],[6165,6174,"",false],[6656,6661,"uh",false],[7359,7362,"your",false],[7547,7549,"OK whether",false],[7554,7561,"have",true],[7588,7600,"mini-stroke. Sure.",false],[8141,8147,"phone",false],[8196,8202,"phone. That's",false],[8242,8248,"you",false],[8426,8431,"can",false],[8506,8509,"TIA",false],[8743,8751,"",false],[8838,8848,"when they got",false],[8991,9010,"OK.",false],[9076,9079,"A and E.",false],[9303,9330,"",false],[9335,9353,"you get get",false],[9369,9369,"back",false],[9379,9391,"OK.",false],[9608,9614,"help",false],[9677,9680,"take",false],[9697,9709,"OK.",false],[9745,9759,"now.",false],[9764,9764,"bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past month' and 'over past 1.5-2 months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'Initially fatigue for a couple of days, then resolved'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles in right hand and episodes of numbness'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Pins and needles in right hand; 'Right arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'lasting ~3 days then resolving'; gait changes 3-4 days."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Leg feels weaker during episodes, coinciding with arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Gait changes noted by colleague'."],["The note captures: Gait is normal outside the episodes.","no","Normal gait outside episodes not stated."],["The note captures: Generally feels tired and weak.","yes","'General tiredness, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'reduced motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'from once a month' - acceptable rendering of less-frequent start."],["The note captures: Episodes now occur a couple of times a day.","yes","'several times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding coffee cup ... during episodes'."],["The note captures: Drinking is slightly harder during episodes.","yes","'harder to drink coffee during episodes'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recent ... during episodes'."],["The note captures: No difficulty swallowing currently.","no","No current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","'something in my throat' during episodes."],["The note captures: No difficulty speaking during episodes.","yes","'No difficulty speaking during episodes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No visual problems during episodes'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Currently asymptomatic'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not stated."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol 'satisfactory'."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes 'satisfactory'."],["The note captures: Blood pressure previously checked; normal.","yes","BP 'satisfactory'."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / fit and well not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-initiated for stroke/heart attack risk reduction, not prescribed'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'not prescribed/discussed with GP'."],["The note captures: Allergic to penicillin.","yes","'Allergies: penicillin'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father had carotid artery operation to reduce stroke risk'."],["The note captures: Non-smoker.","yes","'non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Lost video / no examination not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Symptoms suggestive of TIAs/mini strokes'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","'Concerning given family history of stroke' but young age not noted."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","no","Expected 1-2 day timeframe not documented."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid artery ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'potentially brain scan' without purpose (bleed)."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'If symptoms return and persist, attend A&E immediately'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","'Not an immediate emergency currently' with urgent referral."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","partial","'If ... symptoms worsen, contact back' - no phone assessment/advice detail."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'Provided PALS and TIA clinic contact numbers'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'contact clinic today or tomorrow morning to confirm booking'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'If any delay in appointment ... contact back'."]],"claims":[],"note":"Subjective\n\n- Reports varied symptoms over past month\n\n- Initially fatigue for a couple of days, then resolved\n\n- Subsequently pins and needles in right hand and episodes of numbness\n\n- Right arm weakness, lasting ~3 days then resolving\n\n- Gait changes noted by colleague, lasting 3-4 days\n\n- General tiredness, weakness, occasional nausea, reduced motivation\n\n- Leg feels weaker during episodes, coinciding with arm symptoms\n\n- Episodes increasing in frequency, from once a month to several times daily, over past 1.5-2 months\n\n- Recent difficulty holding coffee cup and harder to drink coffee during episodes\n\n- Sensation of \"something in my throat\" during episodes\n\n- No difficulty speaking during episodes\n\n- No visual problems during episodes\n\n- Currently asymptomatic\n\n- FHx: father had carotid artery operation to reduce stroke risk\n\n- PMHx: bloods (cholesterol, diabetes, BP) satisfactory after father's operation\n\n- Meds: aspirin 75mg daily (self-initiated for stroke/heart attack risk reduction, not prescribed/discussed with GP)\n\n- Allergies: penicillin\n\n- Social: medical doctor (plastic surgery), lives with wife, non-smoker\n\n\n\n\nObjective\n\n- Asymptomatic at time of consultation\n\n\n\n\nAssessment\n\n- Symptoms suggestive of TIAs/mini strokes\n\n- Concerning given family history of stroke\n\n\n\n\nPlan\n\n- Urgent referral to TIA clinic\n\n- TIA clinic to perform carotid artery ultrasound and potentially brain scan\n\n- If symptoms return and persist, attend A&E immediately (risk of prolonged TIA evolving into stroke)\n\n- Provided PALS and TIA clinic contact numbers to chase appointment\n\n- Advised to contact clinic today or tomorrow morning to confirm booking\n\n- Not an immediate emergency currently as asymptomatic\n\n- If any delay in appointment or symptoms worsen, contact back","review":239.13157894736844,"saved":246.86842105263156,"faster":50.79597141000649,"clean":false,"effort":16.304347826086957,"sig":[["missing","Gait is normal outside the episodes.","Normal gait outside episodes not stated."],["missing","No difficulty swallowing currently.","No current swallowing difficulty not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not stated."],["missing","No other illnesses; normally fit and well.","No other illnesses / fit and well not stated."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Lost video / no examination not documented."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","'Concerning given family history of stroke' but young age not noted."],["missing","Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","Expected 1-2 day timeframe not documented."],["partial","TIA clinic may do a brain scan to check for a bleed.","'potentially brain scan' without purpose (bleed)."],["partial","If symptoms recur, can contact the practice for phone assessment and advice.","'If ... symptoms worsen, contact back' - no phone assessment/advice detail."]],"mb":40.98475,"latency":28.364,"finalised":267.4955789473684}],"freed":[{"label":"Run 1","wer":14.671610169491526,"text":"Hi there, good morning, I'm Doctor Dean Miller from UK, I am, nice to hear you. Nice to meet you. Okay, so before we start your appointment, could I confirm your full name and date of birth please?\n  Yes, John Smith and I am 32 years old.\n  Sorry, I didn't catch your date of birth? I'm 32 years old. 32 years old, okay. Could you tell me the 1st line of your address and your postcode please? It's 4 Park Avenue, and it's AB1, CB2. That's great, thank you so much for that. Are you in a private place where you're okay to speak at this point? Yeah. Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n  Sorry, say that again?\n  How can I help you today?\n  So I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it and nothing's coming up, so I thought I'd come and speak to you about it. Okay, so tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired, but for a couple of days, and then I get back to normal. And then I started losing feeling in my hands and arms. I get all these sensations like I get pins and needles.\n  Right, and you, just to say again, the connection's not so great, you've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay, is that the right or left hand? My right hand. Is it always the right? Okay, we've lost video now, maybe is there a button you can press? Okay, are you happy for us to carry on without the video? I can't see you at the moment.\n  Yes, that's fine.\n  Alright, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand or does it go up the arm as well?\n  The pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts for 3 days and then goes back to normal, so it's very weird. Right, okay.\n  And is there any involvement of your leg at all?\n  My colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n  Okay. You said you've been having weird symptoms for about a month?\n  Yes.\n  So what has been happening from the beginning of the month? What else has been happening?\n  I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything.\n  Right. And you know your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker. Right, okay.\n  And you know the abnormal gait, has that been present outside of these episodes?\n  No, it has not. So normally I'm fit and well actually.\n  Alright, okay. And these episodes, how often have they been happening?\n  They have been getting more regular, so at the start it would be maybe once a week to every once a month, but now it's getting a couple of times a day. Right, okay.\n  And how long have these episodes been going on for? When did it all start? Probably a month and a half, maybe 2 months. Right, okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems.\n  So recently I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\n  Right. Is that during these episodes or outside of these episodes?\n  Only during the episodes. OK. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulties swallowing?\n  I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all?\n  No, I can speak fine.\n  Any visual problems during these episodes?\n  I don't think so, but I wear glasses. Okay, all right.\n  Now, can I just ask, is there any history of strokes or mini-strokes in your family?\n  Yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n  Right, okay. And how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n  No, so after my dad had his operation, I was required to be checked and my cholesterol was fine. Excellent, so you had a blood test done and did they check your diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic, okay.\n  Do you have any other illnesses at all? No. Are you on any medication? aspirin, 75 mg once a day, but that's because of something I read on the internet. Okay, so why is that, why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay, have you ever told a doctor before, your GP, that you're on aspirin? Yes, I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay, and has any GP ever spoken to you about... risks of aspirin and whether you should be on it or have you not told the GP in the past? No, I haven't. All right, now in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay, which specialty are you in? I work in plastic surgery. Plastic surgery, okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay, and are you living alone? No, I live with my wife. Okay, fantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Obviously you're a medic yourself, did you have any thoughts as to what might be going on? I've absolutely got no idea. Right, okay. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks, and so that's something quite urgent, and given that you've got a family history of stroke, even though you're quite young, I think is something that we need to exclude. So what I'm probably going to do, in fact what I am going to do, is I'm going to refer you to a stroke clinic, a TIA clinic. Now just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic. I send that referral off now and then you can attend them. They'll usually call you in within the next one or 2 days. because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing, maybe they might do a scan of the brain as well to show that there's any signs of a bleed there. They'll be doing a range of tests in a short time frame in order to exclude whether you have any illness, you've got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they're prolonged, then you may need to attend A and E, okay, because a presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or 2 days. We want you to go to hospital in that instance as soon as possible. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's not a problem. You've got easy access to us. Okay, so this is the plan going forward. through that referral, you should hear back from the hospital relatively soon. The hospital, you could actually ring them on the PALS number and then there's also the CIA clinic number. I'm going to leave that number in the notes for this consultation, okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning, today in the afternoon, wait one or 2 hours, or tomorrow morning, just to find out when they plan to slot you in. and just to make sure they've got you in the system and they've got the books and they're going to be quoting you in, okay? This isn't an immediate emergency that you need to rush out to any, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us, okay? All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have the information at your hands in order to take things further, okay? Great, thank you. All the best. Take care. Bye-bye.","marks":[[35,46,"",false],[52,60,"GP at Hand.",false],[70,74,"see",false],[80,102,"Hi. OK.",false],[200,203,"Yeah it's",false],[343,346,"first",false],[423,432,"AB one CB two.",false],[532,555,"the moment Yes. OK.",false],[669,674,".",false],[1142,1162,"a weird sensation",false],[1170,1173,"guess",false],[1201,1221,"",false],[1602,1609,"All right. Um",false],[1850,1855,"few",false],[2407,2407,"you've",false],[2514,2514,"Can",false],[2779,2793,"Right . All right OK. Um",false],[2797,2797,"these",false],[2943,2943,"once",false],[3075,3075,"when",false],[3092,3092,"Was it a month ago",false],[3698,3710,"difficulty",false],[3821,3821,"Any",false],[3999,3999,"has uh",false],[4025,4032,"stroke",false],[4402,4402,"Good",false],[4462,4466,"for",false],[4596,4601,"OK. Now",false],[4647,4647,"No.",false],[4673,4673,"I take an",false],[4684,4689,"seventy five milligrams",false],[4869,4873,"OK. Do",false],[4950,4950,"took I",false],[5196,5196,"You haven't OK. Um",false],[5223,5223,"your uh",false],[5316,5316,"Uh I'm uh",false],[5684,5684,"Now",false],[5694,5694,"you're a",false],[5781,5791,"actually",false],[6077,6079,"um it's",false],[6218,6224,"",false],[6358,6366,"gonna",false],[6377,6385,"uh I'm gonna",false],[6544,6546,"to",false],[6792,6792,"we're",false],[6936,6942,"arteries",false],[6947,6947,"your",false],[7017,7020,"your",false],[7038,7047,"check if",false],[7190,7196,"OK whether you have",false],[7235,7235,"Sure.",false],[7353,7354,"um our",false],[7447,7447,"then uh",false],[7677,7677,"OK. Sure.",false],[7827,7827,"that's that's",false],[7842,7842,"you know you",false],[7914,7921,"Um I'm going to um do",false],[8011,8016,"can",false],[8081,8084,"TIA",false],[8406,8410,"got time",false],[8529,8536,"calling",false],[8607,8610,"down",false],[8614,8617,"A and E.",false],[8711,8711,"if there's",false],[8830,8857,"",false],[8862,8869,"you get",false],[8889,8889,"back",false],[9090,9090,"um you should",false],[9101,9101,"help you should",false],[9170,9181,"OK.",false],[9219,9227,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","Episodic neurological symptoms 'over the past approximately 6 to 8 weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","Fatigue is described as part of the episodes but the initial couple of days of tiredness then return to normal is not captured as the onset."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'paresthesia in the right hand' and 'right hand numbness'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand consistently documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Paresthesia in the right hand with 'weakness in the right arm'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","Episodes 'last approximately 3 to 4 days before resolving completely'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","Weakness 'in the right arm and right leg' during episodes."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'A colleague has observed an abnormal gait during episodes'."],["The note captures: Gait is normal outside the episodes.","yes","'this is not present between episodes'."],["The note captures: Generally feels tired and weak.","yes","'general fatigue, weakness'."],["The note captures: Sometimes feels nauseous.","yes","Nausea documented."],["The note captures: Low motivation; does not feel like doing anything.","yes","'lack of motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially occurring once a week to once a month'."],["The note captures: Episodes now occur a couple of times a day.","yes","'increased in frequency to several times per day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","Difficulty 'holding a cup of coffee' during episodes."],["The note captures: Drinking is slightly harder during episodes.","yes","'and drinking from it' during episodes."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","Documented as during episodes, but the onset only in the last couple of days is not stated."],["The note captures: No difficulty swallowing currently.","yes","'He denies current difficulty swallowing'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'sensation of something in his throat' during episodes."],["The note captures: No difficulty speaking during episodes.","yes","'He denies difficulty speaking ... during episodes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","Denies visual problems during episodes; glasses omitted but immaterial."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Patient is currently asymptomatic'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","'no history of strokes or mini-strokes personally'."],["The note captures: Cholesterol previously checked and normal.","yes","'normal cholesterol'."],["The note captures: Previously screened for diabetes; normal.","yes","'diabetes screening' normal."],["The note captures: Blood pressure previously checked; normal.","yes","'blood pressure' normal."],["The note captures: No other illnesses; normally fit and well.","yes","'He denies any other illnesses' and feels fit and well between episodes."],["The note captures: Takes aspirin 75 mg once daily.","yes","'Aspirin 75 mg PO daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","Self-prescribed since father's surgery based on internet reading, but the purpose (reduce stroke/heart attack risk) is not stated."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'has not discussed the risks and benefits with a GP'."],["The note captures: Allergic to penicillin.","yes","Penicillin allergy listed."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","Father 'underwent carotid endarterectomy for stroke prevention'."],["The note captures: Non-smoker.","yes","'Non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'Objective N/A' implies no examination but the loss of video is not recorded."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","Assessment 'Transient Ischemic Attacks'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","Concerning for TIAs given 'family history of cerebrovascular disease despite young age'; urgent referral."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA/ministroke clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'Expect appointment within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'Clinic will perform carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","Brain imaging noted but 'to evaluate for stroke risk' rather than to check for a bleed."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'If symptoms return and persist or become prolonged, attend A&E immediately'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","partial","Urgency captured but not that it is currently not an immediate A&E emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'may contact clinic by phone for assessment and guidance if symptoms recur'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'PALS number and TIA clinic contact information provided'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Advised to chase the appointment if no contact, but not to ring this afternoon or tomorrow morning to confirm receipt."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact clinic or chase TIA clinic appointment if no contact received'."]],"claims":[["weakness in the right arm and right leg","Patient said his leg feels weaker during episodes but never gave a side; 'right leg' is not in the transcript."],["Associated symptoms during episodes include nausea","Nausea was a general, occasional symptom over the period, not described as occurring during the episodes."],["Clinic will perform carotid ultrasound and brain imaging","Clinician said the clinic might do a brain scan to look for a bleed; written as certain."]],"note":"Subjective\nCliniTech Benchmark 5ec02e1b, a 32-year-old male, presents with episodic neurological symptoms over the past approximately 6 to 8 weeks. He reports episodes of fatigue, paresthesia in the right hand, and weakness in the right arm and right leg that last approximately 3 to 4 days before resolving completely. He notes the episodes were initially occurring once a week to once a month but have progressively increased in frequency to several times per day. During episodes, he has noticed difficulty with fine motor tasks such as holding a cup of coffee and drinking from it, as well as a sensation of something in his throat. A colleague has observed an abnormal gait during episodes, though this is not present between episodes. He denies difficulty speaking or visual problems during episodes. He denies current difficulty swallowing. He reports that between episodes he feels fit and well.\n\nHe also reports general fatigue, weakness, nausea, and lack of motivation over the same time period. He has no history of strokes or mini-strokes personally. He has a family history of stroke, with his father having undergone a carotid procedure. After his father's operation, he was evaluated and had blood work showing normal cholesterol, blood pressure, and diabetes screening. He has been self-prescribing aspirin 75 mg daily since his father's surgery, based on internet reading, and has not discussed the risks and benefits with a GP. He denies any other illnesses. He denies smoking.\n\nMedications and Supplements  \n- Aspirin 75 mg PO daily\n\nAllergies  \n- Penicillin\n\nFamily History  \n- Father: Stroke, underwent carotid surgery\n\nSocial History  \n- Tobacco: Non-smoker  \n- Occupation: Medical doctor in plastic surgery  \n- Living situation: Lives with wife\n\nReview of Systems  \n- General: Fatigue, weakness, nausea  \n- HEENT: Sensation of something in throat during episodes, denies visual problems, denies difficulty speaking  \n- Gastrointestinal: Denies difficulty swallowing  \n- Neurological: Right-sided paresthesia, right arm and leg weakness, abnormal gait during episodes, difficulty with fine motor tasks during episodes, denies difficulty speaking, denies visual problems\n\nObjective\nN/A\n\nAssessment & Plan\n32-year-old male presenting with episodic neurological symptoms concerning for transient ischemic attacks.\n\nTransient Ischemic Attacks  \nAssessment: Patient presents with episodic neurological symptoms over the past 1-2 months including fatigue, right hand numbness and weakness, right arm weakness, abnormal gait noted by colleague, and difficulty with fine motor tasks like holding a coffee cup. Episodes initially occurred once weekly but have progressed to several times daily, lasting 3-4 days each with complete resolution between episodes. Associated symptoms during episodes include nausea, feeling of something in throat, and generalized weakness. Family history is significant for father who underwent carotid endarterectomy for stroke prevention. Patient is currently asymptomatic. Clinical presentation is concerning for TIAs given the transient nature of focal neurological symptoms, progressive frequency, and family history of cerebrovascular disease despite young age.  \nPlan:  \n- Urgent referral to TIA/ministroke clinic  \n- Expect appointment within 1-2 days  \n- Clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk  \n- If symptoms return and persist or become prolonged, attend A&E immediately as this may indicate stroke rather than TIA  \n- Patient may contact clinic by phone for assessment and guidance if symptoms recur  \n- Patient advised to contact clinic or chase TIA clinic appointment if no contact received within expected timeframe  \n- PALS number and TIA clinic contact information provided for follow-up\n","review":329.5131578947369,"saved":156.48684210526312,"faster":32.19893870478665,"clean":false,"effort":16.304347826086957,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","Fatigue is described as part of the episodes but the initial couple of days of tiredness then return to normal is not captured as the onset."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","Documented as during episodes, but the onset only in the last couple of days is not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","Self-prescribed since father's surgery based on internet reading, but the purpose (reduce stroke/heart attack risk) is not stated."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'Objective N/A' implies no examination but the loss of video is not recorded."],["partial","TIA clinic may do a brain scan to check for a bleed.","Brain imaging noted but 'to evaluate for stroke risk' rather than to check for a bleed."],["partial","Currently not an immediate emergency requiring A&E, but urgent.","Urgency captured but not that it is currently not an immediate A&E emergency."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Advised to chase the appointment if no contact, but not to ring this afternoon or tomorrow morning to confirm receipt."],["fabrication","weakness in the right arm and right leg","Patient said his leg feels weaker during episodes but never gave a side; 'right leg' is not in the transcript."],["fabrication","Associated symptoms during episodes include nausea","Nausea was a general, occasional symptom over the period, not described as occurring during the episodes."],["fabrication","Clinic will perform carotid ultrasound and brain imaging","Clinician said the clinic might do a brain scan to look for a bleed; written as certain."]],"mb":14.324007,"latency":49.754,"finalised":366.7501578947369},{"label":"Run 2","wer":14.671610169491526,"text":"Hi there, good morning, I'm Doctor Dean Miller from UK, I am, nice to hear you. Nice to meet you. Okay, so before we start your appointment, could I confirm your full name and date of birth please?\n  Yes, John Smith and I am 32 years old.\n  Sorry, I didn't catch your date of birth? I'm 32 years old. 32 years old, okay. Could you tell me the 1st line of your address and your postcode please? It's 4 Park Avenue, and it's AB1, CB2. That's great, thank you so much for that. Are you in a private place where you're okay to speak at this point? Yeah. Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n  Sorry, say that again?\n  How can I help you today?\n  So I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it and nothing's coming up, so I thought I'd come and speak to you about it. Okay, so tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired, but for a couple of days, and then I get back to normal. And then I started losing feeling in my hands and arms. I get all these sensations like I get pins and needles.\n  Right, and you, just to say again, the connection's not so great, you've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay, is that the right or left hand? My right hand. Is it always the right? Okay, we've lost video now, maybe is there a button you can press? Okay, are you happy for us to carry on without the video? I can't see you at the moment.\n  Yes, that's fine.\n  Alright, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand or does it go up the arm as well?\n  The pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts for 3 days and then goes back to normal, so it's very weird. Right, okay.\n  And is there any involvement of your leg at all?\n  My colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n  Okay. You said you've been having weird symptoms for about a month?\n  Yes.\n  So what has been happening from the beginning of the month? What else has been happening?\n  I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything.\n  Right. And you know your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker. Right, okay.\n  And you know the abnormal gait, has that been present outside of these episodes?\n  No, it has not. So normally I'm fit and well actually.\n  Alright, okay. And these episodes, how often have they been happening?\n  They have been getting more regular, so at the start it would be maybe once a week to every once a month, but now it's getting a couple of times a day. Right, okay.\n  And how long have these episodes been going on for? When did it all start? Probably a month and a half, maybe 2 months. Right, okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems.\n  So recently I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\n  Right. Is that during these episodes or outside of these episodes?\n  Only during the episodes. OK. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulties swallowing?\n  I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all?\n  No, I can speak fine.\n  Any visual problems during these episodes?\n  I don't think so, but I wear glasses. Okay, all right.\n  Now, can I just ask, is there any history of strokes or mini-strokes in your family?\n  Yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n  Right, okay. And how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n  No, so after my dad had his operation, I was required to be checked and my cholesterol was fine. Excellent, so you had a blood test done and did they check your diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic, okay.\n  Do you have any other illnesses at all? No. Are you on any medication? aspirin, 75 mg once a day, but that's because of something I read on the internet. Okay, so why is that, why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay, have you ever told a doctor before, your GP, that you're on aspirin? Yes, I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay, and has any GP ever spoken to you about... risks of aspirin and whether you should be on it or have you not told the GP in the past? No, I haven't. All right, now in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay, which specialty are you in? I work in plastic surgery. Plastic surgery, okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay, and are you living alone? No, I live with my wife. Okay, fantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Obviously you're a medic yourself, did you have any thoughts as to what might be going on? I've absolutely got no idea. Right, okay. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks, and so that's something quite urgent, and given that you've got a family history of stroke, even though you're quite young, I think is something that we need to exclude. So what I'm probably going to do, in fact what I am going to do, is I'm going to refer you to a stroke clinic, a TIA clinic. Now just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic. I send that referral off now and then you can attend them. They'll usually call you in within the next one or 2 days. because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing, maybe they might do a scan of the brain as well to show that there's any signs of a bleed there. They'll be doing a range of tests in a short time frame in order to exclude whether you have any illness, you've got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they're prolonged, then you may need to attend A and E, okay, because a presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or 2 days. We want you to go to hospital in that instance as soon as possible. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's not a problem. You've got easy access to us. Okay, so this is the plan going forward. through that referral, you should hear back from the hospital relatively soon. The hospital, you could actually ring them on the PALS number and then there's also the CIA clinic number. I'm going to leave that number in the notes for this consultation, okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning, today in the afternoon, wait one or 2 hours, or tomorrow morning, just to find out when they plan to slot you in. and just to make sure they've got you in the system and they've got the books and they're going to be quoting you in, okay? This isn't an immediate emergency that you need to rush out to any, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us, okay? All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have the information at your hands in order to take things further, okay? Great, thank you. All the best. Take care. Bye-bye.","marks":[[35,46,"",false],[52,60,"GP at Hand.",false],[70,74,"see",false],[80,102,"Hi. OK.",false],[200,203,"Yeah it's",false],[343,346,"first",false],[423,432,"AB one CB two.",false],[532,555,"the moment Yes. OK.",false],[669,674,".",false],[1142,1162,"a weird sensation",false],[1170,1173,"guess",false],[1201,1221,"",false],[1602,1609,"All right. Um",false],[1850,1855,"few",false],[2407,2407,"you've",false],[2514,2514,"Can",false],[2779,2793,"Right . All right OK. Um",false],[2797,2797,"these",false],[2943,2943,"once",false],[3075,3075,"when",false],[3092,3092,"Was it a month ago",false],[3698,3710,"difficulty",false],[3821,3821,"Any",false],[3999,3999,"has uh",false],[4025,4032,"stroke",false],[4402,4402,"Good",false],[4462,4466,"for",false],[4596,4601,"OK. Now",false],[4647,4647,"No.",false],[4673,4673,"I take an",false],[4684,4689,"seventy five milligrams",false],[4869,4873,"OK. Do",false],[4950,4950,"took I",false],[5196,5196,"You haven't OK. Um",false],[5223,5223,"your uh",false],[5316,5316,"Uh I'm uh",false],[5684,5684,"Now",false],[5694,5694,"you're a",false],[5781,5791,"actually",false],[6077,6079,"um it's",false],[6218,6224,"",false],[6358,6366,"gonna",false],[6377,6385,"uh I'm gonna",false],[6544,6546,"to",false],[6792,6792,"we're",false],[6936,6942,"arteries",false],[6947,6947,"your",false],[7017,7020,"your",false],[7038,7047,"check if",false],[7190,7196,"OK whether you have",false],[7235,7235,"Sure.",false],[7353,7354,"um our",false],[7447,7447,"then uh",false],[7677,7677,"OK. Sure.",false],[7827,7827,"that's that's",false],[7842,7842,"you know you",false],[7914,7921,"Um I'm going to um do",false],[8011,8016,"can",false],[8081,8084,"TIA",false],[8406,8410,"got time",false],[8529,8536,"calling",false],[8607,8610,"down",false],[8614,8617,"A and E.",false],[8711,8711,"if there's",false],[8830,8857,"",false],[8862,8869,"you get",false],[8889,8889,"back",false],[9090,9090,"um you should",false],[9101,9101,"help you should",false],[9170,9181,"OK.",false],[9219,9227,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past approximately six to eight weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","Mentions 'episodes of fatigue' but not that it began with a couple of days of tiredness."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'paresthesia in the right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Hand paraesthesia and 'weakness in the right arm'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'last approximately three to four days before resolving completely'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","Leg weakness during episodes."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'A colleague has observed that he walks slightly differently'."],["The note captures: Gait is normal outside the episodes.","yes","'between episodes he feels fit and well with no residual symptoms'."],["The note captures: Generally feels tired and weak.","yes","'general fatigue, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not documented."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially ... once a week to once a month'."],["The note captures: Episodes now occur a couple of times a day.","yes","'several times per day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'holding a cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'and drinking from it'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","States during episodes but not the last couple of days."],["The note captures: No difficulty swallowing currently.","yes","'denies current difficulty swallowing'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'sensation of something in his throat'."],["The note captures: No difficulty speaking during episodes.","yes","'denies difficulty speaking'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'denies ... visual problems during the episodes'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'not currently experiencing any symptoms'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","'denies any personal history of mini-strokes or TIAs'."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure normal."],["The note captures: No other illnesses; normally fit and well.","yes","'denies any other illnesses'."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75 mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","Self-started 'after his father's surgery based on internet reading'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'without prior discussion with a GP about its risks or appropriateness'."],["The note captures: Allergic to penicillin.","yes","Penicillin."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father having undergone a carotid procedure to reduce stroke risk'."],["The note captures: Non-smoker.","yes","Non-smoker."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","'Objective N/A'; video loss/no exam not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'concerning for transient ischemic attacks'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","'young patient with family history of stroke ... requires urgent evaluation to exclude'."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days by Thursday or Friday'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain imaging to evaluate for stroke risk' omits the bleed purpose and 'may'."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'If symptoms return and persist or become prolonged ... attend A&E immediately'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not currently an A&E emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'contact clinic if symptoms recur for telephone assessment and guidance'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'provided with PALS number and TIA clinic contact number'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Numbers 'to chase appointment if needed' but no today/tomorrow-morning timing."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'call clinic if there are any delays ... or if unable to attend'."]],"claims":[["weakness in the right arm and right leg","Patient said his leg feels weaker during episodes; the side of the leg was never stated."],["Associated symptoms during episodes include nausea","Nausea was described as a general symptom ('sometimes I feel nauseous'), not tied to the episodes."],["TIA clinic will perform carotid ultrasound and brain imaging","Doctor said they 'might do a scan of your brain'; brain imaging stated as certain."]],"note":"Subjective\nCliniTech Benchmark 4bd6ba3a, a 32-year-old male, presents with episodic neurological symptoms over the past approximately six to eight weeks. He reports episodes of fatigue, paresthesia in the right hand, and weakness in the right arm and right leg that last approximately three to four days before resolving completely. He notes the episodes were initially occurring once a week to once a month but have progressively increased in frequency to several times per day. During episodes, he has noticed difficulty with fine motor tasks such as holding a cup of coffee and drinking from it, as well as a sensation of something in his throat. A colleague has observed that he walks slightly differently than normal during these episodes. He denies difficulty speaking or visual problems during the episodes. He denies current difficulty swallowing. He reports that between episodes he feels fit and well with no residual symptoms. He also reports general fatigue, weakness, and nausea. He is not currently experiencing any symptoms.\n\nHe has a family history of stroke, with his father having undergone a carotid procedure to reduce stroke risk. He reports that after his father's operation, he was screened and his cholesterol, blood pressure, and diabetes were all found to be normal. He denies any personal history of mini-strokes or TIAs. He denies any other illnesses. He is not on any prescribed medications but has been self-medicating with aspirin 75 mg daily, which he started after his father's surgery based on internet reading, without prior discussion with a GP about its risks or appropriateness. He denies smoking.\n\nMedications and Supplements  \n- Aspirin 75 mg PO daily\n\nAllergies  \n- Penicillin\n\nFamily History  \n- Father: History of stroke, underwent carotid surgery to reduce stroke risk\n\nSocial History  \n- Tobacco: Non-smoker  \n- Occupation: Works as a medical doctor in plastic surgery  \n- Living situation: Lives with his wife\n\nReview of Systems  \n- General: Positive for fatigue, weakness, and nausea  \n- HEENT: Positive for sensation of something in throat, denies vision changes  \n- Gastrointestinal: Denies difficulty swallowing  \n- Neurological: Denies difficulty speaking\n\nObjective\nN/A\n\nAssessment & Plan\n32-year-old male with family history of cerebrovascular disease (father with carotid endarterectomy), presenting with episodic neurological symptoms concerning for transient ischemic attacks.\n\nTransient Ischemic Attacks  \nAssessment: Patient presents with episodic neurological symptoms over the past 1-2 months including fatigue, pins and needles in right hand, weakness in right arm and leg, abnormal gait, and difficulty with fine motor tasks like holding and drinking coffee. Episodes last 3-4 days and have increased in frequency from once weekly to several times daily. Associated symptoms during episodes include nausea, feeling of something in throat, but no speech difficulties or visual problems. Patient is currently asymptomatic. The constellation of transient focal neurological symptoms in a young patient with family history of stroke raises concern for TIAs and requires urgent evaluation to exclude cerebrovascular disease.  \nPlan:  \n- Urgent referral to TIA clinic/stroke clinic  \n- Referral to be sent immediately with expected contact within 1-2 days by Thursday or Friday  \n- TIA clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk  \n- If symptoms return and persist or become prolonged, patient should attend A&E immediately as this may indicate stroke rather than TIA  \n- Patient advised to contact clinic if symptoms recur for telephone assessment and guidance  \n- Patient provided with PALS number and TIA clinic contact number to chase appointment if needed  \n- Patient advised to call clinic if there are any delays in receiving appointment or if unable to attend scheduled appointment\n","review":354.7368421052631,"saved":131.26315789473688,"faster":27.0088802252545,"clean":false,"effort":19.565217391304348,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","Mentions 'episodes of fatigue' but not that it began with a couple of days of tiredness."],["missing","Low motivation; does not feel like doing anything.","Low motivation not documented."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","States during episodes but not the last couple of days."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'Objective N/A'; video loss/no exam not documented."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain imaging to evaluate for stroke risk' omits the bleed purpose and 'may'."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not currently an A&E emergency."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Numbers 'to chase appointment if needed' but no today/tomorrow-morning timing."],["fabrication","weakness in the right arm and right leg","Patient said his leg feels weaker during episodes; the side of the leg was never stated."],["fabrication","Associated symptoms during episodes include nausea","Nausea was described as a general symptom ('sometimes I feel nauseous'), not tied to the episodes."],["fabrication","TIA clinic will perform carotid ultrasound and brain imaging","Doctor said they 'might do a scan of your brain'; brain imaging stated as certain."]],"mb":14.195581,"latency":46.918,"finalised":389.1438421052631},{"label":"Run 3","wer":14.141949152542374,"text":"Hi there, good morning, I'm Doctor Jim Miller from Tuesday at hand, nice to see you. Thanks. Okay, so before we start your appointment, could I confirm your full name and date of birth please?\n  Yes, John Smith and I am 32 years old.\n  Sorry, I didn't catch your date of birth? I'm 32 years old. 32 years old, okay. Could you tell me the first line of your address and your postcode please? It's Four Park Avenue, and it's AB1-DB2. That's great, thank you so much for that. Are you in a private place where you're okay to speak in the audience? Yeah. Okay. So how can I help you today? You've been having some problems with your acne, is that right?\n  Sorry, say that again?\n  How can I help you today?\n  So I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it and nothing's coming up, so I thought I'd come and speak to you about it. Okay, so tell me a little more about these weird symptoms that you're having. So it started with feeling very tired, but for a couple of days, and then I get back to normal. And then I started losing feeling in my hands and arms. I get all these sensations like I get pins and needles.\n  Right, just to say again, the connection's not so great. You've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay, is that the right or left hand? My right hand. Is it always the right? Okay, we've lost video now, maybe is there a button you can press? Okay, are you happy for us to carry on without the video? I can't see you at the moment.\n  Yes, that's fine.\n  Alright, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand or does it go up the arm as well?\n  The pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts for 3 days and then goes back to normal, so it's very weird. Right, okay.\n  Is there any involvement of your leg at all?\n  My colleague said I'm walking slightly differently to normal. And again, it's only for 3 days or 3 or 4 days.\n  Okay. You said you've been having weird symptoms for about a month?\n  Yes.\n  So what has been happening from the beginning of the month? What else has been happening?\n  I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything.\n  Right. And you know your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker. Right, okay.\n  And you know the abnormal gait, has that been present outside of these episodes?\n  No, it has not.\n  So normally I'm fit and well actually. Alright, okay. And these episodes, how often have they been happening?\n  They have been getting more regular, so at the start it would be maybe once a week, to every once a month, but now it's getting a couple of times a day.\n  Right, okay. And how long have these episodes been going on for? When did it all start? Probably a month and a half, maybe 2 months. Right, okay. And along with these symptoms of weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems.\n  So recently I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\n  Right. Is that during these episodes or outside of these episodes?\n  Only during the episodes. OK. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulties swallowing?\n  I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all?\n  No, I can speak fine.\n  Any visual problems during these episodes?\n  I don't think so, but I wear glasses. Okay, all right.\n  Now, can I just ask, is there any history of strokes or mini-strokes in your family?\n  Yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n  Right, okay. And how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n  No, so after my dad had his operation, I was required to be checked and my cholesterol was fine. Excellent, so you had a blood test done and did they check your diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic, okay.\n  Do you have any other illnesses at all? No. Are you on any medication? aspirin, 75 mg once a day, but that's because of something I read on the internet. Okay, so why is that, why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay, have you ever told a doctor before, your GP, that you're on aspirin? Yes, I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay, and has any GP ever spoken to you about... risks of aspirin and whether you should be on it or have you not told the GP in the past? No, I haven't.\n Unknown: Okay.\n  All right. Now, in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery, okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay, and are you living alone? No, I live with my wife. Okay, fantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Obviously, you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Right, okay. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks. And so that's something quite urgent. And given that you've got a family history of stroke, even though you're quite young, I think is something that we need to exclude. So what I'm probably going to do, in fact what I am going to do, is I'm going to refer you to a stroke clinic, a TIA clinic. Now just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic. I send that referral off now and then you can attend them. They'll usually call you in within the next one to 2 days. because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so basically the deadline should be Thursday-Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing, maybe they might do a scan of the brain as well to check if there's any signs of a bleed there. They'll be doing a range of tests in a short time frame in order to exclude whether you have any illness, you've got any kind of stroke or mini-stroke. Now if your symptoms return and they persist, they're prolonged, then you may need to attend A and E, okay, because a presumptive working diagnosis is mini-stroke or TIA, okay, and if... a mini-stroke is prolonged, then we end up thinking that this might be a stroke, and in that case, that becomes even more of an emergency. So we're not talking about waiting one or 2 days. We want you to go to hospital in that instance as soon as possible, okay? Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's not a problem. You've got easy access to us. Okay, so this is the plan going forward. I'm going to do that referral. You should hear back from the hospital relatively soon. The hospital, you could actually ring them on the PALS number, and there's also the CIA clinic number. I'm going to leave that number in the notes for this consultation, okay? So you'll have all the information you need to chase this appointment, and if you want, you can ring them either today or tomorrow morning, today in the afternoon, wait one or 2 hours, or tomorrow morning, just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got your books and they're going to be quoting you in, okay? This isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us, okay? Great. All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should... You should have the information at your hands in order to take things further, okay? Great, thank you. All the best, take care now, bye-bye.","marks":[[35,45,"",false],[51,58,"GP",false],[85,97,"Hi. OK.",false],[195,198,"Yeah it's",false],[423,431,"AB one CB two.",true],[535,556,"moment Yes. OK.",false],[629,633,"asthma.",true],[668,673,".",false],[927,933,"bit",false],[966,977,"you've been",false],[1144,1164,"a weird sensation",false],[1172,1175,"guess",false],[1203,1214,"",false],[1595,1602,"All right. Um",false],[1843,1848,"few",false],[2395,2395,"you've",false],[2502,2502,"Can",false],[2767,2781,"Right . All right OK. Um",false],[2785,2785,"these",false],[2932,2932,"once",false],[3064,3064,"when",false],[3081,3081,"Was it a month ago",false],[3683,3695,"difficulty",false],[3806,3806,"Any",false],[3984,3984,"has uh",false],[4010,4017,"stroke",false],[4387,4387,"Good",false],[4447,4451,"for",false],[4581,4586,"OK. Now",false],[4632,4632,"No.",false],[4658,4658,"I take an",false],[4669,4674,"seventy five milligrams",false],[4854,4858,"OK. Do",false],[4935,4935,"took I",false],[5183,5197,"You haven't OK. Um",false],[5227,5227,"your uh",false],[5320,5320,"Uh I'm uh",false],[5688,5688,"Now",false],[5698,5698,"you're a",false],[5786,5796,"actually",false],[6082,6084,"um it's",false],[6223,6229,"",false],[6363,6371,"gonna",false],[6382,6390,"uh I'm gonna",false],[6796,6796,"we're",false],[6940,6946,"arteries",false],[6951,6951,"your",false],[7021,7024,"your",false],[7193,7199,"OK whether you have",false],[7238,7238,"Sure.",false],[7355,7356,"um our",false],[7452,7452,"then uh",false],[7683,7687,"OK. Sure.",false],[7838,7838,"that's that's",false],[7853,7853,"you know you",false],[8030,8035,"can",false],[8078,8078,"then",false],[8096,8099,"TIA",false],[8421,8425,"got time",false],[8512,8516,"in the",false],[8547,8554,"calling",false],[8633,8636,"A and E.",false],[8730,8730,"if there's",false],[8849,8876,"",false],[8881,8888,"you get",false],[8908,8908,"back",false],[8918,8930,"OK.",false],[9119,9119,"um you should be able to help",false],[9199,9210,"OK.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past approximately 6 to 8 weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","'episodes of fatigue' but not the initial couple of days of tiredness."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'paresthesia in the right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Hand paraesthesia and 'weakness in the right arm'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'last approximately 3 to 4 days before resolving completely'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","Leg weakness during episodes."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'A colleague has observed him walking slightly differently'."],["The note captures: Gait is normal outside the episodes.","yes","Gait change 'during these episodes' which resolve completely."],["The note captures: Generally feels tired and weak.","yes","'general fatigue, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'decreased motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'once a week to once a month'."],["The note captures: Episodes now occur a couple of times a day.","yes","'several times per day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'holding a cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'and drinking'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","During episodes but not the last couple of days."],["The note captures: No difficulty swallowing currently.","yes","'denies current difficulty swallowing'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'sensation of something in his throat'."],["The note captures: No difficulty speaking during episodes.","yes","'denies difficulty speaking'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'denies ... visual problems during episodes'."],["The note captures: Currently asymptomatic at the time of consultation.","no","Currently asymptomatic not documented."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","'denies any history of mini-strokes or TIAs'."],["The note captures: Cholesterol previously checked and normal.","no","Not documented."],["The note captures: Previously screened for diabetes; normal.","no","Not documented."],["The note captures: Blood pressure previously checked; normal.","no","Not documented."],["The note captures: No other illnesses; normally fit and well.","no","Not documented."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75 mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","Self-started after father's operation 'based on internet research' but purpose not stated."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'without prior discussion with a GP about the risks and benefits'."],["The note captures: Allergic to penicillin.","yes","Penicillin."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father who underwent carotid endarterectomy for stroke prevention'."],["The note captures: Non-smoker.","yes","Non-smoker."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","'Objective N/A'; video loss not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'concerning for transient ischemic attacks'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","'young patient with family history of stroke ... requiring urgent evaluation to exclude'."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to stroke clinic/TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days by Thursday-Friday'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain imaging to evaluate for stroke risk' omits bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","partial","Adds 'persist beyond typical episode duration' (3-4 days), misstating the prolonged-symptom threshold."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not documented."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'contact clinic by phone for assessment and guidance if symptoms recur'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","no","Not documented."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","no","Not documented."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact clinic if there are any delays ... or if unable to attend'."]],"claims":[["weakness in the right arm and right leg","Patient said his leg feels weaker during episodes; the side of the leg was never stated."],["Associated symptoms during episodes include nausea, decreased motivation","Nausea and low motivation were described as general symptoms, not tied to the episodes."],["Clinic will perform carotid ultrasound and brain imaging","Doctor said they 'might do a scan of your brain'; brain imaging stated as certain."],["If symptoms return and persist beyond typical episode duration, patient should attend A&E immediately","Doctor said attend A&E if symptoms return and persist/are prolonged; no threshold of the typical (3-4 day) episode duration was given."]],"note":"Subjective\nCliniTech Benchmark 1049f298, a 32-year-old male, presents with episodic neurological symptoms over the past approximately 6 to 8 weeks. He reports episodes of fatigue, paresthesia in the right hand, and weakness in the right arm and right leg that last approximately 3 to 4 days before resolving completely. He notes the episodes were initially occurring once a week to once a month but have progressively increased in frequency to several times per day. During episodes, he has noticed difficulty with fine motor tasks such as holding a cup of coffee and drinking, as well as a sensation of something in his throat. A colleague has observed him walking slightly differently than normal during these episodes.\n\nThe patient also reports general fatigue, weakness, and nausea between episodes, along with decreased motivation. He denies difficulty speaking or visual problems during episodes. He denies current difficulty swallowing. He denies any history of mini-strokes or TIAs. He started taking aspirin 75 mg daily on his own after his father had a carotid operation, without prior discussion with a GP about the risks and benefits.\n\nMedications and Supplements  \n- Aspirin 75 mg PO daily\n\nAllergies  \n- Penicillin\n\nFamily History  \n- Father: History of stroke risk requiring carotid surgery\n\nSocial History  \n- Tobacco: Non-smoker  \n- Occupation: Works as a plastic surgeon  \n- Living situation: Lives with wife\n\nReview of Systems  \n- General: Positive for fatigue, weakness, nausea  \n- HEENT: Positive for sensation of something in throat, denies vision changes  \n- Gastrointestinal: Denies difficulty swallowing  \n- Neurological: Denies difficulty speaking\n\nObjective\nN/A\n\nAssessment & Plan\n32-year-old male with episodic neurological symptoms concerning for transient ischemic attacks, presenting for evaluation.\n\nTransient Ischemic Attacks  \nAssessment: Patient presents with episodic neurological symptoms over the past 1-2 months including fatigue, pins and needles in the right hand, weakness in the right arm and leg, abnormal gait, and difficulty with fine motor tasks such as holding and drinking from a coffee cup. Episodes initially occurred once weekly but have progressed to several times daily, with each episode lasting 3-4 days before resolving completely. Associated symptoms during episodes include nausea, decreased motivation, and sensation of something in throat. No speech difficulties or visual problems reported. Family history is significant for father who underwent carotid endarterectomy for stroke prevention. Patient has been taking aspirin 75 mg daily based on internet research following father's surgery, without medical supervision. The constellation of transient focal neurological deficits in a young patient with family history of stroke raises concern for TIAs, requiring urgent evaluation to exclude cerebrovascular disease.  \nPlan:  \n- Urgent referral to stroke clinic/TIA clinic  \n- Expect appointment within 1-2 days by Thursday-Friday  \n- Clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk  \n- If symptoms return and persist beyond typical episode duration, patient should attend A&E immediately as prolonged symptoms may indicate stroke rather than TIA  \n- Patient may contact clinic by phone for assessment and guidance if symptoms recur  \n- Patient advised to contact clinic if there are any delays in receiving the specialist appointment or if unable to attend the scheduled appointment\n","review":480.0526315789474,"saved":5.947368421052602,"faster":1.2237383582412762,"clean":false,"effort":35.869565217391305,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","'episodes of fatigue' but not the initial couple of days of tiredness."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","During episodes but not the last couple of days."],["missing","Currently asymptomatic at the time of consultation.","Currently asymptomatic not documented."],["missing","Cholesterol previously checked and normal.","Not documented."],["missing","Previously screened for diabetes; normal.","Not documented."],["missing","Blood pressure previously checked; normal.","Not documented."],["missing","No other illnesses; normally fit and well.","Not documented."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","Self-started after father's operation 'based on internet research' but purpose not stated."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'Objective N/A'; video loss not documented."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain imaging to evaluate for stroke risk' omits bleed purpose."],["partial","Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","Adds 'persist beyond typical episode duration' (3-4 days), misstating the prolonged-symptom threshold."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not documented."],["missing","TIA clinic and PALS contact numbers to be left in the consultation notes.","Not documented."],["missing","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Not documented."],["fabrication","weakness in the right arm and right leg","Patient said his leg feels weaker during episodes; the side of the leg was never stated."],["fabrication","Associated symptoms during episodes include nausea, decreased motivation","Nausea and low motivation were described as general symptoms, not tied to the episodes."],["fabrication","Clinic will perform carotid ultrasound and brain imaging","Doctor said they 'might do a scan of your brain'; brain imaging stated as certain."],["fabrication","If symptoms return and persist beyond typical episode duration, patient should attend A&E immediately","Doctor said attend A&E if symptoms return and persist/are prolonged; no threshold of the typical (3-4 day) episode duration was given."]],"mb":14.709558,"latency":59.047,"finalised":525.5426315789474},{"label":"Run 4","wer":14.671610169491526,"text":"Hi there, good morning, I'm Doctor Dean Miller from UK, I am, nice to hear you. Nice to meet you. Okay, so before we start your appointment, could I confirm your full name and date of birth please?\n  Yes, John Smith and I am 32 years old.\n  Sorry, I didn't catch your date of birth? I'm 32 years old. 32 years old, okay. Could you tell me the 1st line of your address and your postcode please? It's 4 Park Avenue, and it's AB1, CB2. That's great, thank you so much for that. Are you in a private place where you're okay to speak at this point? Yeah. Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n  Sorry, say that again?\n  How can I help you today?\n  So I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it and nothing's coming up, so I thought I'd come and speak to you about it. Okay, so tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired, but for a couple of days, and then I get back to normal. And then I started losing feeling in my hands and arms. I get all these sensations like I get pins and needles.\n  Right, and you, just to say again, the connection's not so great, you've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay, is that the right or left hand? My right hand. Is it always the right? Okay, we've lost video now, maybe is there a button you can press? Okay, are you happy for us to carry on without the video? I can't see you at the moment.\n  Yes, that's fine.\n  Alright, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand or does it go up the arm as well?\n  The pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts for 3 days and then goes back to normal, so it's very weird. Right, okay.\n  And is there any involvement of your leg at all?\n  My colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n  Okay. You said you've been having weird symptoms for about a month?\n  Yes.\n  So what has been happening from the beginning of the month? What else has been happening?\n  I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything.\n  Right. And you know your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker. Right, okay.\n  And you know the abnormal gait, has that been present outside of these episodes?\n  No, it has not. So normally I'm fit and well actually.\n  Alright, okay. And these episodes, how often have they been happening?\n  They have been getting more regular, so at the start it would be maybe once a week to every once a month, but now it's getting a couple of times a day. Right, okay.\n  And how long have these episodes been going on for? When did it all start? Probably a month and a half, maybe 2 months. Right, okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems.\n  So recently I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\n  Right. Is that during these episodes or outside of these episodes?\n  Only during the episodes. OK. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulties swallowing?\n  I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all?\n  No, I can speak fine.\n  Any visual problems during these episodes?\n  I don't think so, but I wear glasses. Okay, all right.\n  Now, can I just ask, is there any history of strokes or mini-strokes in your family?\n  Yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n  Right, okay. And how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n  No, so after my dad had his operation, I was required to be checked and my cholesterol was fine. Excellent, so you had a blood test done and did they check your diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic, okay.\n  Do you have any other illnesses at all? No. Are you on any medication? aspirin, 75 mg once a day, but that's because of something I read on the internet. Okay, so why is that, why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay, have you ever told a doctor before, your GP, that you're on aspirin? Yes, I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay, and has any GP ever spoken to you about... risks of aspirin and whether you should be on it or have you not told the GP in the past? No, I haven't. All right, now in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay, which specialty are you in? I work in plastic surgery. Plastic surgery, okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay, and are you living alone? No, I live with my wife. Okay, fantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Obviously you're a medic yourself, did you have any thoughts as to what might be going on? I've absolutely got no idea. Right, okay. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks, and so that's something quite urgent, and given that you've got a family history of stroke, even though you're quite young, I think is something that we need to exclude. So what I'm probably going to do, in fact what I am going to do, is I'm going to refer you to a stroke clinic, a TIA clinic. Now just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic. I send that referral off now and then you can attend them. They'll usually call you in within the next one or 2 days. because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing, maybe they might do a scan of the brain as well to show that there's any signs of a bleed there. They'll be doing a range of tests in a short time frame in order to exclude whether you have any illness, you've got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they're prolonged, then you may need to attend A and E, okay, because a presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or 2 days. We want you to go to hospital in that instance as soon as possible. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's not a problem. You've got easy access to us. Okay, so this is the plan going forward. through that referral, you should hear back from the hospital relatively soon. The hospital, you could actually ring them on the PALS number and then there's also the CIA clinic number. I'm going to leave that number in the notes for this consultation, okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning, today in the afternoon, wait one or 2 hours, or tomorrow morning, just to find out when they plan to slot you in. and just to make sure they've got you in the system and they've got the books and they're going to be quoting you in, okay? This isn't an immediate emergency that you need to rush out to any, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us, okay? All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have the information at your hands in order to take things further, okay? Great, thank you. All the best. Take care. Bye-bye.","marks":[[35,46,"",false],[52,60,"GP at Hand.",false],[70,74,"see",false],[80,102,"Hi. OK.",false],[200,203,"Yeah it's",false],[343,346,"first",false],[423,432,"AB one CB two.",false],[532,555,"the moment Yes. OK.",false],[669,674,".",false],[1142,1162,"a weird sensation",false],[1170,1173,"guess",false],[1201,1221,"",false],[1602,1609,"All right. Um",false],[1850,1855,"few",false],[2407,2407,"you've",false],[2514,2514,"Can",false],[2779,2793,"Right . All right OK. Um",false],[2797,2797,"these",false],[2943,2943,"once",false],[3075,3075,"when",false],[3092,3092,"Was it a month ago",false],[3698,3710,"difficulty",false],[3821,3821,"Any",false],[3999,3999,"has uh",false],[4025,4032,"stroke",false],[4402,4402,"Good",false],[4462,4466,"for",false],[4596,4601,"OK. Now",false],[4647,4647,"No.",false],[4673,4673,"I take an",false],[4684,4689,"seventy five milligrams",false],[4869,4873,"OK. Do",false],[4950,4950,"took I",false],[5196,5196,"You haven't OK. Um",false],[5223,5223,"your uh",false],[5316,5316,"Uh I'm uh",false],[5684,5684,"Now",false],[5694,5694,"you're a",false],[5781,5791,"actually",false],[6077,6079,"um it's",false],[6218,6224,"",false],[6358,6366,"gonna",false],[6377,6385,"uh I'm gonna",false],[6544,6546,"to",false],[6792,6792,"we're",false],[6936,6942,"arteries",false],[6947,6947,"your",false],[7017,7020,"your",false],[7038,7047,"check if",false],[7190,7196,"OK whether you have",false],[7235,7235,"Sure.",false],[7353,7354,"um our",false],[7447,7447,"then uh",false],[7677,7677,"OK. Sure.",false],[7827,7827,"that's that's",false],[7842,7842,"you know you",false],[7914,7921,"Um I'm going to um do",false],[8011,8016,"can",false],[8081,8084,"TIA",false],[8406,8410,"got time",false],[8529,8536,"calling",false],[8607,8610,"down",false],[8614,8617,"A and E.",false],[8711,8711,"if there's",false],[8830,8857,"",false],[8862,8869,"you get",false],[8889,8889,"back",false],[9090,9090,"um you should",false],[9101,9101,"help you should",false],[9170,9181,"OK.",false],[9219,9227,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over the past approximately 6 to 8 weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","Fatigue described within episodes, but the initial couple of days of tiredness then return to normal is not captured as the onset."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'paresthesia in the right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'right hand paresthesia with associated arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'last approximately 3 to 4 days before resolving completely'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","Weakness 'in the right arm and right leg'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'A colleague has observed an abnormal gait during episodes'."],["The note captures: Gait is normal outside the episodes.","yes","'this is not present between episodes'."],["The note captures: Generally feels tired and weak.","yes","'general fatigue, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'decreased motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially occurring once a week to once a month'."],["The note captures: Episodes now occur a couple of times a day.","yes","'several times per day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'holding a cup of coffee' during episodes."],["The note captures: Drinking is slightly harder during episodes.","yes","'and drinking' during episodes."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","During episodes, and 'recent difficulty with fine motor tasks like holding and drinking from a coffee cup'."],["The note captures: No difficulty swallowing currently.","yes","'He denies current difficulty swallowing'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'sensation of something in his throat'."],["The note captures: No difficulty speaking during episodes.","yes","'denies difficulty speaking ... during episodes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","Denies visual problems during episodes."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'He denies having any of these symptoms currently'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","'no personal history of mini-strokes or strokes'."],["The note captures: Cholesterol previously checked and normal.","no","Previous cholesterol check not documented."],["The note captures: Previously screened for diabetes; normal.","no","Previous diabetes screening not documented."],["The note captures: Blood pressure previously checked; normal.","no","Previous blood pressure check not documented."],["The note captures: No other illnesses; normally fit and well.","yes","'He denies any other medical conditions'."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75 mg once daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-medicating ... after reading about stroke prevention following his father's carotid surgery'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'has never discussed this with his GP'."],["The note captures: Allergic to penicillin.","yes","Penicillin allergy listed."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","Father 'underwent carotid endarterectomy for stroke prevention'."],["The note captures: Non-smoker.","yes","'Non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'Objective N/A' implies no examination but the loss of video is not recorded."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Transient Ischemic Attacks'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","Highly concerning for TIA given 'family history of stroke'; urgent referral."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA/ministroke clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected contact within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","yes","'brain imaging to evaluate for ... signs of bleeding'."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'If symptoms return and persist or become prolonged, patient should attend A&E immediately'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","partial","Urgency captured but not that it is not an immediate A&E emergency now."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'contact clinic if symptoms recur for telephone assessment and guidance'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'provided with PALS number and TIA clinic contact number'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Numbers given 'to chase appointment if needed' but no advice to ring this afternoon or tomorrow morning."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact clinic if there are any delays ... or inability to attend'."]],"claims":[["weakness in the right arm and right leg","Patient said his leg feels weaker during episodes but never gave a side."],["TIA clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk and signs of bleeding","Clinician said the clinic might do a brain scan to check for a bleed; written as certain."]],"note":"Subjective\nCliniTech Benchmark caab2d1e, a 32-year-old male, presents with episodic neurological symptoms over the past approximately 6 to 8 weeks. He reports episodes of fatigue, paresthesia in the right hand, and weakness in the right arm and right leg that last approximately 3 to 4 days before resolving completely. He notes the episodes were initially occurring once a week to once a month but have progressively increased in frequency to several times per day. During episodes, he has noticed difficulty with fine motor tasks such as holding a cup of coffee and drinking, as well as a sensation of something in his throat. A colleague has observed an abnormal gait during episodes, though this is not present between episodes. He also reports general fatigue, weakness, nausea, and decreased motivation. He denies difficulty speaking or visual problems during episodes. He denies current difficulty swallowing. He denies having any of these symptoms currently.\n\nHe has no personal history of mini-strokes or strokes. He has been self-medicating with aspirin 75 mg once daily after reading about stroke prevention following his father's carotid surgery, but has never discussed this with his GP. He denies any other medical conditions.\n\nMedications and Supplements  \n- Aspirin 75 mg PO daily\n\nAllergies  \n- Penicillin\n\nFamily History  \n- Father: History of stroke or stroke risk requiring carotid surgery\n\nSocial History  \n- Tobacco: Non-smoker  \n- Occupation: Works as a medical doctor in plastic surgery  \n- Living situation: Lives with his wife\n\nReview of Systems  \n- General: Positive for fatigue, weakness, and nausea  \n- HEENT: Positive for sensation of something in throat during episodes, denies vision changes  \n- Gastrointestinal: Denies difficulty swallowing  \n- Neurological: Denies difficulty speaking\n\nObjective\nN/A\n\nAssessment & Plan\n32-year-old male with family history of cerebrovascular disease, presenting with episodic neurological symptoms over the past 1-2 months.\n\nTransient Ischemic Attacks  \nAssessment: Patient presents with concerning episodic neurological symptoms including fatigue, right hand paresthesia with associated arm weakness, abnormal gait noted by colleague, and recent difficulty with fine motor tasks like holding and drinking from a coffee cup. Episodes initially occurred weekly to monthly but have progressed to occurring several times daily over the past 1-2 months. Each episode lasts 3-4 days with complete resolution between episodes. Patient also reports nausea, general weakness, and sensation of something in throat during episodes. Family history is significant for father who underwent carotid endarterectomy for stroke prevention. Patient has been self-medicating with aspirin 75 mg daily due to family history but has not discussed this with GP. Clinical presentation is highly concerning for transient ischemic attacks given the episodic nature, focal neurological symptoms, family history of stroke, and progression in frequency.  \nPlan:  \n- Urgent referral to TIA/ministroke clinic  \n- Referral to be sent immediately with expected contact within 1-2 days  \n- TIA clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk and signs of bleeding  \n- If symptoms return and persist or become prolonged, patient should attend A&E immediately as this may indicate progression to stroke  \n- Patient advised to contact clinic if symptoms recur for telephone assessment and guidance  \n- Patient provided with PALS number and TIA clinic contact number to chase appointment if needed  \n- Patient advised to contact clinic if there are any delays in receiving appointment or inability to attend scheduled appointment\n","review":299.67105263157896,"saved":186.32894736842104,"faster":38.339289581979635,"clean":false,"effort":17.391304347826086,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","Fatigue described within episodes, but the initial couple of days of tiredness then return to normal is not captured as the onset."],["missing","Cholesterol previously checked and normal.","Previous cholesterol check not documented."],["missing","Previously screened for diabetes; normal.","Previous diabetes screening not documented."],["missing","Blood pressure previously checked; normal.","Previous blood pressure check not documented."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'Objective N/A' implies no examination but the loss of video is not recorded."],["partial","Currently not an immediate emergency requiring A&E, but urgent.","Urgency captured but not that it is not an immediate A&E emergency now."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Numbers given 'to chase appointment if needed' but no advice to ring this afternoon or tomorrow morning."],["fabrication","weakness in the right arm and right leg","Patient said his leg feels weaker during episodes but never gave a side."],["fabrication","TIA clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk and signs of bleeding","Clinician said the clinic might do a brain scan to check for a bleed; written as certain."]],"mb":14.331906,"latency":50.063,"finalised":337.22405263157896},{"label":"Run 5","wer":14.671610169491526,"text":"Hi there, good morning, I'm Doctor Dean Miller from UK, I am, nice to hear you. Nice to meet you. Okay, so before we start your appointment, could I confirm your full name and date of birth please?\n  Yes, John Smith and I am 32 years old.\n  Sorry, I didn't catch your date of birth? I'm 32 years old. 32 years old, okay. Could you tell me the 1st line of your address and your postcode please? It's 4 Park Avenue, and it's AB1, CB2. That's great, thank you so much for that. Are you in a private place where you're okay to speak at this point? Yeah. Okay. So how can I help you today? You've been having some problems with your asthma, is that right?\n  Sorry, say that again?\n  How can I help you today?\n  So I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it and nothing's coming up, so I thought I'd come and speak to you about it. Okay, so tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired, but for a couple of days, and then I get back to normal. And then I started losing feeling in my hands and arms. I get all these sensations like I get pins and needles.\n  Right, and you, just to say again, the connection's not so great, you've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay, is that the right or left hand? My right hand. Is it always the right? Okay, we've lost video now, maybe is there a button you can press? Okay, are you happy for us to carry on without the video? I can't see you at the moment.\n  Yes, that's fine.\n  Alright, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand or does it go up the arm as well?\n  The pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts for 3 days and then goes back to normal, so it's very weird. Right, okay.\n  And is there any involvement of your leg at all?\n  My colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days.\n  Okay. You said you've been having weird symptoms for about a month?\n  Yes.\n  So what has been happening from the beginning of the month? What else has been happening?\n  I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything.\n  Right. And you know your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different?\n  Yes, so at the same time I get my arm symptoms, my leg feels weaker. Right, okay.\n  And you know the abnormal gait, has that been present outside of these episodes?\n  No, it has not. So normally I'm fit and well actually.\n  Alright, okay. And these episodes, how often have they been happening?\n  They have been getting more regular, so at the start it would be maybe once a week to every once a month, but now it's getting a couple of times a day. Right, okay.\n  And how long have these episodes been going on for? When did it all start? Probably a month and a half, maybe 2 months. Right, okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time? Like swallowing or difficulty speaking or vision problems.\n  So recently I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\n  Right. Is that during these episodes or outside of these episodes?\n  Only during the episodes. OK. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulties swallowing?\n  I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all?\n  No, I can speak fine.\n  Any visual problems during these episodes?\n  I don't think so, but I wear glasses. Okay, all right.\n  Now, can I just ask, is there any history of strokes or mini-strokes in your family?\n  Yes, my father has had a operation to the side of his neck to reduce the risk of stroke.\n  Right, okay. And how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\n  No, so after my dad had his operation, I was required to be checked and my cholesterol was fine. Excellent, so you had a blood test done and did they check your diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic, okay.\n  Do you have any other illnesses at all? No. Are you on any medication? aspirin, 75 mg once a day, but that's because of something I read on the internet. Okay, so why is that, why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay, have you ever told a doctor before, your GP, that you're on aspirin? Yes, I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay, and has any GP ever spoken to you about... risks of aspirin and whether you should be on it or have you not told the GP in the past? No, I haven't. All right, now in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay, which specialty are you in? I work in plastic surgery. Plastic surgery, okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay, and are you living alone? No, I live with my wife. Okay, fantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Obviously you're a medic yourself, did you have any thoughts as to what might be going on? I've absolutely got no idea. Right, okay. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks, and so that's something quite urgent, and given that you've got a family history of stroke, even though you're quite young, I think is something that we need to exclude. So what I'm probably going to do, in fact what I am going to do, is I'm going to refer you to a stroke clinic, a TIA clinic. Now just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic. I send that referral off now and then you can attend them. They'll usually call you in within the next one or 2 days. because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend, so basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing, maybe they might do a scan of the brain as well to show that there's any signs of a bleed there. They'll be doing a range of tests in a short time frame in order to exclude whether you have any illness, you've got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they're prolonged, then you may need to attend A and E, okay, because a presumptive working diagnosis is mini-stroke or TIA, okay? And if a mini-stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or 2 days. We want you to go to hospital in that instance as soon as possible. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's not a problem. You've got easy access to us. Okay, so this is the plan going forward. through that referral, you should hear back from the hospital relatively soon. The hospital, you could actually ring them on the PALS number and then there's also the CIA clinic number. I'm going to leave that number in the notes for this consultation, okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning, today in the afternoon, wait one or 2 hours, or tomorrow morning, just to find out when they plan to slot you in. and just to make sure they've got you in the system and they've got the books and they're going to be quoting you in, okay? This isn't an immediate emergency that you need to rush out to any, but it's something quite urgent that we need to deal with in a short space of time, okay? So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us, okay? All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have the information at your hands in order to take things further, okay? Great, thank you. All the best. Take care. Bye-bye.","marks":[[35,46,"",false],[52,60,"GP at Hand.",false],[70,74,"see",false],[80,102,"Hi. OK.",false],[200,203,"Yeah it's",false],[343,346,"first",false],[423,432,"AB one CB two.",false],[532,555,"the moment Yes. OK.",false],[669,674,".",false],[1142,1162,"a weird sensation",false],[1170,1173,"guess",false],[1201,1221,"",false],[1602,1609,"All right. Um",false],[1850,1855,"few",false],[2407,2407,"you've",false],[2514,2514,"Can",false],[2779,2793,"Right . All right OK. Um",false],[2797,2797,"these",false],[2943,2943,"once",false],[3075,3075,"when",false],[3092,3092,"Was it a month ago",false],[3698,3710,"difficulty",false],[3821,3821,"Any",false],[3999,3999,"has uh",false],[4025,4032,"stroke",false],[4402,4402,"Good",false],[4462,4466,"for",false],[4596,4601,"OK. Now",false],[4647,4647,"No.",false],[4673,4673,"I take an",false],[4684,4689,"seventy five milligrams",false],[4869,4873,"OK. Do",false],[4950,4950,"took I",false],[5196,5196,"You haven't OK. Um",false],[5223,5223,"your uh",false],[5316,5316,"Uh I'm uh",false],[5684,5684,"Now",false],[5694,5694,"you're a",false],[5781,5791,"actually",false],[6077,6079,"um it's",false],[6218,6224,"",false],[6358,6366,"gonna",false],[6377,6385,"uh I'm gonna",false],[6544,6546,"to",false],[6792,6792,"we're",false],[6936,6942,"arteries",false],[6947,6947,"your",false],[7017,7020,"your",false],[7038,7047,"check if",false],[7190,7196,"OK whether you have",false],[7235,7235,"Sure.",false],[7353,7354,"um our",false],[7447,7447,"then uh",false],[7677,7677,"OK. Sure.",false],[7827,7827,"that's that's",false],[7842,7842,"you know you",false],[7914,7921,"Um I'm going to um do",false],[8011,8016,"can",false],[8081,8084,"TIA",false],[8406,8410,"got time",false],[8529,8536,"calling",false],[8607,8610,"down",false],[8614,8617,"A and E.",false],[8711,8711,"if there's",false],[8830,8857,"",false],[8862,8869,"you get",false],[8889,8889,"back",false],[9090,9090,"um you should",false],[9101,9101,"help you should",false],[9170,9181,"OK.",false],[9219,9227,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"approximately one and a half to two months of episodic neurological symptoms\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","Fatigue is listed as part of episodes, but the note does not say the illness began with a couple of days of tiredness before returning to normal."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"right hand paresthesia\" / \"pins and needles in right hand\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Symptoms consistently documented as right hand; \"right hand paresthesia\"."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Pins and needles in the right hand with separate \"right arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"Each episode lasts approximately three to four days before resolving completely\"."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","Leg weakness during episodes captured (\"right leg weakness\" alongside arm symptoms)."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"abnormal gait, as observed by a colleague\"."],["The note captures: Gait is normal outside the episodes.","partial","Implied by \"abnormal gait during episodes\" and baseline fit and well between episodes, but not explicitly stated that gait is normal outside episodes."],["The note captures: Generally feels tired and weak.","yes","\"general fatigue, weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"nausea\" documented."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"a feeling of wanting to do nothing\" / \"decreased motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"starting at approximately once a week to once a month\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"now occurring a couple of times per day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding a cup of coffee\" during episodes."],["The note captures: Drinking is slightly harder during episodes.","yes","\"difficulty ... drinking coffee\" during episodes."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"Over the past couple of days ... occurring only during the episodes\"."],["The note captures: No difficulty swallowing currently.","yes","\"He denies current difficulty swallowing\"."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"sensation of something in his throat during episodes\"."],["The note captures: No difficulty speaking during episodes.","yes","\"He denies difficulty speaking ... during the episodes\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"denies ... visual problems during the episodes\"; glasses omitted but clinical point captured."],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"He denies having any current symptoms at the time of evaluation\"."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","\"He has no history of mini-strokes or strokes\"."],["The note captures: Cholesterol previously checked and normal.","no","Prior normal cholesterol check is not mentioned."],["The note captures: Previously screened for diabetes; normal.","no","Prior normal diabetes screening is not mentioned."],["The note captures: Blood pressure previously checked; normal.","no","Prior normal blood pressure check is not mentioned."],["The note captures: No other illnesses; normally fit and well.","partial","\"baseline of being fit and well\" captured, but absence of other illnesses/PMH not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","\"Aspirin 75 mg PO daily\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","\"on his own initiative after his father's carotid surgery\" captured, but the reason (reduce stroke/heart attack risk) and internet source are omitted."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","\"without prior discussion with his GP about the risks and benefits\"."],["The note captures: Allergic to penicillin.","yes","Allergies: \"Penicillin\"."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father who underwent carotid endarterectomy for stroke prevention\"."],["The note captures: Non-smoker.","yes","\"Tobacco: Non-smoker\"."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","\"Objective N/A\" implies no examination, but loss of video / inability to see the patient is not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"concerning for transient ischemic attacks\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","\"highly concerning for ... TIAs given ... family history of stroke, despite patient's young age\" with urgent referral."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to stroke clinic/TIA clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"expected contact within 1-2 days, ideally by Thursday or Friday\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"TIA clinic will perform carotid ultrasound\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","Brain imaging mentioned but purpose given as \"to evaluate for stroke risk\" rather than checking for a bleed."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"If symptoms return and persist or become prolonged, patient should attend A&E immediately as this may indicate progression to stroke\"."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","partial","Urgency is conveyed but the note does not state that it is currently not an immediate A&E emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","\"advised to contact clinic if symptoms recur for telephone assessment and guidance\"."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","\"Patient provided with PALS number and TIA clinic contact information\"."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Advised to call to confirm scheduling, but only \"if no contact received\" and without the this-afternoon/tomorrow-morning timing."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","partial","\"call clinic or hospital ... if no contact received\" is ambiguous and omits contacting the practice if unable to attend or delayed."]],"claims":[["right leg weakness","Patient said only that his leg feels weaker during arm symptoms; the side of the leg was never stated."],["He also reports general fatigue, weakness, and nausea between episodes","Patient described general tiredness, weakness and occasional nausea without saying they occur between episodes."],["Associated symptoms during episodes include nausea","Nausea was reported as a general symptom and was never tied to the episodes."],["Patient has been taking aspirin 75 mg daily without medical indication","Transcript says he self-started it and no doctor advised it; no one judged whether there was a medical indication."],["TIA clinic will perform carotid ultrasound and brain imaging","Clinician said the clinic might do a brain scan to check for a bleed, not that it will."]],"note":"Subjective\nCliniTech Benchmark 03618cb9, a 32-year-old male, presents with approximately one and a half to two months of episodic neurological symptoms. He reports episodes of fatigue, right hand paresthesia, right arm weakness, and right leg weakness with associated abnormal gait, as observed by a colleague. Each episode lasts approximately three to four days before resolving completely, with the patient returning to his baseline of being fit and well between episodes. He also reports general fatigue, weakness, and nausea between episodes, along with a feeling of wanting to do nothing. He notes that the episodes have been increasing in frequency, starting at approximately once a week to once a month and now occurring a couple of times per day. Over the past couple of days, he has noticed difficulty holding a cup of coffee and drinking coffee, occurring only during the episodes. He also reports a sensation of something in his throat during episodes. He denies difficulty speaking or visual problems during the episodes. He denies current difficulty swallowing. He denies having any current symptoms at the time of evaluation.\n\nThe patient has been taking aspirin 75 mg daily on his own initiative after his father's carotid surgery, without prior discussion with his GP about the risks and benefits. He has no history of mini-strokes or strokes.\n\nMedications and Supplements  \n- Aspirin 75 mg PO daily\n\nAllergies  \n- Penicillin\n\nSocial History  \n- Tobacco: Non-smoker  \n- Occupation: Works as a medical doctor in plastic surgery  \n- Living situation: Lives with his wife\n\nReview of Systems  \n- General: Positive for fatigue, weakness, decreased motivation  \n- HEENT: Positive for sensation of something in throat during episodes, denies visual problems, difficulty speaking  \n- Gastrointestinal: Positive for nausea, denies difficulty swallowing  \n- Neurological: Positive for right hand paresthesia, right arm weakness, right leg weakness, abnormal gait during episodes, denies difficulty speaking, visual problems\n\nObjective\nN/A\n\nAssessment & Plan\n32-year-old male presenting with episodic neurological symptoms concerning for transient ischemic attacks.\n\nTransient Neurological Episodes  \nAssessment: Patient presents with concerning episodic neurological symptoms over the past 1-2 months including fatigue, pins and needles in right hand, right arm weakness, abnormal gait, and difficulty with fine motor tasks like holding and drinking from a coffee cup. Episodes initially occurred once weekly to monthly but have progressed to occurring several times daily, with each episode lasting 3-4 days before resolving completely. Associated symptoms during episodes include nausea, feeling of something in throat, but no speech difficulties or visual problems. Family history is significant for father who underwent carotid endarterectomy for stroke prevention. Patient has been taking aspirin 75 mg daily without medical indication. Clinical presentation is highly concerning for transient ischemic attacks or TIAs given the episodic nature, focal neurological symptoms, and family history of stroke, despite patient's young age.  \nPlan:  \n- Urgent referral to stroke clinic/TIA clinic  \n- Referral to be sent immediately with expected contact within 1-2 days, ideally by Thursday or Friday  \n- TIA clinic will perform carotid ultrasound and brain imaging to evaluate for stroke risk  \n- If symptoms return and persist or become prolonged, patient should attend A&E immediately as this may indicate progression to stroke  \n- Patient advised to contact clinic if symptoms recur for telephone assessment and guidance  \n- Patient provided with PALS number and TIA clinic contact information  \n- Patient advised to call clinic or hospital to confirm appointment scheduling if no contact received\n","review":412.0263157894737,"saved":73.9736842105263,"faster":15.220922677063026,"clean":false,"effort":30.434782608695656,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","Fatigue is listed as part of episodes, but the note does not say the illness began with a couple of days of tiredness before returning to normal."],["partial","Gait is normal outside the episodes.","Implied by \"abnormal gait during episodes\" and baseline fit and well between episodes, but not explicitly stated that gait is normal outside episodes."],["missing","Cholesterol previously checked and normal.","Prior normal cholesterol check is not mentioned."],["missing","Previously screened for diabetes; normal.","Prior normal diabetes screening is not mentioned."],["missing","Blood pressure previously checked; normal.","Prior normal blood pressure check is not mentioned."],["partial","No other illnesses; normally fit and well.","\"baseline of being fit and well\" captured, but absence of other illnesses/PMH not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","\"on his own initiative after his father's carotid surgery\" captured, but the reason (reduce stroke/heart attack risk) and internet source are omitted."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","\"Objective N/A\" implies no examination, but loss of video / inability to see the patient is not documented."],["partial","TIA clinic may do a brain scan to check for a bleed.","Brain imaging mentioned but purpose given as \"to evaluate for stroke risk\" rather than checking for a bleed."],["partial","Currently not an immediate emergency requiring A&E, but urgent.","Urgency is conveyed but the note does not state that it is currently not an immediate A&E emergency."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Advised to call to confirm scheduling, but only \"if no contact received\" and without the this-afternoon/tomorrow-morning timing."],["partial","If there is any delay (not called or cannot make the appointment), contact the practice again.","\"call clinic or hospital ... if no contact received\" is ambiguous and omits contacting the practice if unable to attend or delayed."],["fabrication","right leg weakness","Patient said only that his leg feels weaker during arm symptoms; the side of the leg was never stated."],["fabrication","He also reports general fatigue, weakness, and nausea between episodes","Patient described general tiredness, weakness and occasional nausea without saying they occur between episodes."],["fabrication","Associated symptoms during episodes include nausea","Nausea was reported as a general symptom and was never tied to the episodes."],["fabrication","Patient has been taking aspirin 75 mg daily without medical indication","Transcript says he self-started it and no doctor advised it; no one judged whether there was a medical indication."],["fabrication","TIA clinic will perform carotid ultrasound and brain imaging","Clinician said the clinic might do a brain scan to check for a bleed, not that it will."]],"mb":14.323902,"latency":56.087,"finalised":455.5413157894737}],"cliniscripts":[{"label":"Run 1","wer":8.103813559322035,"text":"Hi there, good morning. I'm Dr.\nNice to see you. Thanks.\nOkay. So, um, before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay.\nCould you tell me the first line of your address and your postcode, please?\nIt's 4 Park Avenue, and it's AB1 CB2.\nThat's great. Thank you so much for that.\nAre you in a private place where you're okay to speak at the moment? Yes. Okay.\nSo how can I help you today? You've been having some problems with your asthma. Is that right?\nSorry, say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having.\nSo it started with feeling very tired for a couple of days, and then I get back to normal.\nAnd then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I guess pins and needles.\nRight. And.\nSo what, so just to again, the connection's not so great. You've been getting pins and needles in the hand. Is that right?\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yes.\nOkay. Um, we've lost video now. Maybe is there a, a, a button you can press?\nOkay.\nAre you happy for us to carry on without the video? I can't see you at the moment. Yes, that's fine.\nAll right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nUh, the pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts a few days, and then goes back to normal. So it's very weird. Right. Okay. And is it any involvement of your leg at all?\nUh, my colleague said I'm walking slightly differently to normal. And again, it's only for three days, or three or four days.\nOkay. You, you said you've been having weird symptoms for about a month.\nYes. So, so what has been happening from the beginning of the month? What else has been happening? Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\nRight. Okay.\nUm, and, um, you know, your colleague said you've, you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Can you have you noticed anything different?\nYes. So at the same time I get my arm symptoms, my leg feels weaker.\nRight. Okay.\nAnd, you know, you the abnormal gait, has that been present outside of these episodes? No.\nIt has not. Right. So normally I'm fit and well, actually. All right. Okay. Um, and these, these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week, uh, to every once a once a month. But now it's getting uh, a couple of times a day. Right.\nOkay. And how long have these episodes been going on for? When, when did it all start? Is that. It might be a month and a half, maybe two months. Right. Okay.\nOkay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time?\nLike swallowing or difficulty speaking or vision problems? So recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\nRight. Is that during these episodes, or outside of these episodes? Only during the episodes. Okay.\nDo you have any difficulty swallowing at all?\nNot currently, no. Okay. During the episodes, do you have any difficulty swallowing? I, I, I feel like there's something in my throat. Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all? No, I can speak fine. Okay.\nAnd any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, um, can I just ask, h-has uh, is there any history of stroke or mini-strokes in your family?\nUh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke. Right.\nOkay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\nNo. So after my dad had his operation, I was required to be checked, and my cholesterol, uh, was fine.\nGood. Excellent. So you had a, a blood test done, and did they check for diabetes as well?\nThey checked my diabetes, my blood pressure, and my cholesterol. And the doctor said it was all okay. Fantastic. Okay. Now, do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\nOkay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before your GP that you're on aspirin? Yes, I took I started taking it after my father had his operation. But that wasn't the doctor telling me.\nOkay. A-and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G the GP in the past? No, I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment? Yes, I am. What do you work as?\nUh, I'm, I'm actually a doctor.\nYou're a me a, a medical doctor? Yes. Okay. Uh, which specialty are you in?\nI work in, uh, plastic surgery. Plastic surgery. Okay. Great.\nAnd, um, do you have any, um, allergies to any medication at all? I'm allergic to penicillin only.\nOkay. And, um, are you, um, living alone? No, I live with my wife.\nWife. Okay. Um, fantastic. Uh, do you smoke at all? No, I don't. Right. Okay. Um, that's fine.\nNow, obviously, you're, you're a medic yourself. Did you have any thoughts as to what might be going on?\nUh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transi transient ischemic attacks. Um. Okay. And so that's something quite urgent, and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude.\nSo what I'm probably going to do and in fact, what I am going to do is I'm going to refer you to a stroke TIA clinic. Um, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm gonna do is I'm gonna I'm gonna refer you to a, a mini-stroke clinic or a TIA clinic.\nUm, I send that referral off now, and then you can attend them. They-they'll usually call you in within the next one to two days. Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically, the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking they'll be doing the\nultrasound of the carotid arteries like your, your father had. Um, and they'll be doing maybe a they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether you have, um, any illness. Sure. You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they're prolonged, then, um, you may need to attend A&E. Okay? Because, um, our presumptive\nworking diagnosis is mini-stroke or TIA. Okay?\nAnd if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to the hospital in that instance as soon as possible. Okay? Sure.\nNow, if th-things happen again, feel free to contact us. We can assess you over the phone.\nWe can give you direction and guidance over the phone. That's, that's, that's not a problem. You know, you've, you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to use that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this\nappointment. And, um, if you want, you can ring them either today or tomorrow morning to today in the afternoon, wait one or two hours, or tomorrow morning just to find out when they plan to slot you in.\nAnd just to make sure they've got you in the system, that they've got them booked, and they're gonna be calling you in. Okay?\nGreat. So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time.\nOkay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, something needs to be done. You need to be get, get in contact b-back with us. Okay? Great. All right.\nDid you have any questions at all?\nNo, I think that covers most of it.\nOkay. Great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should um, you should be able to have you should have the information at your hands to in order to take things further. Okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye-bye.","marks":[[28,31,"Doctor from GP at Hand.",false],[49,62,"Hi. OK.",false],[163,167,"Yeah it's",false],[388,396,"AB one CB two.",false],[630,636,".",false],[1163,1187,"",false],[1918,1920,"there",false],[2816,2816,"Right .",false],[3176,3184,"a month ago probably",false],[3753,3758,".",false],[4123,4128,"has",false],[5236,5247,"OK. Uh and",false],[5363,5364,"",false],[5608,5610,"",false],[5903,5914,"Right OK.",false],[6112,6122,"actually",false],[6252,6258,"",false],[6744,6749,"uh",false],[7445,7448,"your",false],[7632,7637,"OK whether",false],[7642,7649,"have",true],[7688,7688,"Sure.",false],[8175,8184,"things",false],[8361,8367,"you",false],[8558,8563,"can",false],[8599,8604,"PALS",false],[8671,8674,"leave",false],[8970,8974,"got time",false],[9061,9072,"in the books",false],[9086,9091,"going to",false],[9111,9130,"OK.",false],[9433,9460,"",false],[9465,9475,"you",false],[9496,9502,"back back",false],[9512,9524,"OK.",false],[9744,9748,"help",false],[9831,9843,"OK.",false],[9879,9902,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past month' and 'approximately 1.5 to 2 months ago'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial couple of days of tiredness then return to normal not captured."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles in their right hand, episodes of numbness'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Symptoms consistently documented in the right hand."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'right hand with pins and needles, and the right arm feeling weaker'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'lasting a few days before returning to normal'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'leg feels weaker at the same time as their arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","Colleague noted walking 'slightly differently to normal' during episodes."],["The note captures: Gait is normal outside the episodes.","no","Normal gait outside episodes not stated."],["The note captures: Generally feels tired and weak.","yes","'feeling tired and weak'."],["The note captures: Sometimes feels nauseous.","no","Nausea not mentioned."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not mentioned."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially occurring maybe once a week to once a month'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now happening a couple of times a day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding a cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'harder to drink coffee'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'over the last couple of days ... only during episodes'."],["The note captures: No difficulty swallowing currently.","no","Absence of current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","'something in my throat' during episodes."],["The note captures: No difficulty speaking during episodes.","no","No speech difficulty not documented."],["The note captures: No visual problems noticed during episodes (wears glasses).","no","Only notes glasses; absence of visual problems not stated."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'no current symptoms at the time of consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not stated."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol checked and 'all okay'."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes checked and 'all okay'."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure checked and 'all okay'."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / fit and well not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","Self-started after reading online and not GP-initiated, but the stroke/heart attack risk reason is missing."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'without prior GP consultation regarding risks'."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father had an operation to reduce the risk of stroke'."],["The note captures: Non-smoker.","no","Smoking status not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Lost video / no examination not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Concerns for Transient Ischemic Attacks (TIAs) / mini-strokes'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Urgent exclusion and family history captured, but young age is framed as a risk factor rather than 'despite young age'."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to a Stroke/TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days ... by Thursday/Friday'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'ultrasound of the carotid arteries'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'potentially a brain scan' but purpose (check for bleed) omitted."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E immediately if symptoms return and persist or are prolonged'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","'Urgent but not an immediate emergency' framing not captured."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Contacting the practice for phone assessment if symptoms recur not captured."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'PALS number and TIA clinic number to be provided in notes'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","Contact clinic 'today or tomorrow morning' to confirm."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","partial","'contact the clinic again if ... delays' - unclear it means the practice."]],"claims":[["The patient's age (32 years old) and family history of stroke are noted as relevant risk factors.","Clinician said TIA needed excluding 'even though you're quite young'; young age was not named as a risk factor."],["Differential diagnoses include other transient neurological conditions","No differential diagnosis was discussed; only TIA/mini-stroke was raised."],["Patient advised to contact the clinic again if there are any delays in getting an appointment or if they are not called.","Clinician said to get back in contact with the practice ('with us'), not the TIA clinic."]],"note":"S - Subjective\n- The patient presents with \"very weird symptoms\" over the past month, which they attribute to \"pins and needles\" in their right hand, episodes of numbness, and feeling tired and weak.\n- Symptoms started approximately 1.5 to 2 months ago, initially occurring maybe once a week to once a month, but now happening a couple of times a day.\n- Episodes involve the right hand with pins and needles, and the right arm feeling weaker, lasting a few days before returning to normal.\n- The patient's colleague noted them walking \"slightly differently to normal\" during episodes, and the patient reports their leg feels weaker at the same time as their arm symptoms.\n- Recent symptoms over the last couple of days include difficulty holding a cup of coffee and harder to drink coffee, only during episodes, and a feeling of \"something in my throat\" during episodes.\n\nO - Objective\n- Patient is 32 years old, full name John Smith, address 4 Park Avenue, AB1 CB2.\n- Patient wears glasses.\n- Patient is a medical doctor in plastic surgery.\n- Patient reports no current symptoms at the time of consultation.\n- Patient's father had an operation to reduce the risk of stroke.\n- Patient had blood tests (cholesterol, diabetes, blood pressure) checked after their father's operation, which were reported as \"all okay.\"\n\nA - Assessment\n- Concerns for Transient Ischemic Attacks (TIAs) / mini-strokes based on the patient's description of transient neurological symptoms.\n- The patient's age (32 years old) and family history of stroke are noted as relevant risk factors.\n- Differential diagnoses include other transient neurological conditions, though TIAs are the primary concern given the episodic nature and focal neurological deficits described.\n- The patient's self-medication with aspirin 75mg daily, initiated after reading information on the internet and without prior GP consultation regarding risks, is identified.\n- The patient's symptoms are described as episodic and resolving, which is consistent with TIA.\n\nP - Plan\n- Urgent referral to a Stroke/TIA clinic for further assessment and exclusion of TIA.\n- The patient is advised to expect to be seen within 1-2 days, with a deadline for seeing them by Thursday/Friday.\n- Investigations at the TIA clinic are expected to include ultrasound of the carotid arteries and potentially a brain scan.\n- Patient education provided regarding the need to attend A&E immediately if symptoms return and persist or are prolonged, as this could indicate a stroke.\n- Patient advised to contact the clinic directly (PALS number and TIA clinic number to be provided in notes) to confirm appointment details today or tomorrow morning.\n- Patient advised to contact the clinic again if there are any delays in getting an appointment or if they are not called.\n","review":476.52631578947364,"saved":9.473684210526358,"faster":1.9493177387914316,"clean":false,"effort":42.391304347826086,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial couple of days of tiredness then return to normal not captured."],["missing","Gait is normal outside the episodes.","Normal gait outside episodes not stated."],["missing","Sometimes feels nauseous.","Nausea not mentioned."],["missing","Low motivation; does not feel like doing anything.","Low motivation not mentioned."],["missing","No difficulty swallowing currently.","Absence of current swallowing difficulty not documented."],["missing","No difficulty speaking during episodes.","No speech difficulty not documented."],["missing","No visual problems noticed during episodes (wears glasses).","Only notes glasses; absence of visual problems not stated."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not stated."],["missing","No other illnesses; normally fit and well.","No other illnesses / fit and well not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","Self-started after reading online and not GP-initiated, but the stroke/heart attack risk reason is missing."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Non-smoker.","Smoking status not documented."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Lost video / no examination not documented."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Urgent exclusion and family history captured, but young age is framed as a risk factor rather than 'despite young age'."],["partial","TIA clinic may do a brain scan to check for a bleed.","'potentially a brain scan' but purpose (check for bleed) omitted."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","'Urgent but not an immediate emergency' framing not captured."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Contacting the practice for phone assessment if symptoms recur not captured."],["partial","If there is any delay (not called or cannot make the appointment), contact the practice again.","'contact the clinic again if ... delays' - unclear it means the practice."],["fabrication","The patient's age (32 years old) and family history of stroke are noted as relevant risk factors.","Clinician said TIA needed excluding 'even though you're quite young'; young age was not named as a risk factor."],["fabrication","Differential diagnoses include other transient neurological conditions","No differential diagnosis was discussed; only TIA/mini-stroke was raised."],["fabrication","Patient advised to contact the clinic again if there are any delays in getting an appointment or if they are not called.","Clinician said to get back in contact with the practice ('with us'), not the TIA clinic."]],"mb":30.591022,"latency":23.951,"finalised":487.5323157894736},{"label":"Run 2","wer":9.26906779661017,"text":"Hi there, good morning. I'm Dr.\nNice to see you. Thanks.\nOkay. So, um, before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay.\nCould you tell me the first line of your address and your postcode, please?\nIt's 4 Park Avenue, and it's AB1 CB2.\nThat's great. Thank you so much for that.\nAre you in a private place where you're okay to speak at the moment? Yes. Okay.\nSo how can I help you today? You can have some problems with your asthma. Is that right?\nSorry, say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having.\nSo it started with feeling very tired for a couple of days, and then I get back to normal.\nAnd then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I guess pins and needles.\nRight. And.\nSo what so just tell again, the connection's not so great. You've been getting pins and needles in the hand. Is that right?\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yes.\nOkay. Um, with lots of video now, maybe is a, a, a button you can press. Okay.\nAre you happy for us to carry on without the video? I can't see you at the moment. Yes, that's fine.\nAll right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nUh, the pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts 3 days, and then goes back to normal. So it's very weird. Right. Okay. And is it any involvement of your leg at all?\nUh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days, or 3 or 4 days. Okay. You, you said you've been having weird symptoms for about a month.\nYes. So, so what has been happening from the beginning of the month? What else has been happening? Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\nRight. Okay.\nUm, and, um, you know, your colleague said you've, you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs?\nCan you have you noticed anything different?\nYes. So at the same time I get my arm symptoms, my leg feels weaker.\nRight. Okay.\nAnd, you know, you the abnormal gait, has that been present outside of these episodes? No.\nIt has not. Right. So normally I'm fit and well, actually. All right. Okay. Um, and these, these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week, uh, to every once a once a month. But now it's getting uh, a couple of times a day. Right. Okay. And how long have these episodes been going on for? When, when did it all start? Is it. It could be a month and a half, maybe 2 months. Right. Okay.\nOkay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time?\nLike swallowing or difficulty speaking or vision problems? So recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\nRight.\nIs that during these episodes, or outside of these episodes? Only during the episodes. Okay.\nDo you have any difficulty swallowing at all?\nNot currently, no. Yeah.\nDuring the episodes, do you have any difficulty swallowing?\nI, I, I feel like there's something in my throat. Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all? No, I can speak fine. Okay.\nAnd any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, um, can I just ask, h-has uh, is there any history of stroke or mini-strokes in your family? Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke. Right.\nOkay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\nNo. So after my dad had his operation, I was required to be checked, and my cholesterol, uh, was fine.\nGood. Excellent. So you had a, a blood test done, and did they check for diabetes as well?\nThey checked my diabetes, my blood pressure, and my cholesterol. And the doctor said it was all okay. Fantastic. Okay.\nNow, do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\nOkay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before your GP that you're on aspirin? Yes, I took I started taking it after my father had his operation.\nBut that wasn't the doctor telling me.\nOkay. A-and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G the GP in the past? No, I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment? Yes, I am. What do you work as?\nUh, I'm, I'm actually a doctor. You're a me a, a medical doctor? Yes.\nOkay. Uh, which specialty are you in?\nI work in, uh, plastic surgery. Plastic surgery. Okay. Great. And, um, do you have any, um, allergies to any medication at all? I'm allergic to penicillin only. Okay. And, um, are you, um, living alone? No, I live with my wife.\nWife. Okay. Um, fantastic. Uh, do you smoke at all? No, I don't. Right. Okay.\nUm, that's fine.\nNow, obviously, you're, you're a medic yourself. Did you have any thoughts as to what might be going on?\nUh, I've absolutely got no idea. Right.\nOkay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient transient ischemic attacks.\nUm. Okay. And so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do and in fact, what I am going to do is I'm going to refer you to a stroke TIA clinic.\nUm, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm going to do is I'm go I'm going to refer you to a, a mini-stroke clinic or a TIA clinic. Um, I send that referral off now, and then you can attend them. They-they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically, the deadline should be Th\nursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things.\nUm, they'll be checking they'll be doing the ultrasound of the carotid arteries like your, your father had. Um, and they'll be doing maybe a they might do a scan of the brain as well, to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether you have, um, any illness. Sure. You have got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E. Okay? Because, um\n, our presumptive working diagnosis is mini-stroke or TIA. Okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to the hospital in that instance, as soon as possible. Okay? Sure. Now, if th-things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's, that'\ns, that's not a problem. You know, we've got you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to use that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tom\norrow morning to today in the afternoon. Wait 1 or 2 hours, or tomorrow morning, just to find out when they plan to slot you in. And just to make sure they've got you in the system, that they've got them booked, and they're going to be calling you in. Okay? Great. So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time. Okay?\nSo if there's if there's any delay that transpires, for example, you can't make the appointment, or, you know, that you don't get called, something needs to be done.\nYou need to be ge-get in contact b-back with us. Okay? Great. All right. Did you have any questions at all? No, I think that covers most of it.\nOkay. Great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should um, you should be able to have you should have the information at your hands to in order to take things further.","marks":[[28,31,"Doctor from GP at Hand.",false],[49,62,"Hi. OK.",false],[163,167,"Yeah it's",false],[388,396,"AB one CB two.",false],[548,560,"You've been having",false],[624,630,".",false],[1157,1182,"",false],[1400,1412,"we've lost",false],[1432,1432,"there",false],[1827,1828,"few",false],[1905,1907,"there",false],[2792,2792,"Right .",false],[3147,3158,"a month ago probably",false],[3725,3730,".",false],[4095,4100,"has",false],[5208,5219,"OK. Uh and",false],[5335,5336,"",false],[5580,5582,"",false],[5875,5886,"Right OK.",false],[6084,6094,"actually",false],[6234,6243,"",false],[6703,6711,"gonna",false],[6722,6724,"uh",false],[6729,6737,"gonna",false],[7083,7092,"Thursday",false],[7420,7423,"your",false],[7608,7613,"OK whether",false],[7661,7661,"Sure.",false],[7709,7713,"they're",false],[8143,8152,"things",false],[8289,8296,"that's",false],[8330,8339,"you",false],[8529,8534,"can",false],[8570,8575,"PALS",false],[8642,8645,"leave",false],[8827,8836,"tomorrow",false],[8939,8943,"got time",false],[9030,9041,"in the books",false],[9083,9102,"OK.",false],[9406,9433,"",false],[9438,9455,"you get get",false],[9467,9473,"back back",false],[9483,9495,"OK.",false],[9715,9719,"help",false],[9801,9801,"OK. thank you. All the best. Take care now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"over the past one to two months\"."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","\"feeling very tired for a couple of days\" initially."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"losing feeling in their right hand and arm, described as pins and needles\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","\"right hand and arm\"."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Pins and needles in right hand/arm \"with the arm feeling weaker\" (arm mention acceptable)."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"episodes typically last for three days before resolving\"."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"feeling weaker in their leg concurrently with arm symptoms\"."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"colleague noted changes in their gait\"."],["The note captures: Gait is normal outside the episodes.","no","Normal gait outside episodes not stated."],["The note captures: Generally feels tired and weak.","yes","\"persistent tiredness, weakness\"."],["The note captures: Sometimes feels nauseous.","yes","\"occasional nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","yes","\"a lack of motivation\"."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"progressing from monthly/weekly\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"to a couple of times a day\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding a cup of coffee\"."],["The note captures: Drinking is slightly harder during episodes.","yes","\"harder drinking during episodes\"."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","\"Recently ... during episodes\"."],["The note captures: No difficulty swallowing currently.","no","Absence of current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"sensation of \\\"something in my throat\\\"\"."],["The note captures: No difficulty speaking during episodes.","yes","\"no difficulty speaking\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"no ... visual problems\"."],["The note captures: Currently asymptomatic at the time of consultation.","yes","\"\\\"perfectly fine at the moment\\\"\"."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not documented."],["The note captures: Cholesterol previously checked and normal.","yes","\"normal cholesterol\"."],["The note captures: Previously screened for diabetes; normal.","yes","\"diabetes screening ... normal\"."],["The note captures: Blood pressure previously checked; normal.","yes","\"blood pressure results\" normal."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / normally fit and well not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75mg daily\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","\"self-prescribed aspirin\" but reason (stroke/heart attack risk, after father's operation) omitted."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","\"lack of prior medical consultation regarding its use and risks\"."],["The note captures: Allergic to penicillin.","yes","\"known allergy to penicillin\"."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father having undergone a carotid artery operation\"."],["The note captures: Non-smoker.","yes","\"they do not smoke\"."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","\"video connection noted to be problematic ... No physical examination was performed\"."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"primary concern is for Transient Ischemic Attacks (TIAs) or mini-strokes\"."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Concern \"heightened by ... family history\" but urgent exclusion despite young age not explicitly framed."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral initiated to a stroke TIA clinic.\""],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"within the next one to two days ... Thursday or Friday\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"ultrasound of the carotid arteries\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","yes","\"potentially a brain scan to check for signs of a bleed\"."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","\"if symptoms return and persist or prolong ... attend A&E immediately\"."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Contacting practice for phone assessment if symptoms recur not captured."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","\"PALS number or TIA clinic number provided in the consultation notes\"."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","\"contact the TIA clinic today afternoon or tomorrow morning to confirm\"."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"contact the current service if any delays occur\"."]],"claims":[],"note":"S – Subjective\n- The Patient reports experiencing \"very weird symptoms\" over the past one to two months, prompting the visit.\n- Initial symptoms included feeling very tired for a couple of days, followed by episodes of losing feeling in their right hand and arm, described as pins and needles, with the arm feeling weaker. These episodes typically last for three days before resolving.\n- The Patient's colleague noted changes in their gait, which the Patient confirms as feeling weaker in their leg concurrently with arm symptoms, lasting three to four days during episodes.\n- Other general symptoms during this period include persistent tiredness, weakness, occasional nausea, and a lack of motivation. Episodes have become more frequent, progressing from monthly/weekly to a couple of times a day.\n- Recently, the Patient has experienced difficulty holding a cup of coffee and harder drinking during episodes, along with a sensation of \"something in my throat,\" but no difficulty speaking or visual problems.\n- The Patient reports a family history of stroke, with their father having undergone a carotid artery operation. They have a known allergy to penicillin and are currently taking self-prescribed aspirin 75mg daily. The Patient works as a plastic surgeon and lives with their wife; they do not smoke.\n\nO – Objective\n- The Patient's identity was confirmed as John Smith, 32 years old, residing at 4 Park Avenue, AB1 CB2.\n- The encounter was conducted via a phone call, with the video connection noted to be problematic.\n- The Patient stated they were \"perfectly fine at the moment\" when asked about current symptoms.\n- No physical examination was performed or documented during this telephone consultation.\n- Insufficient information documented regarding vital signs, laboratory results, or imaging findings from the current encounter.\n\nA – Assessment\n- The physician's primary concern is for Transient Ischemic Attacks (TIAs) or mini-strokes, based on the Patient's episodic neurological symptoms.\n- This concern is heightened by the Patient's family history of stroke.\n- The Patient's self-reported history of normal cholesterol, diabetes screening, and blood pressure results from prior testing was noted.\n- The physician acknowledged the Patient's self-prescription of aspirin and the lack of prior medical consultation regarding its use and risks.\n\nP – Plan\n- Urgent referral initiated to a stroke TIA clinic.\n- The Patient is expected to be seen at the clinic within the next one to two days, with a target deadline of Thursday or Friday from the current Wednesday.\n- Anticipated investigations at the TIA clinic include an ultrasound of the carotid arteries and potentially a brain scan to check for signs of a bleed.\n- Patient education provided: if symptoms return and persist or prolong, the Patient should attend A&E immediately, as this could indicate a full stroke.\n- The Patient was advised to contact the TIA clinic today afternoon or tomorrow morning to confirm the appointment details, using the PALS number or TIA clinic number provided in the consultation notes.\n- The Patient was instructed to contact the current service if any delays occur with the referral or appointment.\n","review":296.57894736842104,"saved":189.42105263157896,"faster":38.97552523283518,"clean":false,"effort":15.217391304347828,"sig":[["missing","Gait is normal outside the episodes.","Normal gait outside episodes not stated."],["missing","No difficulty swallowing currently.","Absence of current swallowing difficulty not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not documented."],["missing","No other illnesses; normally fit and well.","No other illnesses / normally fit and well not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","\"self-prescribed aspirin\" but reason (stroke/heart attack risk, after father's operation) omitted."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Concern \"heightened by ... family history\" but urgent exclusion despite young age not explicitly framed."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not an immediate emergency."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Contacting practice for phone assessment if symptoms recur not captured."]],"mb":30.796517,"latency":36.984,"finalised":318.627947368421},{"label":"Run 3","wer":9.004237288135593,"text":"Hi there, good morning. I'm Dr.\nNice to see you. Thanks.\nOkay. So, um, before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay.\nCould you tell me the first line of your address and your postcode, please?\nIt's 4 Park Avenue, and it's AB1 CB2.\nThat's great. Thank you so much for that.\nAre you in a private place where you're okay to speak at the moment? Yes. Okay.\nSo how can I help you today? You can have some problems with your asthma. Is that right?\nSorry, say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having.\nSo it started with feeling very tired for a couple of days, and then I get back to normal.\nAnd then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I get pins and needles, and. Right.\nSo what so just to get the connection's not so great. You've been getting pins and needles in the hand. Is that right?\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yes.\nOkay. Um, with lots of video now, maybe is a, a, a button you can press.\nOkay.\nAre you happy for us to carry on without the video? I can't see you at the moment. Yes, that's fine.\nAll right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nUh, the pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts 3 days, and then goes back to normal. So it's very weird. Right. Okay. And is it any involvement of your leg at all?\nUh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days or 3 or 4 days. Okay. You, you said you've been having weird symptoms for about a month.\nYes. So, so what has been happening from the beginning of the month? What else has been happening? Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\nRight. Okay.\nUm, and, um, you know, your colleague said you've, you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs?\nCan you have you noticed anything different?\nYes. So at the same time I get my arm symptoms, my leg feels weaker.\nRight. Okay.\nAnd, you know, you the abnormal gait. Has that been present outside of these episodes? No.\nIt has not. Right. So normally I'm fit and well, actually. All right. Okay. Um, and these, these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week, uh, to every once a once a month. But now it's getting a, a couple of times a day. Right.\nOkay. And how long have these episodes been going on for? When, when did it all start? Is it. It might be a month and a half, maybe 2 months. Right. Okay.\nOkay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time?\nLike swallowing or difficulty speaking or vision problems? So recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\nRight. Is that during these episodes or outside of these episodes? Only during the episodes. Okay.\nDo you have any difficulty swallowing at all?\nNot currently, no. Yeah. During the episodes, do you have any difficulty swallowing? I, I, I feel like there's something in my throat. Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all? No, I can speak fine. Okay.\nAnd any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, um, can I just ask, h-has uh, is there any history of stroke or mini-strokes in your family? Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke. Right.\nOkay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\nNo. So after my dad had his operation, I was required to be checked, and my cholesterol, uh, was fine.\nGood. Excellent. So you had a, a blood test done, and did they check for diabetes as well?\nThey checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Now, do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin 75 milligrams once a day, but that's because of something I read on the internet.\nOkay. So, so why is that? Why did you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do you have you ever told a doctor before your GP that you're on aspirin? Yes. I took I started taking it after my father had his operation. But that wasn't the doctor telling me.\nOkay. A-and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G the GP in the past? No, I haven't. Yeah. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment? Yes, I am. What do you work as?\nUh, I'm, I'm actually a doctor.\nYou're a me a, a medical doctor? Yes. Okay. Uh, which specialty are you in?\nI work in, uh, plastic surgery. Plastic surgery. Okay. Great.\nAnd, um, do you have any, um, allergies to any medication at all? I'm allergic to penicillin only.\nOkay. And, um, are you, um, living alone? No, I live with my wife.\nWife. Okay. Um, fantastic. Uh, do you smoke at all? No, I don't. Right. Okay. Um, that's fine.\nNow, obviously, you're, you're a medic yourself. Did you have any thoughts as to what might be going on?\nUh, I've absolutely got no idea. Right. Okay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient transient ischemic attacks. Um. Okay. And so that's something quite urgent and given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude.\nSo what I'm probably going to do and in fact, what I am going to do is I'm going to refer you to a stroke TIA clinic.\nUm, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm going to do is I'm going I'm going to refer you to a, a mini-stroke clinic or a TIA clinic.\nUm, I send that referral off now, and then you can attend them. They-they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically, the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking they'll be doing the\nultrasound of the carotid arteries like your, your father had. Um, and they'll be doing maybe they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether you have, um, any illness. Sure. You haven't got any kind of stroke or mini-stroke.\nNow, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E. Okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA. Okay?\nAnd if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure.\nNow, if th-things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's, that's, that's not a problem. You know, you've, you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to use that number in the\nnotes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning to today in the afternoon.\nWait 1 or 2 hours, or tomorrow morning just to find out when they plan to slot you in. And just to make sure they've got you in the system, that they've got them booked and they're going to be calling you in. Okay?\nGreat. So, um, this isn't, uh, an immediate emergency that you need to rush down to A&E, but it's something quite urgent that we need to deal with in a short space of time.\nOkay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, something needs to be done. You need to be ge-get in contact b-back with us. Okay? Great. All right.\nDid you have any questions at all?\nNo, I think that covers most of it.\nOkay. Great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should um, you should be able to have you should have the information at your hands to in order to take things further. Okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye-bye.","marks":[[28,31,"Doctor from GP at Hand.",false],[49,62,"Hi. OK.",false],[163,167,"Yeah it's",false],[388,396,"AB one CB two.",false],[548,560,"You've been having",false],[624,630,".",false],[1126,1129,"guess",false],[1160,1182,"again",false],[1393,1405,"we've lost",false],[1425,1425,"there",false],[1820,1821,"few",false],[1898,1900,"there",false],[2784,2784,"Right .",false],[3138,3149,"a month ago probably",false],[3715,3720,".",false],[4085,4090,"has",false],[4929,4932,"do",false],[5201,5212,"OK. Uh and",false],[5328,5329,"",false],[5365,5376,"You haven't OK.",false],[5566,5568,"",false],[5861,5872,"Right OK.",false],[6070,6080,"actually",false],[6220,6229,"",false],[6688,6696,"gonna",false],[6707,6712,"uh",false],[6717,6725,"gonna",false],[7405,7408,"your",false],[7592,7597,"OK whether",false],[7602,7609,"have",true],[7648,7648,"Sure.",false],[7696,7700,"they're",false],[8124,8133,"things",false],[8310,8316,"you",false],[8507,8512,"can",false],[8548,8553,"PALS",false],[8620,8623,"leave",false],[8915,8919,"got time",false],[9006,9017,"in the books",false],[9058,9077,"OK.",false],[9380,9407,"",false],[9412,9429,"you get get",false],[9441,9447,"back back",false],[9457,9469,"OK.",false],[9689,9693,"help",false],[9776,9788,"OK.",false],[9824,9847,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past month to month and a half, possibly two months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'started with feeling very tired for a couple of days'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'losing feeling ... pins and needles in the right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Pins and needles in right hand; 'right arm feels weaker'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'last approximately 3 days and then return to normal'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","no","Leg weakness not mentioned."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","Colleague noted walking 'slightly differently to normal'."],["The note captures: Gait is normal outside the episodes.","partial","'during these 3-4 day episodes' implies but does not state normal gait otherwise."],["The note captures: Generally feels tired and weak.","yes","'general tiredness, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'lack of motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","no","Initial frequency not documented."],["The note captures: Episodes now occur a couple of times a day.","no","Current frequency not documented."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding a cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'slight difficulty drinking'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'recent ... during episodes'."],["The note captures: No difficulty swallowing currently.","no","No current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","'something in my throat'."],["The note captures: No difficulty speaking during episodes.","no","Speech not documented."],["The note captures: No visual problems noticed during episodes (wears glasses).","no","Visual symptoms not documented."],["The note captures: Currently asymptomatic at the time of consultation.","no","Current asymptomatic status not documented."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not stated."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure normal."],["The note captures: No other illnesses; normally fit and well.","no","Not documented."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-prescribed ... to reduce stroke/heart attack risk based on internet information'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'without GP consultation regarding risks'."],["The note captures: Allergic to penicillin.","yes","'allergic to penicillin'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father, who underwent carotid artery surgery'."],["The note captures: Non-smoker.","yes","'denies smoking'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Lost video / no examination not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'concerned about Transient Ischemic Attacks (TIAs) or mini-strokes'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","Family history 'adds to the concern despite the patient's young age'; urgent appointment."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","Referral to stroke/TIA clinic 'for an urgent appointment'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days (by Thursday/Friday)'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'ultrasound of the carotid arteries'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain scan to rule out stroke' - bleed purpose not specified."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E immediately if symptoms return and become prolonged'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not captured."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'follow up with the physician ... if symptoms recur for further guidance'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","no","PALS/TIA numbers in notes not documented."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","no","Calling clinic to confirm not documented."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact the clinic or follow up with the physician if there are any delays'."]],"claims":[["Differential diagnosis includes other causes of transient neurological deficits.","No differential diagnosis was discussed; only TIA/mini-stroke was raised."]],"note":"S - Subjective\n- The patient presents with a chief complaint of \"very weird symptoms\" over the past month to month and a half, possibly two months.\n- Symptoms started with feeling very tired for a couple of days, followed by episodes of losing feeling in their hands and arms, specifically pins and needles in the right hand.\n- The patient reports the right arm feels weaker during these episodes, which last approximately 3 days and then return to normal.\n- A colleague noted the patient walking \"slightly differently to normal\" during these 3-4 day episodes.\n- Other associated symptoms include general tiredness, weakness, occasional nausea, and lack of motivation, along with recent difficulty holding a cup of coffee and slight difficulty drinking during episodes, and a sensation of \"something in my throat.\"\n\nO - Objective\n- Patient's full name confirmed as John Smith, 32 years old.\n- Patient's address confirmed as 4 Park Avenue, AB1 CB2.\n- Patient reports being a medical doctor specializing in plastic surgery.\n- Patient is allergic to penicillin.\n- Patient denies smoking and lives with their wife.\n\nA - Assessment\n- The physician is concerned about Transient Ischemic Attacks (TIAs) or mini-strokes based on the patient's described episodes of transient neurological symptoms.\n- The family history of stroke in the patient's father, who underwent carotid artery surgery, adds to the concern despite the patient's young age.\n- The patient's self-prescribed aspirin 75mg daily, taken to reduce stroke/heart attack risk based on internet information and without GP consultation regarding risks, is noted.\n- The patient's prior blood tests (cholesterol, diabetes, blood pressure) were reported as normal after their father's operation.\n- Differential diagnosis includes other causes of transient neurological deficits.\n\nP - Plan\n- Referral to a stroke/TIA clinic will be sent immediately.\n- The patient is expected to be contacted by the clinic within 1-2 days (by Thursday/Friday) for an urgent appointment.\n- Investigations at the clinic may include ultrasound of the carotid arteries and a brain scan to rule out stroke or mini-stroke.\n- Patient advised to attend A&E immediately if symptoms return and become prolonged, as this could indicate a full stroke.\n- Patient advised to contact the clinic or follow up with the physician if there are any delays in receiving an appointment or if symptoms recur for further guidance.\n","review":420.63157894736844,"saved":65.36842105263156,"faster":13.450292397660816,"clean":false,"effort":33.69565217391305,"sig":[["missing","Leg feels weaker at the same time as the arm symptoms.","Leg weakness not mentioned."],["partial","Gait is normal outside the episodes.","'during these 3-4 day episodes' implies but does not state normal gait otherwise."],["missing","Episodes becoming more frequent: initially roughly once a week to once a month.","Initial frequency not documented."],["missing","Episodes now occur a couple of times a day.","Current frequency not documented."],["missing","No difficulty swallowing currently.","No current swallowing difficulty not documented."],["missing","No difficulty speaking during episodes.","Speech not documented."],["missing","No visual problems noticed during episodes (wears glasses).","Visual symptoms not documented."],["missing","Currently asymptomatic at the time of consultation.","Current asymptomatic status not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not stated."],["missing","No other illnesses; normally fit and well.","Not documented."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Lost video / no examination not documented."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain scan to rule out stroke' - bleed purpose not specified."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not captured."],["missing","TIA clinic and PALS contact numbers to be left in the consultation notes.","PALS/TIA numbers in notes not documented."],["missing","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Calling clinic to confirm not documented."],["fabrication","Differential diagnosis includes other causes of transient neurological deficits.","No differential diagnosis was discussed; only TIA/mini-stroke was raised."]],"mb":30.647551,"latency":23.76,"finalised":431.61457894736844},{"label":"Run 4","wer":8.209745762711865,"text":"Hi there, good morning. I'm Dr.\nNice to see you. Thanks.\nOkay. So, um, before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old, okay.\nCould you tell me the first line of your address and your postcode, please?\nIt's 4 Park Avenue, and it's AB1 CB2.\nThat's great. Thank you so much for that.\nAre you in a private place where you're okay to speak at the moment? Yes. Okay.\nSo how can I help you today? You've been having some problems with your asthma. Is that right?\nSorry, say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having.\nSo it started with feeling very tired for a couple of days, and then I get back to normal.\nAnd then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I guess pins and needles.\nRight. And.\nSo what so just to get the connection's not so great. You've been getting pins and needles in the hand. Is that right?\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yes.\nOkay. Um, we've lost video now. Maybe is there a, a, a button you can press?\nOkay.\nAre you happy for us to carry on without the video? I can't see you at the moment. Yes, that's fine.\nAll right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nUh, the pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts a few days, and then goes back to normal. So it's very weird. Right. Okay. And is it any involvement of your leg at all?\nUh, my colleague said I'm walking slightly differently to normal. And again, it's only for three days, or three or four days.\nOkay. You, you said you've been having weird symptoms for about a month.\nYes. So, so what has been happening from the beginning of the month? What else has been happening? Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\nRight. Okay.\nUm, and, um, you know, your colleague said you've, you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Can you have you noticed anything different?\nYes. So at the same time I get my arm symptoms, my leg feels weaker.\nRight. Okay.\nAnd, you know, you the abnormal gait, has that been present outside of these episodes? No.\nIt has not. Right. So normally I'm fit and well, actually. All right. Okay. Um, and these, these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week, uh, to every once a once a month. But now it's getting uh, a couple of times a day. Right.\nOkay. And how long have these episodes been going on for? When, when did it all start? Is that. It might be a month and a half, maybe two months. Right. Okay.\nOkay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time?\nLike swallowing or difficulty speaking or vision problems? So recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\nRight. Is that during these episodes, or outside of these episodes? Only during the episodes. Okay.\nDo you have any difficulty swallowing at all?\nNot currently, no. Okay. During the episodes, do you have any difficulty swallowing? I, I, I feel like there's something in my throat. Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all? No, I can speak fine. Okay.\nAnd any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, um, can I just ask, h-has uh, is there any history of stroke or mini-strokes in your family?\nUh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke. Right.\nOkay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\nNo. So after my dad had his operation, I was required to be checked, and my cholesterol, uh, was fine.\nGood. Excellent. So you had a, a blood test done, and did they check for diabetes as well?\nThey checked my diabetes, my blood pressure, and my cholesterol. And the doctor said it was all okay. Fantastic. Okay. Now, do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\nOkay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before your GP that you're on aspirin? Yes, I took I started taking it after my father had his operation. But that wasn't the doctor telling me.\nOkay. A-and has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the G the GP in the past? No, I haven't.\nYou haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment? Yes, I am. What do you work as?\nUh, I'm, I'm actually a doctor.\nYou're a me a, a medical doctor? Yes. Okay. Uh, which specialty are you in?\nI work in, uh, plastic surgery. Plastic surgery. Okay. Great.\nAnd, um, do you have any, um, allergies to any medication at all? I'm allergic to penicillin only.\nOkay. And, um, are you, um, living alone? No, I live with my wife.\nWife. Okay. Um, fantastic. Uh, do you smoke at all?\nNo, I don't. Right. Okay. Um, that's fine. Now, obviously, you're, you're a medic yourself. Did you have any thoughts as to what might be going on?\nUh, I've absolutely got no idea.\nRight. Okay. Um, well, the, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient transient ischemic attacks. Um. Okay. And so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude. So what I'm probably going to do and in fact, what I am going to do is I'm going to refer you to a stroke and TIA clinic. Um, now, just to double-check, do you have the symptoms right now\n? No, I'm perfectly fine at the moment. Okay. So, so what I'm going to do is I'm go I'm going to refer you to a, a mini-stroke clinic or a TIA clinic.\nUm, I send that referral off now, and then you can attend them. They-they'll usually call you in within the next one to two days. Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically, the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking they'll be doing\nthe ultrasound of the carotid arteries, like your, your father had. Um, and they'll be doing maybe a they might do a scan of the brain as well, to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether you have, um, any illness. Sure. You haven't got any kind of stroke or mini-stroke. Now, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E. Okay? Because, um, our presumptive\nworking diagnosis is mini-stroke or TIA. Okay?\nAnd if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to the hospital in that instance, as soon as possible. Okay? Sure. Now, if th-things happen again, feel free to contact us. We can assess you over the phone.\nWe can give you direction and guidance over the phone. That's, that's, that's not a problem. You know, you've, you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to use that number in the notes for this consultation. Okay?\nSo you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning to today in the afternoon. Wait one or two hours, or tomorrow morning, just to find out when they plan to slot you in.\nAnd just to make sure they've got you in the system, that they've got you in books, and they're going to be calling you in. Okay? Great. So, um, this isn't a-an immediate emergency. You need to rush down to A&E. But it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment, or, you know, that you don't get called, something needs to be done. You need to be get-get in contact b-back with\nus. Okay? Great. All right. Did you have any questions at all?\nNo, I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should um, you should be able to have you should have the information at your hands to in order to take things further. Okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye-bye.","marks":[[28,31,"Doctor from GP at Hand.",false],[49,62,"Hi. OK.",false],[163,167,"Yeah it's",false],[388,396,"AB one CB two.",false],[630,636,".",false],[1163,1190,"again",false],[1914,1916,"there",false],[2812,2812,"Right .",false],[3172,3180,"a month ago probably",false],[3749,3754,".",false],[4119,4124,"has",false],[5232,5243,"OK. Uh and",false],[5359,5360,"",false],[5604,5606,"",false],[5899,5910,"Right OK.",false],[6108,6118,"actually",false],[6263,6272,"",false],[6737,6745,"gonna",false],[6756,6758,"uh",false],[6763,6771,"gonna",false],[7458,7461,"your",false],[7646,7651,"OK whether",false],[7656,7663,"have",true],[7702,7702,"Sure.",false],[7750,7754,"they're",false],[8187,8196,"things",false],[8373,8379,"you",false],[8570,8575,"can",false],[8611,8616,"PALS",false],[8683,8686,"leave",false],[8983,8987,"got time",false],[9128,9147,"OK.",false],[9444,9471,"",false],[9476,9494,"you get get",false],[9506,9512,"back back",false],[9522,9534,"OK.",false],[9754,9758,"help",false],[9841,9853,"OK.",false],[9889,9912,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over the past 1.5 to 2 months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'feeling very tired for a couple of days'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles sensation ... in the right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","partial","'pins and needles ... and weakness in the right hand and arm' blurs pins and needles being confined to the hand."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'lasting a few days before resolving'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","no","Leg weakness during episodes not mentioned."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'colleague noted an abnormal gait during these episodes'."],["The note captures: Gait is normal outside the episodes.","yes","Gait abnormality 'during these episodes, which also resolves'."],["The note captures: Generally feels tired and weak.","yes","'general tiredness, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'lack of motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'from once a week/month'."],["The note captures: Episodes now occur a couple of times a day.","yes","'a couple of times a day'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding a cup'."],["The note captures: Drinking is slightly harder during episodes.","yes","'drinking coffee' difficulty."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recent symptoms (last couple of days) during episodes'."],["The note captures: No difficulty swallowing currently.","no","No current swallowing status documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","'sensation of \"something in my throat\"'."],["The note captures: No difficulty speaking during episodes.","yes","'no difficulty speaking'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'no ... visual problems during episodes'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'asymptomatic during the current consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not documented."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure normal."],["The note captures: No other illnesses; normally fit and well.","no","No statement of no other illnesses/fit and well."],["The note captures: Takes aspirin 75 mg once daily.","yes","'Aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-prescribed ... to reduce stroke/heart attack risk'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'has not been discussed with their GP regarding risks'."],["The note captures: Allergic to penicillin.","yes","'penicillin allergy'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father undergoing an operation to reduce stroke risk'."],["The note captures: Non-smoker.","yes","'deny smoking'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","'video connection was lost'; no exam findings documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'raise concern for transient ischemic attacks (TIAs) or mini-strokes'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","FHx 'relevant risk factor ... despite their young age' with urgent referral."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to a Stroke and TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days ... by Thursday or Friday'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'ultrasound of the carotid arteries'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'potentially a brain scan' without the bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E immediately should symptoms return and persist or prolong'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","partial","Notes urgency but not that it is currently not an A&E emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Contacting the practice for phone assessment if symptoms recur not documented."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'TIA clinic and PALs contact numbers'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'contact the clinic today or tomorrow morning to confirm their slot'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","partial","Says contact 'the clinic' (the TIA clinic) about delays, not the practice."]],"claims":[["The patient was advised to contact the clinic again if there are any delays in receiving an appointment or if they are not called.","Doctor said to get back in contact with the practice (us) if there is any delay, not the TIA clinic."]],"note":"S – Subjective\n- The patient, a 32-year-old plastic surgery doctor, presents with \"very weird symptoms\" experienced over the past 1.5 to 2 months, which they are unable to identify.\n- Initial symptoms included feeling very tired for a couple of days, followed by episodes of pins and needles sensation and weakness in the right hand and arm, lasting a few days before resolving.\n- The patient's colleague noted an abnormal gait during these episodes, which also resolves.\n- Episodes have increased in frequency from once a week/month to \"a couple of times a day.\"\n- Recent symptoms (last couple of days) during episodes include difficulty holding a cup and drinking coffee, and a sensation of \"something in my throat.\"\n- They report general tiredness, weakness, occasional nausea, and lack of motivation, but no difficulty speaking or visual problems during episodes.\n- Family history includes father undergoing an operation to reduce stroke risk; the patient had routine blood tests (cholesterol, diabetes, blood pressure) after this, which were reported as normal.\n- The patient takes self-prescribed Aspirin 75mg daily to reduce stroke/heart attack risk, which has not been discussed with their GP regarding risks.\n- The patient has a penicillin allergy and lives with their wife; they deny smoking.\n\nO – Objective\n- The patient reports being \"perfectly fine\" and asymptomatic during the current consultation.\n- The video connection was lost during the consultation, which continued without visual contact.\n- Insufficient information documented regarding vital signs, physical examination findings, or lab/imaging results from this encounter.\n\nA – Assessment\n- The patient's episodic neurological symptoms, including transient weakness, pins and needles, and gait disturbance, raise concern for transient ischemic attacks (TIAs) or mini-strokes.\n- The family history of stroke, specifically the father's carotid artery intervention, is a relevant risk factor for the patient despite their young age.\n- The patient's self-administration of Aspirin 75mg daily without physician guidance or risk assessment is noted.\n- Differential diagnoses considered include TIA/mini-stroke.\n\nP – Plan\n- Urgent referral to a Stroke and TIA clinic has been made for further assessment and exclusion of TIA/mini-stroke.\n- The patient is expected to be seen within 1-2 days, with an anticipated turnaround by Thursday or Friday.\n- Investigations at the clinic are expected to include an ultrasound of the carotid arteries and potentially a brain scan.\n- The patient was advised to attend A&E immediately should symptoms return and persist or prolong, as this could indicate a stroke.\n- The patient will be provided with the TIA clinic and PALs contact numbers to follow up on the appointment.\n- The patient was advised to contact the clinic today or tomorrow morning to confirm their slot and ensure they are in the system.\n- The patient was advised to contact the clinic again if there are any delays in receiving an appointment or if they are not called.\n- Patient education included the urgency of the situation and the critical need for immediate A&E attendance if symptoms become prolonged.\n","review":314.36842105263156,"saved":171.63157894736844,"faster":35.31513970110462,"clean":false,"effort":17.391304347826086,"sig":[["partial","Pins and needles confined to the hand; arm feels weaker during episodes.","'pins and needles ... and weakness in the right hand and arm' blurs pins and needles being confined to the hand."],["missing","Leg feels weaker at the same time as the arm symptoms.","Leg weakness during episodes not mentioned."],["missing","No difficulty swallowing currently.","No current swallowing status documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not documented."],["missing","No other illnesses; normally fit and well.","No statement of no other illnesses/fit and well."],["partial","TIA clinic may do a brain scan to check for a bleed.","'potentially a brain scan' without the bleed purpose."],["partial","Currently not an immediate emergency requiring A&E, but urgent.","Notes urgency but not that it is currently not an A&E emergency."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Contacting the practice for phone assessment if symptoms recur not documented."],["partial","If there is any delay (not called or cannot make the appointment), contact the practice again.","Says contact 'the clinic' (the TIA clinic) about delays, not the practice."],["fabrication","The patient was advised to contact the clinic again if there are any delays in receiving an appointment or if they are not called.","Doctor said to get back in contact with the practice (us) if there is any delay, not the TIA clinic."]],"mb":30.701573,"latency":28.691,"finalised":332.38042105263156},{"label":"Run 5","wer":8.845338983050848,"text":"Hi there, good morning. I'm Dr.\nNice to see you. Thanks.\nOkay. So, um, before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay.\nCould you tell me the first line of your address and your postcode, please?\nIt's 4 Park Avenue, and it's AB1 CB2.\nThat's great. Thank you so much for that.\nAre you in a private place where you're okay to speak at the moment? Yes. Okay.\nSo how can I help you today? You can have some problems with your asthma. Is that right?\nSorry, say that again. How can I help you today? So, um, I've been experiencing very weird symptoms over the past month or so, and I don't know what's causing them. I have Googled it, and, um, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms you've been having.\nSo it started with feeling very tired for a couple of days, and then I get back to normal.\nAnd then I started losing feeling of my hands and arms, I get a weird sensation like, uh, I get pins and needles, and. Right.\nSo what so just to get the connection's not so great. You've been getting pins and needles in the hand. Is that right?\nYeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right? Yes.\nOkay. Um, with lots of video now, maybe is a, a, a button you can press.\nOkay.\nAre you happy for us to carry on without the video? I can't see you at the moment. Yes, that's fine.\nAll right. Um, so you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nUh, the pins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts 3 days, and then goes back to normal. So it's very weird. Right. Okay. And is it any involvement of your leg at all?\nUh, my colleague said I'm walking slightly differently to normal. And again, it's only for 3 days or 3 or 4 days.\nOkay. You, you said you've been having weird symptoms for about a month.\nYes. So, so what has been happening from the beginning of the month? What else has been happening? Um, I generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything.\nRight. Okay.\nUm, and, um, you know, your colleague said you've, you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs?\nHave you noticed anything different?\nYes. So at the same time I get my arm symptoms, my leg feels weaker.\nRight. Okay.\nAnd, you know, you the abnormal gait. Has that been present outside of these episodes? No.\nIt has not. Right. So normally I'm fit and well, actually. All right. Okay. Um, and these, these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week, uh, to every once, once a month. But now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When, when did it all start? Is it. It might be a month and a half, maybe 2 months. Right. Okay.\nOkay. And along with these symptoms, uh, of the weakness and numbness, do you have any other symptoms at the same time?\nLike swallowing or difficulty speaking or vision problems? So recently I've noticed I can't hold my cup of coffee, and when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess.\nRight. Is that during these episodes or outside of these episodes? Only during the episodes. Okay.\nDo you have any difficulty swallowing at all?\nNot currently, no. Okay.\nDuring the episodes, do you have any difficulty swallowing?\nI, I, I feel like there's something in my throat. Okay. What about, um, difficulty speaking during these episodes? Any, any issues with that at all? No, I can speak fine. Okay.\nAnd any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, um, can I just ask, has is there any history of stroke or mini-strokes in your family? Uh, yes, my father has had a operation to the side of his neck to reduce the risk of stroke. Right.\nOkay. Um, and, uh, how about yourself? Have you had any history of mini-strokes or anything like that along those lines? I know you're quite young.\nNo. So after my dad had his operation, I was required to be checked, and my cholesterol was fine.\nGood. Excellent. So you had a, a blood test done. And did they check for diabetes as well?\nThey checked my diabetes, my blood pressure, and my cholesterol, and the doctor said it was all okay. Fantastic. Okay.\nNow, do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin, 75 milligrams, once a day, but that's because of something I read on the internet.\nOkay. So, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before your GP that you're on aspirin? Yes. I took I started taking it after my father had his operation. But that wasn't the doctor telling me.\nOkay. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the, the GP in the past? No. I haven't. You haven't. Okay. Um, all right. Um, now, um, in terms of your, uh, your kind of social situation, um, are you working at the moment? Yes, I am. What do you work as?\nUh, I'm, I'm actually a doctor.\nYou're a me a, a medical doctor? Yes.\nOkay. Uh, which specialty are you in?\nI work in, uh, plastic surgery. Plastic surgery. Okay. Great. And, um, do you have any, um, allergies to any medication at all? I'm allergic to penicillin only. Okay. And, um, are you, um, living alone? No, I live with my wife.\nWife. Okay. Um, fantastic. Uh, do you smoke at all? No, I don't. Right. Okay.\nUm, that's fine.\nNow, obviously, you're, you're a medic yourself. Did you have any thoughts as to what might be going on?\nUh, I've absolutely got no idea. Right.\nOkay. Um, well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient transient ischemic attacks. Um. Okay. And so that's something quite urgent. And given that you've got a family history of, um, stroke, um, even though you're quite young, I think, um, it's something that we need to exclude.\nSo what I'm probably going to do and in fact, what I am going to do is I'm going to refer you to a stroke TIA clinic.\nUm, now, just to double-check, do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay. So, so what I'm going to do is I'm go I'm going to refer you to a, a mini-stroke clinic or a TIA clinic.\nUm, I send that referral off now, and then you can attend them. They-they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So, um, uh, basically, the deadline should be Thursday, Friday, we're expecting to be seen by that time. That's the kind of turnaround we're, we're looking at. And in that clinic, they'll be doing a number of things. Um, they'll be checking they'll be doing the ul\ntrasound of the carotid arteries like your, your father had. Um, and they'll be doing maybe they might do a scan of the brain as well to check if there's any signs of a bleed there. But, um, they'll be doing a range of tests in a short time frame, in order to exclude whether you have, um, any illness. Sure. You haven't got any kind of stroke or mini-stroke.\nNow, if your symptoms return and they persist, they prolonged, then, um, you may need to attend A&E. Okay? Because, um, our presumptive working diagnosis is mini-stroke or TIA. Okay? And if a mini-stroke is prolonged, then, uh, then we end up thinking that this might be a stroke, and in that case, that becomes even more of an emergency.\nSo we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure.\nNow, if th-things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's, that's, that's not a problem. You know, you've, you've got easy access to us. Okay? So, um, this is the plan going forward. Um, I'm going to, um, do that referral. You should hear back from the hospital relatively soon. The hospital you could actually ring them on, um, uh, the pal's number, and then there's also the TIA clinic number. I'm going to use that number in the not\nes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And, um, if you want, you can ring them either today or tomorrow morning to today in the afternoon.\nWait 1 or 2 hours. Or tomorrow morning, just to find out when they plan to slot you in, and just to make sure they've got you in the system, that they've got them booked and they're going to be calling you in. Okay?\nGreat. So, um, this isn't a-an immediate emergency. You need to rush down to A&E. But it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment, or, you know, that you don't get called, something needs to be done. You need to be ge-get in contact b-back with us. Okay? Great. All right.\nDid you have any questions at all?\nNo, I think that covers most of it.\nOkay. Great. So just bear with me a few minutes, and then I'll send that, uh, all through, and then you should um, you should be able to have you should have the information at your hands to in order to take things further. Okay? Great. Thank you. All the best. Take care then. Bye-bye. Bye-bye.","marks":[[28,31,"Doctor from GP at Hand.",false],[49,62,"Hi. OK.",false],[163,167,"Yeah it's",false],[388,396,"AB one CB two.",false],[548,560,"You've been having",false],[624,630,".",false],[1126,1129,"guess",false],[1160,1182,"again",false],[1393,1405,"we've lost",false],[1425,1425,"there",false],[1820,1821,"few",false],[1898,1900,"there",false],[2506,2506,"Can",false],[2776,2776,"Right .",false],[3126,3137,"a month ago probably",false],[3703,3708,".",false],[5544,5546,"",false],[5839,5850,"Right OK.",false],[6048,6058,"actually",false],[6198,6207,"",false],[6667,6675,"gonna",false],[6686,6688,"uh",false],[6693,6701,"gonna",false],[7259,7274,"a ultrasound",false],[7382,7385,"your",false],[7569,7574,"OK whether",false],[7579,7586,"have",true],[7625,7625,"Sure.",false],[7673,7677,"they're",false],[8101,8110,"things",false],[8287,8293,"you",false],[8484,8489,"can",false],[8525,8530,"PALS",false],[8597,8600,"leave",false],[8620,8626,"notes",false],[8894,8898,"got time",false],[8985,8996,"in the books",false],[9037,9056,"OK.",false],[9353,9380,"",false],[9385,9402,"you get get",false],[9414,9420,"back back",false],[9430,9442,"OK.",false],[9662,9666,"help",false],[9749,9761,"OK.",false],[9797,9820,"now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over the past month to month and a half, possibly two months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'started with feeling very tired for a couple of days, then returning to normal'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'losing feeling ... described as pins and needles'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Pins and needles with 'the arm feeling weaker'; mention of arm is acceptable."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'These episodes last approximately 3 days and then resolve'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'leg feels weaker at the same time as arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'colleague noted they were walking slightly differently'."],["The note captures: Gait is normal outside the episodes.","yes","'Abnormal gait is not present outside of episodes'."],["The note captures: Generally feels tired and weak.","yes","'general tiredness, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'lack of desire to do anything'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","Less frequent at start ('once a month to once a week'), acceptable rendering."],["The note captures: Episodes now occur a couple of times a day.","yes","'now \"a couple of times a day.\"'"],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding a cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'difficulty drinking coffee'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recently (last couple of days)... only during episodes'."],["The note captures: No difficulty swallowing currently.","yes","'no current difficulty swallowing'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'feels \"something in my throat\" during episodes'."],["The note captures: No difficulty speaking during episodes.","yes","'no difficulty speaking during episodes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'wears glasses and denies visual problems during episodes'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'perfectly fine at the moment' and not experiencing symptoms."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","Absence of personal history of stroke/TIA not documented."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol checked, 'all okay'."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes checked, 'all okay'."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure checked, 'all okay'."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / normally fit and well not documented."],["The note captures: Takes aspirin 75 mg once daily.","yes","'Aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","'self-prescribed based on internet reading, to reduce stroke and heart attack risk'."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'have not discussed the risks with a GP'."],["The note captures: Allergic to penicillin.","yes","Penicillin allergy documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father who had an operation to reduce stroke risk'."],["The note captures: Non-smoker.","yes","'They deny smoking'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","'patient agreed to continue the consultation without video'; no exam recorded."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'TIA / Mini-stroke is the presumptive working diagnosis'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","Age 'does not rule out TIA, especially with family history'; urgent referral for exclusion."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to a Stroke TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days ... Thursday/Friday for a Wednesday consultation'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'ultrasound of carotid arteries'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","yes","'potentially a brain scan to check for bleed'."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E immediately if symptoms return and persist or are prolonged'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","yes","'urgency of the referral despite not being an immediate A&E emergency'."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","Contact the service 'if symptoms recur for guidance'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","partial","TIA clinic number provided, but PALS number not mentioned."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Number given 'to confirm appointment scheduling' but no advice to ring this afternoon or tomorrow morning."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","Contact the service 'if any delays occur with the appointment'."]],"claims":[["they informed their GP after their father's operation","Patient said the aspirin was not doctor-directed and, asked whether he had told the GP, answered 'No, I haven't'."],["recurrent, transient neurological symptoms (... dysphagia ...)","Patient denied current swallowing difficulty and described only a sensation of something in the throat and drinking being slightly harder during episodes; dysphagia was not reported."]],"note":"S - Subjective\n- Patient reports experiencing \"very weird symptoms\" over the past month to month and a half, possibly two months, which started with feeling very tired for a couple of days, then returning to normal.\n- Symptoms progressed to episodes of losing feeling in their right hand and arm, described as pins and needles, with the arm feeling weaker. These episodes last approximately 3 days and then resolve.\n- Patient's colleague noted they were walking slightly differently for 3-4 days during these episodes; patient confirms their leg feels weaker at the same time as arm symptoms. Abnormal gait is not present outside of episodes.\n- Patient also reports general tiredness, weakness, occasional nausea, and lack of desire to do anything, which has been happening since the beginning of the month.\n- Recently (last couple of days), patient noticed difficulty holding a cup of coffee and difficulty drinking coffee, only during episodes. Patient feels \"something in my throat\" during episodes but reports no current difficulty swallowing and no difficulty speaking during episodes. Patient wears glasses and denies visual problems during episodes.\n- Episodes have become more regular, increasing from once a month to once a week, and now \"a couple of times a day.\" Patient is a medical doctor specializing in plastic surgery, lives with their wife, and has no known drug allergies except penicillin. They deny smoking.\n- Family history includes father who had an operation to reduce stroke risk. Patient takes Aspirin 75mg daily, self-prescribed based on internet reading, to reduce stroke and heart attack risk; they informed their GP after their father's operation but have not discussed the risks with a GP. Patient's cholesterol, diabetes, and blood pressure were checked after their father's operation and reported as \"all okay.\"\n\nO - Objective\n- Patient's identity confirmed as John Smith, 32 years old, residing at 4 Park Avenue, AB1 CB2.\n- Patient confirmed being in a private place to speak.\n- Video connection issues were noted, and the patient agreed to continue the consultation without video.\n- Patient states they are \"perfectly fine at the moment\" and not experiencing symptoms during the consultation.\n\nA - Assessment\n- Transient Ischemic Attack (TIA) / Mini-stroke is the presumptive working diagnosis given the nature of recurrent, transient neurological symptoms (right-sided weakness, pins and needles, gait disturbance, dysphagia, difficulty holding objects) and family history of stroke.\n- The increasing frequency of episodes raises concern for evolving cerebrovascular risk.\n- Patient's self-prescribed aspirin use without documented medical advice is noted.\n- Patient's age (32) makes this presentation atypical for stroke but does not rule out TIA, especially with family history.\n\nP - Plan\n- Urgent referral to a Stroke TIA clinic initiated for further assessment and exclusion of TIA/mini-stroke.\n- Patient is advised that they should be seen within 1-2 days, with a deadline expectation of Thursday/Friday for a Wednesday consultation.\n- Investigations at the TIA clinic are expected to include ultrasound of carotid arteries and potentially a brain scan to check for bleed or other pathology.\n- Patient advised to attend A&E immediately if symptoms return and persist or are prolonged, as this would indicate a potential stroke, which is an immediate emergency.\n- Patient is encouraged to contact the clinic/hospital or the current service if any delays occur with the appointment or if symptoms recur for guidance.\n- Patient provided with the TIA clinic number by the physician for follow-up and to confirm appointment scheduling.\n- Patient educated on the urgency of the referral despite not being an immediate A&E emergency.\n- Patient denies any questions regarding the plan.\n","review":279.38157894736844,"saved":206.61842105263156,"faster":42.51407840589127,"clean":false,"effort":13.043478260869565,"sig":[["missing","No personal history of stroke or mini-stroke (TIA).","Absence of personal history of stroke/TIA not documented."],["missing","No other illnesses; normally fit and well.","No other illnesses / normally fit and well not documented."],["partial","TIA clinic and PALS contact numbers to be left in the consultation notes.","TIA clinic number provided, but PALS number not mentioned."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Number given 'to confirm appointment scheduling' but no advice to ring this afternoon or tomorrow morning."],["fabrication","they informed their GP after their father's operation","Patient said the aspirin was not doctor-directed and, asked whether he had told the GP, answered 'No, I haven't'."],["fabrication","recurrent, transient neurological symptoms (... dysphagia ...)","Patient denied current swallowing difficulty and described only a sensation of something in the throat and drinking being slightly harder during episodes; dysphagia was not reported."]],"mb":30.633672,"latency":25.298,"finalised":291.3655789473684}],"lyrebird":[{"label":"Run 1","wer":12.817796610169491,"text":"Hi there. Good morning. I'm doctor. To see you. Hi. Okay. So before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry. I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay. Could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue, and it's a b 1 c b 2.\n\nThat's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've having some problems with your acne. Is that right? Sorry. Say that again. How can I help you today? So I've been experiencing very weird symptoms over the past month or so, and I don't causing them. I have googled it, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms.\n\nYou were having? So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling from my hands and arms. I get a weird sensation, I get pins and needles. Right. So just say that again. The connection is not so great. You've been getting pins and needles in the hand. Is that right? Yeah. That's correct. Is that the right or left hand? My right hand.\n\nIs it always the right? Yes. Okay. We've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yes. That's fine. Alright. So you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? The pins and needles\n\nIn the hand, but I feel like my arm is getting weaker. But it only lasts 3 days and then goes back to normal. So it's very weird. Right. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And, again, it's only for 3 days or 3 or 4 days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else\n\nI generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. You know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time I get my arm symptoms,\n\nMy leg feels weaker. Right. Okay. And, you know, you the abnormal gait, has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week\n\nTo every once once a month, but now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When when did it all start? Is that Probably a month and a half, maybe 2 months. Right. Okay. K. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed\n\nI can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about\n\nDifficulty speaking during these episodes. Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck to reduce the risk of\n\nRight. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my\n\nCholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin 75 milligrams once a day, but that's because of something I read on the Internet. Okay. So so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before, your GP, that you're on aspirin? Yes. I took\n\nI started taking it after my father had his operation, but that wasn't the doctor telling me. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the GP in the past? No. I haven't. Yeah. Okay. Alright. Now in terms of your your kind of social situation, are you working at the moment? Yes. I am. What do you work as? I'm I'm\n\nActually, doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Right. Okay. Fantastic. Do you smoke\n\nAt all? No. I don't. Right. Okay. That's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Right. Okay. Well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient ischemic attacks. Okay. And so that's something quite urgent.\n\nAnd given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do in fact, what I am going to do is I'm going to refer you to a stroke at the TIA clinic. Now just to double check, do you have the symptoms right now? No. I'm perfectly fine at the moment. Okay. So so what I'm gonna do is I'm gonna I'm gonna refer you to a a mini stroke clinic or a TIA clinic. I send that referral off now, and then you can\n\nAttend them. They they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now today, it's Wednesday, so we've got a few days before the weekend. So, basically, the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking they'll be doing the ultrasound of the carotid artery like your your father had, they'll be doing maybe they might do a scan\n\nThe brain as well. Sure. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. Okay. You haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they prolong, then you may need to attend the A and E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. K? And if a mini stroke is\n\nProlonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's that's that's not the problem. You know, you've got easy access to us. Okay. So this is the plan going forward. I'm going to do that referral. You should hear back from\n\nHospital relatively soon. The hospital, you could actually ring them on the PALS number, and then there's also the tria clinic number. I'm going to leave that number in the notes for this complication. Okay? So you have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. So today in the afternoon, you wait at 1 or 2 hours, or tomorrow morning just to find out when they have time to slot you in and just to make sure they've got you in the system, that they've got in the books, and they're gonna be calling you in. Okay? Great.\n\nThis isn't an immediate emergency. You need to rush out to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, Something is you you get get in contact back with us. Okay? Great. Alright. Did you have any questions at all? No. I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that all through, and then you should you should be able to have\n\nThe information at your hands to in order to get things better. Okay? Great. Thank you. All the best. Take care then. Bye bye.","marks":[[35,35,"from GP at Hand. Nice",false],[153,157,"Yeah it's",false],[378,381,"AB",false],[384,387,"CB",false],[550,550,"been",false],[582,587,"asthma.",true],[619,625,".",false],[736,736,"know what's",false],[894,902,"you've been",false],[1036,1040,"in",false],[1087,1090,"guess",false],[1116,1132,"",false],[1144,1157,"connection's",false],[1510,1518,"All right. Um",false],[1754,1755,"few",false],[2134,2134,"has been happening Um",false],[2401,2401,"Can",false],[2675,2689,"Right . All right OK. Um",false],[3004,3011,"Was it a month ago",false],[3064,3072,"OK. OK.",false],[3895,3909,"OK all right.",false],[4077,4077,"stroke.",false],[4391,4395,"for",false],[5162,5182,"You haven't OK. Um all right. Um.",false],[5788,5798,"actually",false],[6389,6394,"uh",false],[6975,6981,"arteries",false],[7054,7057,"of your",false],[7073,7078,"to check if",false],[7225,7230,"OK whether",false],[7235,7242,"have",true],[7269,7281,"mini-stroke. Sure.",false],[7328,7340,"they're prolonged.",false],[7454,7455,"OK.",false],[8100,8105,"can",false],[8171,8175,"TIA",false],[8244,8262,"consultation OK.",false],[8267,8270,"you'll",false],[8501,8505,"got",false],[8622,8627,"going to",false],[8647,8659,"OK.",false],[8713,8716,"down",false],[8720,8723,"A and E.",false],[8952,8964,"",false],[8996,8996,"back",false],[9006,9027,"OK. All right.",false],[9226,9226,"help you should",false],[9278,9281,"take",false],[9289,9309,"further OK.",false],[9345,9350,"now.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over 6-8 weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial tiredness for a couple of days not captured."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'Right hand paraesthesia'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right-sided hand symptoms documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'Right hand paraesthesia with associated right arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Episodes last 3-4 days then resolve completely'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Right leg weakness occurring concurrently with arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Colleague observed abnormal gait during episodes only'."],["The note captures: Gait is normal outside the episodes.","yes","Abnormal gait 'during episodes only'."],["The note captures: Generally feels tired and weak.","yes","'generalised fatigue, weakness'."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not mentioned."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially occurred weekly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now occurring multiple times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'Recent difficulty holding cup during episodes'."],["The note captures: Drinking is slightly harder during episodes.","no","Drinking difficulty not mentioned."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recent' and 'during episodes'."],["The note captures: No difficulty swallowing currently.","yes","'no frank dysphagia'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'Sensation of throat obstruction during episodes'."],["The note captures: No difficulty speaking during episodes.","yes","'No dysarthria'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No ... visual disturbance'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'No current symptoms at time of consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not stated."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure normal."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","Self-initiated after father's surgery, not prescribed, but reason (stroke/heart attack risk) missing."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'No previous counselling regarding aspirin risks and benefits'."],["The note captures: Allergic to penicillin.","yes","'Allergy: penicillin'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'Father underwent carotid endarterectomy for stroke prevention'."],["The note captures: Non-smoker.","yes","'Non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'intermittent connection issues' noted but not loss of video / no examination."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Transient ischaemic attacks (TIAs)'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Family history and urgent referral present; young-age rationale missing."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid Doppler ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain imaging' without purpose (bleed)."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend Emergency Department if symptoms recur and persist'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","'Not an immediate emergency but urgent' not captured."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","partial","'contact practice ... if symptoms change' - no phone assessment detail."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'TIA clinic and PALS contact details provided'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Details given 'to chase appointment' but not the today/tomorrow timing."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact practice if unable to secure timely appointment'."]],"claims":[["Right leg weakness occurring concurrently with arm symptoms","Patient said 'my leg feels weaker'; the side of the leg was never stated."],["Completely asymptomatic between episodes","Only gait was said to be normal outside episodes; patient also reported general tiredness, weakness and nausea."],["Recurrent stereotyped episodes with complete resolution between attacks","Episodes were not described as stereotyped (new cup/drinking symptoms recently) and complete resolution between attacks was not stated."],["Increasing frequency of episodes concerning for crescendo TIAs","Clinician never mentioned crescendo TIAs."],["Investigations to include carotid Doppler ultrasound and brain imaging","Clinician said they 'might do a scan of your brain'; brain imaging was a possibility, not definite."],["Discussion regarding self-initiated aspirin therapy and need for formal GP review of cardiovascular risk","No such discussion or plan for GP cardiovascular risk review occurred; aspirin was only asked about."]],"note":"SOAP Notes\n\n\n\n\nPatient: John Smith\n\nDate of Birth: 32 years old\n\nAddress: 4 Park Avenue, AB1CB2\n\nDate of Consultation: 27/09/2026\n\n\n\n\nSubjective:\n\n32-year-old plastic surgeon presenting with recurrent episodes of right-sided weakness and paraesthesia over 6-8 weeks\n\nEpisodes initially occurred weekly, now occurring multiple times daily\n\nRight hand paraesthesia with associated right arm weakness\n\nRight leg weakness occurring concurrently with arm symptoms\n\nEpisodes last 3-4 days then resolve completely with return to baseline\n\nColleague observed abnormal gait during episodes only\n\nRecent difficulty holding cup during episodes\n\nSensation of throat obstruction during episodes, no frank dysphagia\n\nNo dysarthria or visual disturbance\n\nAssociated generalised fatigue, weakness and nausea\n\nCompletely asymptomatic between episodes\n\nNo current symptoms at time of consultation\n\nFather underwent carotid endarterectomy for stroke prevention\n\nPatient previously screened following father's surgery: cholesterol, diabetes and blood pressure all normal\n\nSelf-initiated aspirin 75mg daily after father's surgery, not prescribed by GP\n\nNo previous counselling regarding aspirin risks and benefits\n\nLives with wife\n\nNon-smoker\n\nAllergy: penicillin\n\n\n\n\nObjective:\n\nVideo consultation with intermittent connection issues\n\nPatient asymptomatic at time of assessment\n\n\n\n\nAssessment:\n\nTransient ischaemic attacks (TIAs)\n\nSignificant family history of cerebrovascular disease\n\nRecurrent stereotyped episodes with complete resolution between attacks\n\nIncreasing frequency of episodes concerning for crescendo TIAs\n\n\n\n\nPlan:\n\nUrgent referral to TIA clinic for assessment within 1-2 days\n\nInvestigations to include carotid Doppler ultrasound and brain imaging\n\nPatient advised to attend Emergency Department if symptoms recur and persist\n\nTIA clinic and PALS contact details provided for patient to chase appointment\n\nAdvised to contact practice if unable to secure timely appointment or if symptoms change\n\nSafety netting provided regarding stroke symptoms and need for immediate emergency presentation if symptoms prolonged\n\nDiscussion regarding self-initiated aspirin therapy and need for formal GP review of cardiovascular risk","review":380.4868421052632,"saved":105.51315789473682,"faster":21.71052631578947,"clean":false,"effort":38.04347826086957,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial tiredness for a couple of days not captured."],["missing","Low motivation; does not feel like doing anything.","Low motivation not mentioned."],["missing","Drinking is slightly harder during episodes.","Drinking difficulty not mentioned."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not stated."],["missing","No other illnesses; normally fit and well.","No other illnesses not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","Self-initiated after father's surgery, not prescribed, but reason (stroke/heart attack risk) missing."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'intermittent connection issues' noted but not loss of video / no examination."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Family history and urgent referral present; young-age rationale missing."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain imaging' without purpose (bleed)."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","'Not an immediate emergency but urgent' not captured."],["partial","If symptoms recur, can contact the practice for phone assessment and advice.","'contact practice ... if symptoms change' - no phone assessment detail."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Details given 'to chase appointment' but not the today/tomorrow timing."],["fabrication","Right leg weakness occurring concurrently with arm symptoms","Patient said 'my leg feels weaker'; the side of the leg was never stated."],["fabrication","Completely asymptomatic between episodes","Only gait was said to be normal outside episodes; patient also reported general tiredness, weakness and nausea."],["fabrication","Recurrent stereotyped episodes with complete resolution between attacks","Episodes were not described as stereotyped (new cup/drinking symptoms recently) and complete resolution between attacks was not stated."],["fabrication","Increasing frequency of episodes concerning for crescendo TIAs","Clinician never mentioned crescendo TIAs."],["fabrication","Investigations to include carotid Doppler ultrasound and brain imaging","Clinician said they 'might do a scan of your brain'; brain imaging was a possibility, not definite."],["fabrication","Discussion regarding self-initiated aspirin therapy and need for formal GP review of cardiovascular risk","No such discussion or plan for GP cardiovascular risk review occurred; aspirin was only asked about."]],"mb":15.944255,"latency":38.498,"finalised":418.98484210526317},{"label":"Run 2","wer":12.764830508474576,"text":"Hi there. Good morning. I'm doctor. To see you. Hi. Okay. So before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry. I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay. Could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue, and it's a b 1 c b 2.\n\nThat's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've having some problems with your acne. Is that right? Sorry. Say that again. How can I help you today? So I've been experiencing very weird symptoms over the past month or so, and I don't causing them. I have googled it, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms.\n\nYou were having? So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling from my hands and arms. I get a weird sensation, I get pins and needles. Right. So just say that again. The connection is not so great. You've been getting pins and needles in the hand. Is that right? Yeah. That's correct. Is that the right or left hand? My right hand.\n\nIs it always the right? Yes. Okay. We've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yes. That's fine. Alright. So you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? The pins and needles\n\nIn the hand, but I feel like my arm is getting weaker. But it only lasts 3 days and then goes back to normal. So it's very weird. Right. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And, again, it's only for 3 days or 3 or 4 days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else has\n\nI generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time I get my arm symptoms,\n\nMy leg feels weaker. Right. Okay. And, you know, you the abnormal gait, has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week\n\nTo every once once a month, but now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When when did it all start? Is that Probably a month and a half, maybe 2 months. Right. Okay. K. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed\n\nI can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about\n\nSpeaking during these episodes, any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck to reduce the risk of\n\nRight. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my\n\nCholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin 75 milligrams once a day, but that's because of something I read on the Internet. Okay. So so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do you have you ever told a doctor before, your GP, that you're on aspirin? Yes. I\n\nI started taking it after my father had his operation, but that wasn't the doctor telling me. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the GP in the past? No. I haven't. Okay. Alright. Now in terms of your your kind of social situation, are you working at the moment? Yes. I am. What do you work as? I'm I'm\n\nActually, doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Right. Okay. Fantastic. Do you smoke\n\nAt all? No. I don't. Right. Okay. That's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Right. Okay. Well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient ischemic attacks. Okay. And so that's something quite urgent.\n\nAnd given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do in fact, what I am going to do is I'm going to refer you to a stroke at the TIA clinic. Now just to double check, do you have the symptoms right now? No. I'm perfectly fine at the moment. Okay. So so what I'm gonna do is I'm gonna I'm gonna refer you to a a mini stroke clinic or a TIA clinic. I send that referral off now, and then you can\n\nAttend them. They they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now today, it's Wednesday, so we've got a few days before the weekend. So, basically, the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking they'll be doing the ultrasound of the carotid artery like your your father had, and they'll be doing maybe they might do a scan\n\nThe brain as well. Sure. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. Okay. You haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they prolong, then you may need to attend the A and E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. K? And if a mini stroke is\n\nProlonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's that's that's not the problem. You know, you've got easy access to us. Okay. So this is the plan going forward. I'm going to do that referral. You should hear back from\n\nHospital relatively soon. The hospital, you could actually ring them on the PALS number, and then there's also the tria clinic number. I'm going to leave that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. So today in the afternoon, you wait at 1 or 2 hours, or tomorrow morning just to find out when they have time to slot you in and just to make sure they've got you in the system, that they've got in the books, and they're gonna be calling you in. Okay? Great.\n\nThis isn't an immediate emergency. You need to rush out to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, Something is you you get get in contact back with us. Okay? Great. Alright. Did you have any questions at all? No. I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that all through, and then you should you should be able to have\n\nThe information at your hands to in order to get things better. Okay? Great. Thank you. All the best. Take care then. Bye bye. Bye.","marks":[[35,35,"from GP at Hand. Nice",false],[153,157,"Yeah it's",false],[378,381,"AB",false],[384,387,"CB",false],[550,550,"been",false],[582,587,"asthma.",true],[619,625,".",false],[736,736,"know what's",false],[894,902,"you've been",false],[1036,1040,"in",false],[1087,1090,"guess",false],[1116,1132,"",false],[1144,1157,"connection's",false],[1510,1518,"All right. Um",false],[1754,1755,"few",false],[2138,2138,"been happening Um",false],[2410,2410,"Can",false],[2684,2698,"Right . All right OK. Um",false],[3013,3020,"Was it a month ago",false],[3073,3081,"OK. OK.",false],[3713,3713,"um difficulty",false],[3893,3907,"OK all right.",false],[4075,4075,"stroke.",false],[4389,4393,"for",false],[4913,4913,"took",false],[5159,5173,"You haven't OK. Um all right. Um.",false],[5779,5789,"actually",false],[6380,6385,"uh",false],[6966,6972,"arteries",false],[7049,7052,"of your",false],[7068,7073,"to check if",false],[7220,7225,"OK whether",false],[7230,7237,"have",true],[7264,7276,"mini-stroke. Sure.",false],[7323,7335,"they're prolonged.",false],[7449,7450,"OK.",false],[8095,8100,"can",false],[8166,8170,"TIA",false],[8499,8503,"got",false],[8620,8625,"going to",false],[8645,8657,"OK.",false],[8711,8714,"down",false],[8718,8721,"A and E.",false],[8950,8962,"",false],[8994,8994,"back",false],[9004,9025,"OK. All right.",false],[9224,9224,"help you should",false],[9276,9279,"take",false],[9287,9307,"further OK.",false],[9343,9348,"now.",false],[9358,9362,"",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'past 6-8 weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial tiredness for a couple of days not captured."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles sensation in right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'Right arm weakness with pins and needles sensation in right hand'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Each episode lasts 3-4 days'; asymptomatic between."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Right leg weakness concurrent with arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Abnormal gait during episodes, noted by colleague'."],["The note captures: Gait is normal outside the episodes.","yes","'Between episodes: completely asymptomatic and fully functional'."],["The note captures: Generally feels tired and weak.","yes","'Generalised fatigue and weakness'."],["The note captures: Sometimes feels nauseous.","yes","'Nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not mentioned."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'initially occurred weekly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now occurring multiple times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'Difficulty holding cup of coffee during episodes'."],["The note captures: Drinking is slightly harder during episodes.","no","Drinking difficulty not mentioned."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'during episodes (onset last few days)'."],["The note captures: No difficulty swallowing currently.","yes","'No dysphagia'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'Sensation of something in throat during episodes'."],["The note captures: No difficulty speaking during episodes.","yes","'No speech difficulty'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No visual disturbance (patient wears glasses)'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Currently asymptomatic at time of consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not stated."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes screening normal."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure normal."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated, not prescribed' but reason not given."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Lack of GP discussion of aspirin risks not documented."],["The note captures: Allergic to penicillin.","yes","'Allergy documented: penicillin'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father underwent carotid surgery for stroke prevention'."],["The note captures: Non-smoker.","no","Smoking status not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'video connection lost partway' but no statement that no examination was possible."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Transient ischaemic attacks (TIAs)'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","'Young age but significant family history warrants urgent investigation'."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","partial","'within 1-2 days' correct but calendar dates given do not match the stated Thursday/Friday."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain imaging' without bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'if symptoms return and persist, attend emergency department immediately'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","'Not an immediate emergency but urgent' not captured."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Practice phone assessment if symptoms recur not captured."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'TIA clinic contact number provided in consultation notes' and PALS number referenced."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","Contact clinic to confirm booking, but no today/tomorrow timing."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'re-contact GP if unable to attend appointment or if not contacted'."]],"claims":[["Right leg weakness concurrent with arm symptoms","Patient said 'my leg feels weaker'; the side of the leg was never stated."],["Between episodes: completely asymptomatic and fully functional","Only gait was said to be normal outside episodes; patient also reported general tiredness, weakness and nausea."],["Patient alert and communicating clearly","No such observation was made; video was lost and no examination or observation was documented."],["expected appointment within 1-2 days, by 29/09/2026 or 30/09/2026","Clinician said Thursday/Friday (consultation on Wednesday); these dates were not given."],["TIA clinic investigations to include carotid ultrasound and brain imaging","Clinician said they 'might do a scan of your brain'; brain imaging was a possibility, not definite."],["patient to discuss appropriateness [of aspirin] with TIA clinic","No plan to discuss aspirin with the TIA clinic was stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n32-year-old male plastic surgeon presenting with recurrent episodes of neurological symptoms over the past 6-8 weeks\n\nEpisodes initially occurred weekly, now occurring multiple times daily\n\nEach episode lasts 3-4 days\n\nRight arm weakness with pins and needles sensation in right hand\n\nRight leg weakness concurrent with arm symptoms\n\nAbnormal gait during episodes, noted by colleague\n\nGeneralised fatigue and weakness\n\nNausea\n\nDifficulty holding cup of coffee during episodes (onset last few days)\n\nSensation of something in throat during episodes\n\nNo dysphagia\n\nNo speech difficulty\n\nNo visual disturbance (patient wears glasses)\n\nBetween episodes: completely asymptomatic and fully functional\n\nFamily history: father underwent carotid surgery for stroke prevention\n\nPatient previously screened following father's surgery: cholesterol, diabetes screening, and blood pressure all within normal limits\n\nCurrently asymptomatic at time of consultation\n\n\n\n\nObjective:\n\nVideo consultation conducted (video connection lost partway through consultation)\n\nPatient alert and communicating clearly\n\nNo acute symptoms present during consultation\n\n\n\n\nAssessment:\n\nTransient ischaemic attacks (TIAs)\n\nConcerning features: recurrent episodes, increasing frequency, right-sided weakness and paraesthesia, family history of cerebrovascular disease\n\nYoung age but significant family history warrants urgent investigation\n\n\n\n\nPlan:\n\nUrgent referral to TIA clinic (expected appointment within 1-2 days, by 29/09/2026 or 30/09/2026)\n\nTIA clinic investigations to include carotid ultrasound and brain imaging\n\nSafety netting advice provided: if symptoms return and persist, attend emergency department immediately\n\nPatient advised to contact TIA clinic via PALS number to confirm appointment booking\n\nPatient to re-contact GP if unable to attend appointment or if not contacted by clinic\n\nCurrent medication: aspirin 75mg daily (self-initiated, not prescribed) - patient to discuss appropriateness with TIA clinic\n\nAllergy documented: penicillin\n\nTIA clinic contact number provided in consultation notes","review":421.0,"saved":65.0,"faster":13.37448559670782,"clean":false,"effort":40.21739130434783,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial tiredness for a couple of days not captured."],["missing","Low motivation; does not feel like doing anything.","Low motivation not mentioned."],["missing","Drinking is slightly harder during episodes.","Drinking difficulty not mentioned."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not stated."],["missing","No other illnesses; normally fit and well.","No other illnesses not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated, not prescribed' but reason not given."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Lack of GP discussion of aspirin risks not documented."],["missing","Non-smoker.","Smoking status not documented."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'video connection lost partway' but no statement that no examination was possible."],["partial","Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","'within 1-2 days' correct but calendar dates given do not match the stated Thursday/Friday."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain imaging' without bleed purpose."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","'Not an immediate emergency but urgent' not captured."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Practice phone assessment if symptoms recur not captured."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Contact clinic to confirm booking, but no today/tomorrow timing."],["fabrication","Right leg weakness concurrent with arm symptoms","Patient said 'my leg feels weaker'; the side of the leg was never stated."],["fabrication","Between episodes: completely asymptomatic and fully functional","Only gait was said to be normal outside episodes; patient also reported general tiredness, weakness and nausea."],["fabrication","Patient alert and communicating clearly","No such observation was made; video was lost and no examination or observation was documented."],["fabrication","expected appointment within 1-2 days, by 29/09/2026 or 30/09/2026","Clinician said Thursday/Friday (consultation on Wednesday); these dates were not given."],["fabrication","TIA clinic investigations to include carotid ultrasound and brain imaging","Clinician said they 'might do a scan of your brain'; brain imaging was a possibility, not definite."],["fabrication","patient to discuss appropriateness [of aspirin] with TIA clinic","No plan to discuss aspirin with the TIA clinic was stated."]],"mb":17.045927,"latency":39.131,"finalised":460.131},{"label":"Run 3","wer":12.658898305084746,"text":"Hi there. Good morning. I'm doctor. To see you. Hi. Okay. So before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry. I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay. Could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue, and it's a b 1 c b 2.\n\nThat's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've having some problems with your acne. Is that right? Sorry. Say that again. How can I help you today? So I've been experiencing very weird symptoms over the past month or so, and I don't causing them. I have googled it, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms.\n\nYou were having? So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling from my hands and arms. I get a weird sensation, I get pins and needles. Right. So just say that again. The connection is not so great. You've been getting pins and needles in the hand. Is that right? Yeah. That's correct. Is that the right or left hand? My right hand.\n\nIs it always the right? Yes. Okay. We've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yes. That's fine. Alright. So you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? The pins and needles\n\nIn the hand, but I feel like my arm is getting weaker. But it only lasts 3 days and then goes back to normal. So it's very weird. Right. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And, again, it's only for 3 days or 3 or 4 days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else\n\nI generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. You know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time I get my arm symptoms,\n\nMy leg feels weaker. Right. Okay. And, you know, you the abnormal gait, has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week\n\nTo every once once a month, but now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When when did it all start? Is that Probably a month and a half, maybe 2 months. Right. Okay. K. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed\n\nI can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about\n\nDifficulty speaking during these episodes. Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck to reduce the risk of\n\nRight. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my\n\nCholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin 75 milligrams once a day, but that's because of something I read on the Internet. Okay. So so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before, your GP, that you're on aspirin? Yes. I took\n\nI started taking it after my father had his operation, but that wasn't the doctor telling me. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the GP in the past? No. I haven't. Yeah. Okay. Alright. Now in terms of your your kind of social situation, are you working at the moment? Yes. I am. What do you work as? I'm I'm\n\nActually, doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Right. Okay. Fantastic. Do you smoke\n\nAt all? No. I don't. Right. Okay. That's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Right. Okay. Well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient ischemic attacks. Okay. And so that's something quite urgent.\n\nAnd given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do in fact, what I am going to do is I'm going to refer you to a stroke at the TIA clinic. Now just to double check, do you have the symptoms right now? No. I'm perfectly fine at the moment. Okay. So so what I'm gonna do is I'm gonna I'm gonna refer you to a a mini stroke clinic or a TIA clinic. I send that referral off now, and then you can\n\nAttend them. They they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now today, it's Wednesday, so we've got a few days before the weekend. So, basically, the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking they'll be doing the ultrasound of the carotid artery like your your father had, they'll be doing maybe they might do a scan\n\nThe brain as well to show if there's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. Okay. You haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they prolong, then you may need to attend the A and E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. K? And if a mini stroke is\n\nProlonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's that's that's not the problem. You know? You've got easy access to us. Okay? So this is the plan going forward. I'm going to do that referral. You should hear back from\n\nHospital relatively soon. The hospital, you could actually ring them on the PALS number, and then there's also the TriA clinic number. I'm going to leave that number in the notes for this complication. Okay? So you have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. So today in the afternoon, you wait at 1 or 2 hours, or tomorrow morning just to find out when they have time to slot you in and just to make sure they've got you in the system, that they've got in the books, and they're gonna be calling you in. Okay? Great.\n\nThis isn't an immediate emergency. You need to rush out to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, Something is you you get get in contact back with us. Okay? Great. Alright. Did you have any questions at all? No. I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that all through, and then you should you should be able to have\n\nThe information at your hands to in order to get things better. Okay? Great. Thank you. All the best. Take care now. Bye bye.","marks":[[35,35,"from GP at Hand. Nice",false],[153,157,"Yeah it's",false],[378,381,"AB",false],[384,387,"CB",false],[550,550,"been",false],[582,587,"asthma.",true],[619,625,".",false],[736,736,"know what's",false],[894,902,"you've been",false],[1036,1040,"in",false],[1087,1090,"guess",false],[1116,1132,"",false],[1144,1157,"connection's",false],[1510,1518,"All right. Um",false],[1754,1755,"few",false],[2134,2134,"has been happening Um",false],[2401,2401,"Can",false],[2675,2689,"Right . All right OK. Um",false],[3004,3011,"Was it a month ago",false],[3064,3072,"OK. OK.",false],[3895,3909,"OK all right.",false],[4077,4077,"stroke.",false],[4391,4395,"for",false],[5162,5182,"You haven't OK. Um all right. Um.",false],[5788,5798,"actually",false],[6389,6394,"uh",false],[6975,6981,"arteries",false],[7054,7057,"of your",false],[7075,7079,"check",false],[7229,7234,"OK whether",false],[7239,7246,"have",true],[7273,7285,"mini-stroke. Sure.",false],[7332,7344,"they're prolonged.",false],[7458,7459,"OK.",false],[8104,8109,"can",false],[8175,8179,"TIA",false],[8248,8266,"consultation OK.",false],[8271,8274,"you'll",false],[8505,8509,"got",false],[8626,8631,"going to",false],[8651,8663,"OK.",false],[8717,8720,"down",false],[8724,8727,"A and E.",false],[8956,8968,"",false],[9000,9000,"back",false],[9010,9031,"OK. All right.",false],[9230,9230,"help you should",false],[9282,9285,"take",false],[9293,9313,"further OK.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'Recurrent episodes of neurological symptoms over 1.5-2 months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","The initial couple of days of tiredness then return to normal is not captured."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'Right hand paraesthesia and numbness'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","Right hand paraesthesia with 'Right arm weakness during episodes'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Each episode lasts 3-4 days'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Right leg weakness during episodes'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Abnormal gait during episodes, noted by colleague'."],["The note captures: Gait is normal outside the episodes.","partial","Gait abnormality stated as 'during episodes' only; normal gait outside episodes not explicitly stated."],["The note captures: Generally feels tired and weak.","yes","'Generalised fatigue and weakness'."],["The note captures: Sometimes feels nauseous.","yes","'Nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not documented."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'Episodes initially occurred weekly to monthly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now occurring multiple times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'Difficulty holding cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'Difficulty drinking during episodes'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'in last few days' and 'during episodes' both captured."],["The note captures: No difficulty swallowing currently.","yes","'No dysphagia'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'Sensation of something in throat during episodes'."],["The note captures: No difficulty speaking during episodes.","yes","'No dysarthria'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No visual disturbance (wears glasses)'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Patient asymptomatic at time of consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not documented."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol within normal limits."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes screening within normal limits."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure within normal limits."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / normally fit and well not documented."],["The note captures: Takes aspirin 75 mg once daily.","yes","'Aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated, not prescribed' but no reason (internet, father's operation, stroke/heart attack risk)."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Does not state that no GP has discussed aspirin risks; only 'Discussed self-initiated aspirin'."],["The note captures: Allergic to penicillin.","yes","Penicillin allergy listed."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'Father had carotid surgery for stroke prevention'."],["The note captures: Non-smoker.","yes","'Non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","'Video connection lost during consultation, continued via audio only'."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Transient ischaemic attacks'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Urgent referral documented but not linked to excluding TIA despite young age given family history."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'Carotid ultrasound to be arranged by TIA clinic'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'Brain imaging' noted but not to check for a bleed."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend ED immediately if symptoms persist or prolong'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","partial","Urgency captured but not that it is not an immediate A&E emergency now."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Contacting the practice for phone assessment if symptoms recur is not documented."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'PALS and TIA clinic contact numbers provided in consultation notes'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'chase appointment today afternoon or tomorrow morning'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact clinic if appointment delayed'."]],"claims":[["Right leg weakness during episodes","Patient reported leg weakness during episodes without specifying a side."],["Brain imaging to be arranged by TIA clinic","Clinician said the clinic might do a brain scan; stated as a definite plan."]],"note":"SOAP Notes\n\n\n\n\nPatient: John Smith\n\nDate of Birth: 32 years old\n\nAddress: 4 Park Avenue, AB1CB2\n\nDate of Consultation: 27/09/2026\n\n\n\n\nSubjective:\n\nRecurrent episodes of neurological symptoms over 1.5-2 months\n\nEpisodes initially occurred weekly to monthly, now occurring multiple times daily\n\nEach episode lasts 3-4 days\n\nRight hand paraesthesia and numbness during episodes\n\nRight arm weakness during episodes\n\nRight leg weakness during episodes\n\nAbnormal gait during episodes, noted by colleague\n\nGeneralised fatigue and weakness\n\nNausea\n\nDifficulty holding cup of coffee in last few days\n\nDifficulty drinking during episodes\n\nSensation of something in throat during episodes\n\nNo dysphagia\n\nNo dysarthria\n\nNo visual disturbance (wears glasses)\n\nCurrently asymptomatic between episodes\n\nFather had carotid surgery for stroke prevention\n\nPrevious investigations: cholesterol, diabetes screening, blood pressure all within normal limits\n\nOccupation: plastic surgeon\n\nLives with wife\n\nNon-smoker\n\n\n\n\nObjective:\n\nPatient asymptomatic at time of consultation\n\nVideo connection lost during consultation, continued via audio only\n\n\n\n\nAssessment:\n\nTransient ischaemic attacks\n\n\n\n\nPlan:\n\nUrgent referral to TIA clinic (expected within 1-2 days)\n\nCarotid ultrasound to be arranged by TIA clinic\n\nBrain imaging to be arranged by TIA clinic\n\nPatient advised to attend ED immediately if symptoms persist or prolong\n\nPatient advised to contact clinic if appointment delayed\n\nPALS and TIA clinic contact numbers provided in consultation notes\n\nDiscussed self-initiated aspirin 75mg daily (not prescribed)\n\nPatient advised to chase appointment today afternoon or tomorrow morning\n\n\n\n\nAllergies:\n\nPenicillin\n\n\n\n\nCurrent Medications:\n\nAspirin 75mg daily (self-initiated, not prescribed)","review":301.2368421052631,"saved":184.76315789473688,"faster":38.0171106779294,"clean":false,"effort":23.91304347826087,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","The initial couple of days of tiredness then return to normal is not captured."],["partial","Gait is normal outside the episodes.","Gait abnormality stated as 'during episodes' only; normal gait outside episodes not explicitly stated."],["missing","Low motivation; does not feel like doing anything.","Low motivation not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not documented."],["missing","No other illnesses; normally fit and well.","No other illnesses / normally fit and well not documented."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated, not prescribed' but no reason (internet, father's operation, stroke/heart attack risk)."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Does not state that no GP has discussed aspirin risks; only 'Discussed self-initiated aspirin'."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Urgent referral documented but not linked to excluding TIA despite young age given family history."],["partial","TIA clinic may do a brain scan to check for a bleed.","'Brain imaging' noted but not to check for a bleed."],["partial","Currently not an immediate emergency requiring A&E, but urgent.","Urgency captured but not that it is not an immediate A&E emergency now."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Contacting the practice for phone assessment if symptoms recur is not documented."],["fabrication","Right leg weakness during episodes","Patient reported leg weakness during episodes without specifying a side."],["fabrication","Brain imaging to be arranged by TIA clinic","Clinician said the clinic might do a brain scan; stated as a definite plan."]],"mb":16.04053,"latency":36.36,"finalised":337.59684210526314},{"label":"Run 4","wer":13.1885593220339,"text":"Hi there. Good morning. I'm doctor. To see you. Hi. Okay. So before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry. I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay. Could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue, and it's a b 1 c b 2.\n\nThat's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've having some problems with your acne. Is that right? Sorry. Say that again. How can I help you today? So I've been experiencing very weird symptoms over the past month or so, and I don't causing them. I have googled it, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms.\n\nYou were having? So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling from my hands and arms. I get a weird sensation, I get pins and needles. Right. So just say that again. The connection is not so great. You've been getting pins and needles in the hand. Is that right? Yeah. That's correct. Is that the right or left hand? My right hand.\n\nIs it always the right? Yes. Okay. We've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yes. That's fine. Alright. So you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? The pins and needles\n\nIn the hand, but I feel like my arm is getting weaker. But it only lasts 3 days and then goes back to normal. So it's very weird. Right. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And, again, it's only for 3 days or 3 or 4 days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else\n\nI generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time I get my arm symptoms,\n\nMy leg feels weaker. Right. Okay. And, you know, you the abnormal gait, has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week\n\nTo every once once a month, but now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When when did it all start? Is that Probably a month and a half, maybe 2 months. Right. Okay. K. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed\n\nI can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about\n\nDifficulty speaking during these episodes. Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck to reduce the risk of\n\nRight. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my\n\nCholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin 75 milligrams once a day, but that's because of something I read on the Internet. Okay. So so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do have you ever told a doctor before, your GP, that you're on aspirin? Yes. I took\n\nI started taking it after my father had his operation, but that wasn't the doctor telling me. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the GP in the past? No. I haven't. Okay. Alright. Now in terms of your your kind of social situation, are you working at the moment? Yes. I am. What do you work as? I'm I'm\n\nActually, doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Right. Okay. Fantastic. Do you smoke\n\nAt all? No. I don't. Right. Okay. That's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Right. Okay. Well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient ischemic attacks. Okay. And so that's something quite urgent.\n\nAnd given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do in fact, what I am going to do is I'm going to refer you to a stroke at the TIA clinic. Now just to double check, do you have the symptoms right now? No. I'm perfectly fine at the moment. Okay. So so what I'm gonna do is I'm gonna I'm gonna refer you to a a mini stroke clinic or a TIA clinic. I send that referral off now, and then you can\n\nAttend them. They they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now today, it's Wednesday, so we've got a few days before the weekend. So, basically, the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking they'll be doing the ultrasound of the carotid artery like your your father had, they'll be doing maybe they might do a scan\n\nThe brain as well. Sure. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. Okay. You haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they prolong, then you may need to attend the A and E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. K? And if a mini stroke is\n\nProlonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's that's that's not the problem. You know, you've got easy access to us. Okay. So this is the plan going forward. I'm going to do that referral. You should hear back from\n\nHospital relatively soon. The hospital, you could actually ring them on the PALS number, and then there's also the tria clinic number. I'm going to leave that number in the notes for this complication. Okay? So you have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. So today in the afternoon, you wait at 1 or 2 hours, or tomorrow morning just to find out when they have time to slot you in and just to make sure they've got you in the system, that they've got in the books, and they're gonna be calling you in. Okay? Great.\n\nThis isn't an immediate emergency. You need to rush out to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, Something is you you get get in contact back with us. Okay? Great. Alright. Did you have any questions at all? No. I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that all through, and then you should you should be able to have\n\nThe information at your hands to in order to get things better. Okay?","marks":[[35,35,"from GP at Hand. Nice",false],[153,157,"Yeah it's",false],[378,381,"AB",false],[384,387,"CB",false],[550,550,"been",false],[582,587,"asthma.",true],[619,625,".",false],[736,736,"know what's",false],[894,902,"you've been",false],[1036,1040,"in",false],[1087,1090,"guess",false],[1116,1132,"",false],[1144,1157,"connection's",false],[1510,1518,"All right. Um",false],[1754,1755,"few",false],[2134,2134,"has been happening Um",false],[2406,2406,"Can",false],[2680,2694,"Right . All right OK. Um",false],[3009,3016,"Was it a month ago",false],[3069,3077,"OK. OK.",false],[3900,3914,"OK all right.",false],[4082,4082,"stroke.",false],[4396,4400,"for",false],[5167,5181,"You haven't OK. Um all right. Um.",false],[5787,5797,"actually",false],[6388,6393,"uh",false],[6974,6980,"arteries",false],[7053,7056,"of your",false],[7072,7077,"to check if",false],[7224,7229,"OK whether",false],[7234,7241,"have",true],[7268,7280,"mini-stroke. Sure.",false],[7327,7339,"they're prolonged.",false],[7453,7454,"OK.",false],[8099,8104,"can",false],[8170,8174,"TIA",false],[8243,8261,"consultation OK.",false],[8266,8269,"you'll",false],[8500,8504,"got",false],[8621,8626,"going to",false],[8646,8658,"OK.",false],[8712,8715,"down",false],[8719,8722,"A and E.",false],[8951,8963,"",false],[8995,8995,"back",false],[9005,9026,"OK. All right.",false],[9225,9225,"help you should",false],[9277,9280,"take",false],[9288,9300,"further OK. thank you. All the best. Take care now. Bye bye.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'Recurrent episodes of neurological symptoms over past 6-8 weeks'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial couple of days of tiredness then return to normal not captured."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles in right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'Right arm weakness with paraesthesia (pins and needles in right hand)'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Each episode lasts 3-4 days'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Right leg weakness concurrent with arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Abnormal gait during episodes, noted by colleague'."],["The note captures: Gait is normal outside the episodes.","yes","Gait abnormal 'during episodes' and 'Fit and well between episodes'."],["The note captures: Generally feels tired and weak.","yes","'Generalised fatigue and weakness'."],["The note captures: Sometimes feels nauseous.","yes","'Nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not documented."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'Episodes initially occurred weekly', acceptable rendering of less frequent start."],["The note captures: Episodes now occur a couple of times a day.","yes","'now multiple times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'Difficulty holding cup ... during episodes'."],["The note captures: Drinking is slightly harder during episodes.","yes","'drinking coffee during episodes'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'during episodes (last few days)'."],["The note captures: No difficulty swallowing currently.","yes","'No swallowing difficulty'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'Sensation of something in throat during episodes only'."],["The note captures: No difficulty speaking during episodes.","yes","'No speech difficulty'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No visual disturbance (patient wears glasses)'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Patient asymptomatic at time of consultation'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not documented."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","Blood pressure normal."],["The note captures: No other illnesses; normally fit and well.","partial","'Fit and well between episodes' but absence of other illnesses not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75mg daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated after father's surgery, not previously prescribed' but reason (internet, stroke/heart attack risk) omitted."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","yes","'risks not discussed with GP'."],["The note captures: Allergic to penicillin.","yes","'Allergy: penicillin'."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'Father had carotid surgery for stroke prevention'."],["The note captures: Non-smoker.","yes","'Non-smoker'."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","'intermittent connection issues' noted but not that video was lost and no examination possible."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Suspected transient ischaemic attacks (TIAs)'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","yes","Concerning features include 'family history of stroke'; urgent referral."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected appointment within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'possible brain imaging' but not to check for a bleed."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend Emergency Department if symptoms persist or prolong'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","partial","Urgency captured but not that it is not an immediate A&E emergency now."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Contacting the practice for phone assessment if symptoms recur is not documented."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'PALS and TIA clinic contact numbers provided in consultation notes'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'ring clinic today afternoon or tomorrow morning to confirm appointment'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","'contact practice if unable to attend appointment or not called by clinic'."]],"claims":[["Right leg weakness concurrent with arm symptoms","Patient reported leg weakness with the arm symptoms but never said which side."]],"note":"SOAP Notes\n\n\n\n\nPatient: John Smith\n\nDate of Birth: 32 years old\n\nAddress: 4 Park Avenue, AB1CB2\n\nDate of Consultation: 27/09/2026\n\n\n\n\nSubjective:\n\nRecurrent episodes of neurological symptoms over past 6-8 weeks\n\nEpisodes initially occurred weekly, now multiple times daily\n\nEach episode lasts 3-4 days\n\nRight arm weakness with paraesthesia (pins and needles in right hand)\n\nRight leg weakness concurrent with arm symptoms\n\nAbnormal gait during episodes, noted by colleague\n\nGeneralised fatigue and weakness\n\nNausea\n\nSensation of something in throat during episodes only\n\nDifficulty holding cup and drinking coffee during episodes (last few days)\n\nNo swallowing difficulty\n\nNo speech difficulty\n\nNo visual disturbance (patient wears glasses)\n\nFit and well between episodes\n\nFather had carotid surgery for stroke prevention\n\nPatient previously screened following father's surgery - cholesterol, diabetes, and blood pressure all normal\n\nOccupation: plastic surgeon\n\nLives with wife\n\nNon-smoker\n\nAllergy: penicillin\n\n\n\n\nObjective:\n\nVideo consultation with intermittent connection issues\n\nPatient asymptomatic at time of consultation\n\n\n\n\nAssessment:\n\nSuspected transient ischaemic attacks (TIAs)\n\nConcerning features: recurrent episodes, right-sided weakness, increasing frequency, family history of stroke\n\nPatient currently asymptomatic\n\n\n\n\nPlan:\n\nUrgent referral to TIA clinic (expected appointment within 1-2 days)\n\nPatient advised to attend Emergency Department if symptoms persist or prolong\n\nDiscussed aspirin 75mg daily - patient self-initiated after father's surgery, not previously prescribed, risks not discussed with GP\n\nPALS and TIA clinic contact numbers provided in consultation notes\n\nPatient advised to contact practice if unable to attend appointment or not called by clinic\n\nPatient advised to ring clinic today afternoon or tomorrow morning to confirm appointment\n\nExpected investigations at TIA clinic: carotid ultrasound, possible brain imaging\n\n\n\n\nTreating Clinician","review":258.07894736842104,"saved":227.92105263157896,"faster":46.89733593242366,"clean":false,"effort":17.391304347826086,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial couple of days of tiredness then return to normal not captured."],["missing","Low motivation; does not feel like doing anything.","Low motivation not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not documented."],["partial","No other illnesses; normally fit and well.","'Fit and well between episodes' but absence of other illnesses not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated after father's surgery, not previously prescribed' but reason (internet, stroke/heart attack risk) omitted."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'intermittent connection issues' noted but not that video was lost and no examination possible."],["partial","TIA clinic may do a brain scan to check for a bleed.","'possible brain imaging' but not to check for a bleed."],["partial","Currently not an immediate emergency requiring A&E, but urgent.","Urgency captured but not that it is not an immediate A&E emergency now."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Contacting the practice for phone assessment if symptoms recur is not documented."],["fabrication","Right leg weakness concurrent with arm symptoms","Patient reported leg weakness with the arm symptoms but never said which side."]],"mb":16.014816,"latency":39.719,"finalised":297.79794736842103},{"label":"Run 5","wer":23.99364406779661,"text":"That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yeah. Okay. So how can I help you today? You've having some problems with your acne. Is that right? Sorry. Say that again. How can I help you today? So I've been experiencing very weird symptoms over the past month or so, and I don't causing them. I have googled it, nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weird symptoms.\n\nHi there. Good morning. I'm doctor. To see you. Hi. Okay. So before we start your appointment, could I confirm your full name and date of birth, please? Yes. John Smith, and I am 32 years old. Sorry. I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay. Could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue, and it's a b 1 c b 2.\n\nIs it always the right? Yes. Okay. We've lost video now. Maybe is there a button you can press? Okay. Are you happy for us to carry on without the video? I can't see you at the moment. Yes. That's fine. Alright. So you've been having these pins and needles episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well? The pins and needles\n\nIn the hand, but I feel like my arm is getting weaker. But it only lasts 3 days and then goes back to normal. So it's very weird. Right. Okay. And is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And, again, it's only for 3 days or 3 or 4 days. Okay. You you said you've been having weird symptoms for about a month. Yeah. So so what has been happening from the beginning of the month? What else has\n\nYou were having? So it started with feeling very tired for a couple of days, and then I get back to normal. And then I started losing feeling from my hands and arms. I get a weird sensation, I get pins and needles. Right. So just say that again. The connection is not so great. You've been getting pins and needles in the hand. Is that right? Yeah. That's correct. Is that the right or left hand? My right hand.\n\nI generally feel tired and weak, and sometimes I feel nauseous, and I don't feel like I want to do anything. Right. Okay. And, you know, your colleague said you've you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time I get my arm symptoms,\n\nMy leg feels weaker. Right. Okay. And, you know, you the abnormal gait, has that been present outside of these episodes? No. It has not. Right. So, normally, I'm fit and well, actually. Alright. Okay. And these these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week\n\nTo every once once a month, but now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When when did it all start? Is that Probably a month and a half, maybe 2 months. Right. Okay. K. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So recently, I've noticed\n\nI can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently. No. During the episodes, do you have any difficulty swallowing? I I I feel like there's something in my throat. Okay. What about\n\nDifficulty speaking during these episodes. Any any issues with that at all? No. I can speak fine. Okay. And any visual problems during these episodes? I don't think so, but I wear glasses. Okay. Alright. Now can I just ask, has is there any history of stroke or mini strokes in your family? Yes. My father has had a operation to the side of his neck to reduce the risk of\n\nRight. Okay. And how about yourself? Have you had any history of mini strokes or anything like that along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked, and my cholesterol was fine. Good. Excellent. So you had a a blood test done. And did they check your diabetes as well? They checked my diabetes, my blood pressure, and my\n\nCholesterol, and the doctor said it was all okay. Fantastic. Okay. Now do you have any other illnesses at all? No. No. Are you on any medication? I take an aspirin 75 milligrams once a day, but that's because of something I read on the Internet. Okay. So so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Do you have you ever told a doctor before, your GP, that you're on aspirin? Yes. I took\n\nI started taking it after my father had his operation, but that wasn't the doctor telling me. And has any GP ever spoken to you about the risks of aspirin and whether you should be on it, or have you not told the GP in the past? No. I haven't. Okay. Alright. Now in terms of your your kind of social situation, are you working at the moment? Yes. I am. What do you work as? I'm I'm\n\nActually, doctor. You're a a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay. Great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No. I live with my wife. Right. Okay. Fantastic. Do you smoke\n\nAt all? No. I don't. Right. Okay. That's fine. Now, obviously, you're you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Right. Okay. Well, the way you're describing these episodes, they make me concerned about mini strokes or TIAs, transient ischemic attacks. Okay. And so that's something quite urgent.\n\nAnd given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do in fact, what I am going to do is I'm going to refer you to a stroke at the TIA clinic. Now just to double check, do you have the symptoms right now? No. I'm perfectly fine at the moment. Okay. So so what I'm gonna do is I'm gonna I'm gonna refer you to a a mini stroke clinic or a TIA clinic. I send that referral off now, and then you can\n\nAttend them. They they'll usually call you in within the next 1 to 2 days. Okay? Because it's something relatively urgent. Now today, it's Wednesday, so we've got a few days before the weekend. So, basically, the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking they'll be doing the ultrasound of the carotid artery like your your father had, they'll be doing maybe they might do a scan\n\nThe brain as well. Sure. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. Okay. You haven't got any kind of stroke or mini stroke. Now if your symptoms return and they persist, they prolong, then you may need to attend the A and E. Okay? Because our presumptive working diagnosis is mini stroke or TIA. K? And if a mini stroke is\n\nProlonged, then then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting 1 or 2 days. We want you to go to hospital in that instance as soon as possible. Okay? Sure. Now if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's that's that's not the problem. You know? You've got easy access to us. Okay? So this is the plan going forward. I'm going to do that referral. You should hear back from\n\nHospital relatively soon. The hospital, you could actually ring them on the PALS number, and then there's also the tria clinic number. I'm going to leave that number in the notes for this complication. Okay? So you have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. So today in the afternoon, you wait at 1 or 2 hours, or tomorrow morning just to find out when they have time to slot you in and just to make sure they've got you in the system, that they've got in the books, and they're gonna be calling you in. Okay? Great.\n\nThis isn't an immediate emergency. You need to rush out to Amy, but it's something quite urgent that we need to deal with in a short space of time. Okay? So if there's if there's any delay that transpires, for example, you can't make the appointment or, you know, that you don't get called, Something is you you get get in contact back with us. Okay? Great. Alright. Did you have any questions at all? No. I think that covers most of it. Okay. Great. So just bear with me a few minutes, and then I'll send that all through, and then you should you should be able to have\n\nThe information at your hands to in order to get things better. Okay? Great. Thank you. All the best. Take care then. Bye bye. Bye.","marks":[[0,500,"",true],[537,537,"from GP at Hand. Nice",false],[655,659,"Yeah it's",false],[880,883,"AB",false],[886,889,"CB",false],[892,892,"That's great thank you so much for that. Are you in a private place where you're OK to speak at the moment Yes. OK. So how can I help you today You've been having some problems with your asthma. Is that right Sorry say that . How can I help you today So um I've been experiencing very weird symptoms over the past month or so. And I don't know what's causing them. I have googled it and um nothing's coming up so I thought I'd come and speak to you about it. OK. OK. So tell me a bit more about these weird symptoms you've been having. So it started with feeling very tired but for a couple of days and then I get back to normal. And then I started losing feeling in my hands and arms. I get a weird sensation like uh I guess pins and needles. Right again the connection's not so great. You've been getting pins and needles in the hand. Is that right And. Yeah that's correct. OK. Is that the right or left hand My right hand.",false],[1097,1105,"All right. Um",false],[1341,1342,"few",false],[1727,2011,"",false],[2017,2138,"happening Um",false],[2410,2410,"Can",false],[2684,2698,"Right . All right OK. Um",false],[3013,3020,"Was it a month ago",false],[3073,3081,"OK. OK.",false],[3904,3918,"OK all right.",false],[4086,4086,"stroke.",false],[4400,4404,"for",false],[5175,5189,"You haven't OK. Um all right. Um.",false],[5795,5805,"actually",false],[6396,6401,"uh",false],[6982,6988,"arteries",false],[7061,7064,"of your",false],[7080,7085,"to check if",false],[7232,7237,"OK whether",false],[7242,7249,"have",true],[7276,7288,"mini-stroke. Sure.",false],[7335,7347,"they're prolonged.",false],[7461,7462,"OK.",false],[8107,8112,"can",false],[8178,8182,"TIA",false],[8251,8269,"consultation OK.",false],[8274,8277,"you'll",false],[8508,8512,"got",false],[8629,8634,"going to",false],[8654,8666,"OK.",false],[8720,8723,"down",false],[8727,8730,"A and E.",false],[8959,8971,"",false],[9003,9003,"back",false],[9013,9034,"OK. All right.",false],[9233,9233,"help you should",false],[9285,9288,"take",false],[9296,9316,"further OK.",false],[9352,9357,"now.",false],[9367,9371,"",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over 1.5-2 months'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","yes","'Initial symptom was fatigue for a couple of days'."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'Right hand paraesthesia'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right-sided specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'Right hand paraesthesia with right arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Episodes last 3-4 days each'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Right leg weakness occurring concurrently with arm symptoms'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'Colleague observed abnormal gait'."],["The note captures: Gait is normal outside the episodes.","yes","'during episodes only'."],["The note captures: Generally feels tired and weak.","partial","'Generalised fatigue' but general weakness not stated."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","yes","'reduced motivation'."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'Initially occurring weekly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now multiple times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding cup of coffee'."],["The note captures: Drinking is slightly harder during episodes.","yes","'Slight difficulty drinking during episodes'."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","yes","'Recent onset ... (last few days)' and 'during episodes'."],["The note captures: No difficulty swallowing currently.","yes","'No dysphagia between episodes'."],["The note captures: During episodes, feels as if something is in his throat.","yes","'Sensation of throat obstruction during episodes'."],["The note captures: No difficulty speaking during episodes.","yes","'No dysarthria'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No visual disturbance (wears glasses)'."],["The note captures: Currently asymptomatic at the time of consultation.","yes","'Currently asymptomatic'."],["The note captures: No personal history of stroke or mini-stroke (TIA).","partial","Only 'PMH: Nil significant'; no explicit denial of prior stroke/TIA."],["The note captures: Cholesterol previously checked and normal.","yes","Cholesterol normal."],["The note captures: Previously screened for diabetes; normal.","yes","Diabetes normal."],["The note captures: Blood pressure previously checked; normal.","yes","BP normal."],["The note captures: No other illnesses; normally fit and well.","yes","'Fit and well between episodes'; PMH nil."],["The note captures: Takes aspirin 75 mg once daily.","yes","'Aspirin 75mg once daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated, not GP-prescribed' but purpose not stated."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","No statement that no GP has discussed risks/appropriateness."],["The note captures: Allergic to penicillin.","yes","Penicillin."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'carotid surgery for stroke prevention'."],["The note captures: Non-smoker.","yes","Non-smoker."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","yes","'Examination not performed (telehealth consultation, video connection lost)'."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'?Transient ischaemic attacks'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","'Urgent referral' without rationale about FHx/young age."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected contact within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain imaging' without bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend ED if symptoms recur and persist'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not documented."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","no","Not documented."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'TIA clinic and PALS contact details provided in consultation notes'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","yes","'contact clinic today or tomorrow to confirm appointment'."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","no","Not documented."]],"claims":[["Right leg weakness occurring concurrently with arm symptoms","Patient said his leg feels weaker during episodes; the side of the leg was never stated."],["TIA clinic to arrange carotid ultrasound and brain imaging","Doctor said they 'might do a scan of your brain'; brain imaging stated as certain."],["Discussed aspirin use - patient to be reviewed regarding appropriateness of self-initiated antiplatelet therapy","The doctor asked about aspirin but gave no plan for review of its appropriateness."]],"note":"SOAP Notes\n\n\n\n\nPatient: John Smith\n\nDate of Birth: 32 years old\n\nAddress: 4 Park Avenue, AB1CB2\n\nDate of Consultation: 27/09/2026\n\n\n\n\nSubjective:\n\nRecurrent episodes of right-sided weakness and paraesthesia over 1.5-2 months\n\nInitially occurring weekly, now multiple times daily\n\nEpisodes last 3-4 days each\n\nRight hand paraesthesia with right arm weakness\n\nRight leg weakness occurring concurrently with arm symptoms\n\nColleague observed abnormal gait during episodes only\n\nRecent onset difficulty holding cup of coffee (last few days)\n\nSlight difficulty drinking during episodes\n\nSensation of throat obstruction during episodes\n\nNo dysphagia between episodes\n\nNo dysarthria\n\nNo visual disturbance (wears glasses)\n\nGeneralised fatigue, nausea, reduced motivation\n\nFit and well between episodes\n\nCurrently asymptomatic\n\nInitial symptom was fatigue for a couple of days before onset of neurological symptoms\n\n\n\n\nObjective:\n\nExamination not performed (telehealth consultation, video connection lost)\n\nPrevious screening post-father's surgery: cholesterol, diabetes, blood pressure all within normal limits\n\n\n\n\nAssessment:\n\n?Transient ischaemic attacks\n\n\n\n\nPast Medical History:\n\nNil significant\n\n\n\n\nFamily History:\n\nFather: carotid surgery for stroke prevention\n\n\n\n\nMedications:\n\nAspirin 75mg once daily (self-initiated, not GP-prescribed)\n\n\n\n\nAllergies:\n\nPenicillin\n\n\n\n\nSocial History:\n\nOccupation: plastic surgeon\n\nLives with wife\n\nNon-smoker\n\n\n\n\nPlan:\n\nUrgent referral to TIA clinic (expected contact within 1-2 days)\n\nTIA clinic to arrange carotid ultrasound and brain imaging\n\nSafety netting advice provided: attend ED if symptoms recur and persist\n\nTIA clinic and PALS contact details provided in consultation notes\n\nPatient advised to contact clinic today or tomorrow to confirm appointment\n\nDiscussed aspirin use - patient to be reviewed regarding appropriateness of self-initiated antiplatelet therapy","review":288.4736842105263,"saved":197.5263157894737,"faster":40.643274853801174,"clean":false,"effort":21.73913043478261,"sig":[["partial","Generally feels tired and weak.","'Generalised fatigue' but general weakness not stated."],["partial","No personal history of stroke or mini-stroke (TIA).","Only 'PMH: Nil significant'; no explicit denial of prior stroke/TIA."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated, not GP-prescribed' but purpose not stated."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","No statement that no GP has discussed risks/appropriateness."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","'Urgent referral' without rationale about FHx/young age."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain imaging' without bleed purpose."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not documented."],["missing","If symptoms recur, can contact the practice for phone assessment and advice.","Not documented."],["missing","If there is any delay (not called or cannot make the appointment), contact the practice again.","Not documented."],["fabrication","Right leg weakness occurring concurrently with arm symptoms","Patient said his leg feels weaker during episodes; the side of the leg was never stated."],["fabrication","TIA clinic to arrange carotid ultrasound and brain imaging","Doctor said they 'might do a scan of your brain'; brain imaging stated as certain."],["fabrication","Discussed aspirin use - patient to be reviewed regarding appropriateness of self-initiated antiplatelet therapy","The doctor asked about aspirin but gave no plan for review of its appropriateness."]],"mb":16.639073,"latency":39.968,"finalised":328.4416842105263}],"patientnotes":[{"label":"Run 1","wer":14.72457627118644,"text":"Hi there. Good morning. I'm Dr. Jim Levis from TK Hannah. Nice to see you. Okay, so before we start your appointment, could I confirm your full name is Dr. Birth, please? Yes. John Smith. And I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay. Could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue and it's AB1BB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yes. Okay. So how can I help you today? You've been having some problems with your asthma, is that right? Sorry? How can I help you today? So I've been experiencing very weird symptoms over the past month or so. I don't know what's causing them. I have Googled it and nothing's coming up. I thought I'd come and speak to you about it. Okay. So tell me a bit more about these weeds.\nSo it started with feeling very tired for a couple of days, and then I get back to normal, and then I started moving feeling. I get a weird sensation, like, I guess, pins and needles.\nRight. The connection is not so great. You've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right?\nYes.\nOkay, we've lost video now. Maybe is a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\nYes, that's fine.\nAll right. So you've been having these pins and needles, episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nNeedles are in the hand, but I feel like my arm is getting weaker. But it only lasts few days and then goes back to normal. So it's very weird. Right. Okay. Is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You said you've been having weird symptoms for about a month. Yeah. So what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything. Right, okay. And you know, your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time, I get.\nMy arm symptoms, my leg feels weaker. Right. Okay. And, you know, you. The abnormal gait, has that been present outside of these episodes? No, it has not. So normally I'm fit and well, actually. All right. Okay. And these, these episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week to every once at once a month. But now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When did it all start? A month and a half, maybe two months. Right. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So.\nRecently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all? No, I can speak fine. Any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, can I just ask, is there any history of stroke or mini strokes in your harmony? Yes. My father has had an operation to the side of his neck.\nTo reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that? Along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked and my cholesterol was fine. Good. Excellent. So you had a blood test done. Did they check the diabetes as well? They checked my diabetes, my blood pressure and my cholesterol, and the doctor said it was all okay. Fantastic. Okay. Do you have any other illnesses at all? No. Are you on any medication? I take an Aspirin, 75 milligrams once a day, but that's because of something I read on the Internet. Okay, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Have you ever told a doctor before your GP.\nYou're on Aspirin? Yes. I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. And has any GP ever spoken to you about the risks of Aspirin and whether you should be on it, or have you not told the GP in the past? No, I haven't. Okay. All right. Now, in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No, I live with my wife. Okay.\nFantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Now, obviously you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIA, transient ischemic attacks. And so that's something quite urgent. And given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do, in fact what I'm going to do is I'm going to refer you to a stroke TIA clinic now, just to double check. Do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic.\nI send that referral off now, and then you can attend them. They'll usually call you in within the next one to two days. Okay. Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing, maybe, they might do a scan of the brain as well, signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness, you haven't got, any kind of stroke or mini stroke. Now, if your symptoms return and they persist, then you may need to attend A and E. Okay. Because a presumptive working diagnosis is minuscule.\nStroke or TIA. Okay? And if a mini stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital in that instance, as soon as possible. Okay? Sure. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the time. That's not the problem. You've got easy access to us. Okay, so this is the plan going forward. I'm going to do that referral. You should hear back from the hospital relatively soon. The hospital? You could actually ring them on the PALS number. And then there's also the CIA clinic number. I'm going to put that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. Today in the afternoon, wait one or two hours or tomorrow morning, just to find out when they plan to slot you in. And just to.\nMake sure they've got you in the system that they've got in the books and they're going to be calling you in. Okay, great. This isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us. Okay, great. All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have. Yes, you have the information at your hands in order to. Okay, great. Thank you. All the best. Take care then. Bye. Bye.","marks":[[28,41,"Doctor",false],[47,57,"GP at Hand.",false],[75,79,"Hi. OK.",false],[149,155,"and date of",false],[171,175,"Yeah it's",false],[395,402,"AB one CB two.",true],[625,625,"say that .",false],[889,895,"weird symptoms you've been having.",false],[1006,1012,"losing",true],[1021,1021,"in my hands and arms.",false],[1086,1086,"again",false],[1091,1104,"connection's",false],[1324,1324,"there a a",false],[1606,1606,"Uh the pins and",false],[2248,2248,"you've",false],[2355,2355,"Can",false],[2621,2621,"Right .",false],[2932,2932,"when",false],[2949,2949,"Was it a month ago probably",false],[3665,3665,"Any",false],[3835,3835,"has uh",false],[3892,3899,"family Uh",false],[4432,4437,"OK. Now",false],[4476,4476,"No.",false],[4721,4726,"OK. Do",false],[4796,4796,"took I",false],[5045,5050,"You haven't OK. Um",false],[5078,5078,"your uh",false],[5171,5171,"Uh I'm uh",false],[5554,5554,"you're a",false],[5641,5651,"actually",false],[5758,5761,"TIAs",false],[6010,6013,"I am",false],[6194,6202,"gonna",false],[6213,6221,"uh I'm gonna",false],[6637,6637,"we're",false],[6781,6787,"arteries",false],[6792,6792,"your",false],[6863,6866,"your",false],[6880,6880,"to check if there's any",false],[7014,7014,"OK whether",false],[7020,7027,"have",true],[7055,7067,"mini-stroke. Sure.",false],[7113,7113,"they're prolonged.",false],[7166,7167,"um our",false],[7201,7218,"mini-stroke",true],[7266,7266,"then uh",false],[7648,7653,"phone. That's that's",false],[7677,7677,"you know you",false],[7854,7859,"can",false],[7925,7928,"TIA",false],[7957,7960,"leave",false],[8249,8253,"got time",false],[8393,8405,"OK.",false],[8470,8473,"A and E.",false],[8567,8567,"if there's",false],[8686,8713,"",false],[8718,8725,"you get",false],[8745,8745,"back",false],[8755,8767,"OK.",false],[8953,8953,"um you should",false],[8965,8974,"help",false],[8979,8979,"should",false],[9028,9040,"take things further OK.",false],[9076,9081,"now.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'~1-2 months', 'began ~1.5 months ago'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","'began ... with fatigue and weakness lasting a few days' - adds weakness, return to normal not explicit."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'right-hand pins-and-needles'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'right-hand pins-and-needles and arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'Each episode lasts a few days then resolves'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'Associated leg weakness ... during episodes'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'abnormal gait during episodes' (colleague detail immaterial)."],["The note captures: Gait is normal outside the episodes.","partial","Gait abnormal 'during episodes' but normal gait otherwise not explicit."],["The note captures: Generally feels tired and weak.","partial","Fatigue and weakness only described at onset, not as ongoing general symptoms."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not mentioned."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'Frequency increased from weekly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'now occur several times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding coffee cup only during attacks'."],["The note captures: Drinking is slightly harder during episodes.","no","Drinking difficulty not mentioned."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","'only during attacks' captured but not the last couple of days onset."],["The note captures: No difficulty swallowing currently.","yes","'No dysphagia'."],["The note captures: During episodes, feels as if something is in his throat.","no","Throat sensation during episodes not documented."],["The note captures: No difficulty speaking during episodes.","yes","'No ... speech ... changes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No ... visual changes'."],["The note captures: Currently asymptomatic at the time of consultation.","no","Current asymptomatic status not documented."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","Not documented."],["The note captures: Cholesterol previously checked and normal.","no","Not documented."],["The note captures: Previously screened for diabetes; normal.","no","Not documented."],["The note captures: Blood pressure previously checked; normal.","no","Not documented."],["The note captures: No other illnesses; normally fit and well.","no","Not documented."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75 mg once daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated after father's stroke-prevention surgery' but reason/not prescribed incomplete."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Not documented."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father's stroke-prevention surgery'."],["The note captures: Non-smoker.","no","Not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Objective 'Not discussed'; video loss/no exam not captured."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Presumptive diagnosis: transient ischemic attack (TIA)'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Family history cited but urgency and young age not stated."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","partial","Referral to stroke/TIA clinic not labelled urgent, though 1-2 day timeframe given."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected appointment within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","no","Carotid ultrasound not documented."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","no","Brain scan not documented."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","yes","'attend A&E immediately for prolonged episodes'."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not captured."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'call if symptoms recur'; 'Follow-up possible via phone'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","partial","Clinic/PALS numbers referenced but not that they are left in the notes."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","partial","'confirm slot via clinic or PALS numbers' without timing."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","no","Contacting practice if delayed not documented."]],"claims":[["Presumptive diagnosis: transient ischemic attack (TIA) / minor stroke","Clinician said mini-stroke (i.e. TIA); minor stroke is a different diagnosis that was not stated."],["No dysphagia, speech or visual changes reported.","When asked about swallowing during episodes, patient said he feels there is something in his throat."]],"note":"Subjective\n\nChief Complaint::\n\nIntermittent pins‑and‑needles and weakness in right hand/arm; occasional leg weakness and gait change; duration ~1–2 months.\n\nHistory of Presenting Complaint::\n\nSymptoms began ~1.5 months ago with fatigue and weakness lasting a few days.\n\nEvolved to right‑hand pins‑and‑needles and arm weakness; episodes now occur several times daily.\n\nEach episode lasts a few days then resolves before recurring.\n\nAssociated leg weakness and abnormal gait during episodes; nausea; difficulty holding coffee cup only during attacks.\n\nNo dysphagia, speech or visual changes reported.\n\nFrequency increased from weekly to multiple times per day.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPresumptive diagnosis: transient ischemic attack (TIA) / minor stroke given episodic neurological deficits and family history.\n\nPlan\n\nMedications::\n\nPatient is taking aspirin 75 mg once daily, self‑initiated after father's stroke‑prevention surgery.\n\nReferral to stroke/TIA clinic; expected appointment within 1–2 days.\n\nPatient advised to confirm slot via clinic or PALS numbers and to call if symptoms recur or worsen.\n\nInstructed to attend A&E immediately for prolonged episodes.\n\nFollow‑up possible via phone; contact practitioner for further guidance.","review":516.4868421052631,"saved":-30.486842105263122,"faster":-6.273012778860725,"clean":false,"effort":52.17391304347826,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","'began ... with fatigue and weakness lasting a few days' - adds weakness, return to normal not explicit."],["partial","Gait is normal outside the episodes.","Gait abnormal 'during episodes' but normal gait otherwise not explicit."],["partial","Generally feels tired and weak.","Fatigue and weakness only described at onset, not as ongoing general symptoms."],["missing","Low motivation; does not feel like doing anything.","Low motivation not mentioned."],["missing","Drinking is slightly harder during episodes.","Drinking difficulty not mentioned."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","'only during attacks' captured but not the last couple of days onset."],["missing","During episodes, feels as if something is in his throat.","Throat sensation during episodes not documented."],["missing","Currently asymptomatic at the time of consultation.","Current asymptomatic status not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","Not documented."],["missing","Cholesterol previously checked and normal.","Not documented."],["missing","Previously screened for diabetes; normal.","Not documented."],["missing","Blood pressure previously checked; normal.","Not documented."],["missing","No other illnesses; normally fit and well.","Not documented."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated after father's stroke-prevention surgery' but reason/not prescribed incomplete."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Not documented."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Non-smoker.","Not documented."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Objective 'Not discussed'; video loss/no exam not captured."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Family history cited but urgency and young age not stated."],["partial","Urgent referral to TIA (mini-stroke) clinic.","Referral to stroke/TIA clinic not labelled urgent, though 1-2 day timeframe given."],["missing","TIA clinic will do carotid artery ultrasound.","Carotid ultrasound not documented."],["missing","TIA clinic may do a brain scan to check for a bleed.","Brain scan not documented."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not captured."],["partial","TIA clinic and PALS contact numbers to be left in the consultation notes.","Clinic/PALS numbers referenced but not that they are left in the notes."],["partial","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","'confirm slot via clinic or PALS numbers' without timing."],["missing","If there is any delay (not called or cannot make the appointment), contact the practice again.","Contacting practice if delayed not documented."],["fabrication","Presumptive diagnosis: transient ischemic attack (TIA) / minor stroke","Clinician said mini-stroke (i.e. TIA); minor stroke is a different diagnosis that was not stated."],["fabrication","No dysphagia, speech or visual changes reported.","When asked about swallowing during episodes, patient said he feels there is something in his throat."]],"mb":34.30551,"latency":30.178,"finalised":546.6648421052631},{"label":"Run 2","wer":14.9364406779661,"text":"Hi there. Good morning. I'm Dr. Jim. Nice to see you. Okay, so before we start your appointment, could I confirm your full name is Dr. Birth, please? Yes. John Smith. And I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay, could you tell me the first line of your address and your postcode, please? It's 4 Park Avenue and it's AB1BB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yes. Okay, so how can I help you today? You've been having some problems with your asthma, is that right? Sorry, how can I help you today? So I've been experiencing very weird symptoms over the past month or so. I don't know what's causing them. I have googled it and nothing's coming up. I thought I'd come and speak to you about it. Okay, so tell me a bit more about these waiting.\nSo it started with getting very tired for a couple of days, and then I get back to normal, and then I started using feeling. I get a weird sensation. I get pins and\nneedles. Right. The connection is not so great. You've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right?\nYes.\nOkay, we've lost video now maybe is a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\nYes, that's fine.\nAll right. So you've been having these pins and needles, episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nThe.\nPins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts three days and then goes back to normal. So it's very weird. Right. Okay. Is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal, and again, it's only for three days or three or four days. Okay. You said you've been having weird symptoms for about a month. Yeah. So what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything. Right, okay. And you know, your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time.\nI get my arm symptoms, my leg feels weaker. Right. Okay. And you know, the abnormal gait, has that been present outside of these episodes? No, it has not. So normally I'm fit and well, actually. All right. Okay. And these. These episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week to every once at once a month. But now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When did it all start? A month and a half, maybe two months. Right. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So.\nRecently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that? No, I can speak fine. Any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, can I just ask, is there any history of stroke or mini strokes in your heredity? Yes. My father has had an operation to the side of his.\nNeck to reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that? Along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked and my cholesterol was fine. Good. Excellent. So you had a blood test done. Did they check the diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic. Okay. Do you have any other illnesses at all? No. No. Are you on any medication? I take an Aspirin, 75 milligrams once a day, but that's because of something I read on the Internet. Okay, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Have you ever told a doctor before you're just.\nGP that you're on Aspirin? Yes, I took. I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. And has any GP ever spoken to you about the risks of Aspirin and whether you should be on it, or have you not told the gp? No, I haven't. Okay. All right. Now, in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No, I live with my wife. Okay.\nFantastic. Do you smoke at all? No, I don't. That's fine. Now, obviously you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIA, transient ischemic attacks. And so that's something quite urgent. And given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do, in fact what I'm going to do is I'm going to refer you to a stroke TIA clinic now, just to double check. Do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic.\nNick. I send that referral off now, and then you can attend them. They'll usually call you in within the next one to two days. Okay. Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had, and they'll be doing maybe they might do a scan of the brain as well. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. You haven't got any kind of stroke or mini stroke. Now, if your symptoms return and they persist, then you may need to attend A and E. Okay. Because a presumptive working diagnosis is.\nMini stroke or TIA. Okay? And if a mini stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital in that instance, as soon as possible. Okay? Sure. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the time. That's not the problem. You've got easy access to us. Okay, so, people, this is the plan going forward. I'm going to do that referral. You should hear back from the hospital relatively soon. The hospital? You could actually ring them on the PALS number. And then there's also the clinic number. I'm going to put that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. Today in the afternoon, Wait one or two hours or tomorrow morning, just to find out. One day at time to slot you in and.\nJust to make sure they put you in the system that they've got in the books and they're going to be calling you in. Okay, great. This isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us. Okay, great. All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have. Yes, you have the information at your hands in order to get things further. Okay, great. Thank you. All the best. Take care then. Bye. Bye.","marks":[[28,36,"Doctor from GP at Hand.",false],[54,58,"Hi. OK.",false],[128,134,"and date of",false],[150,154,"Yeah it's",false],[374,381,"AB one CB two.",true],[604,604,"say that .",false],[868,876,"weird symptoms you've been having.",false],[896,903,"feeling",false],[987,992,"losing",true],[1001,1001,"in my hands and arms.",false],[1029,1032,"guess",false],[1057,1057,"again",false],[1062,1075,"connection's",false],[1294,1294,"there a a",false],[1677,1682,"few",false],[2234,2234,"you've",false],[2341,2341,"Can",false],[2600,2600,"Right .",false],[2911,2911,"when",false],[2928,2928,"Was it a month ago probably",false],[3649,3649,"any",false],[3666,3666,"at all",false],[3807,3807,"has uh",false],[3864,3872,"family Uh",false],[4404,4409,"OK. Now",false],[4697,4702,"OK. Do",false],[4738,4750,"your",false],[5012,5012,"in the past",false],[5029,5034,"You haven't OK. Um",false],[5062,5062,"your uh",false],[5155,5155,"Uh I'm uh",false],[5525,5525,"you're a",false],[5612,5622,"actually",false],[5729,5732,"TIAs",false],[5981,5984,"I am",false],[6165,6173,"gonna",false],[6184,6192,"uh I'm gonna",false],[6244,6249,"Um",false],[6614,6614,"we're",false],[6758,6764,"arteries",false],[6769,6769,"your",false],[6838,6841,"your",false],[6856,6856,"to check if",false],[7002,7002,"OK whether",false],[7007,7014,"have",true],[7041,7053,"mini-stroke. Sure.",false],[7099,7099,"they're prolonged.",false],[7152,7153,"um our",false],[7247,7247,"then uh",false],[7629,7634,"phone. That's that's",false],[7658,7658,"you know you",false],[7699,7705,"um",false],[7844,7849,"can",false],[7914,7914,"TIA",false],[7943,7946,"leave",false],[8226,8236,"when they got",false],[8280,8288,"they've got",false],[8377,8389,"OK.",false],[8454,8457,"A and E.",false],[8551,8551,"if there's",false],[8670,8697,"",false],[8702,8709,"you get",false],[8729,8729,"back",false],[8739,8751,"OK.",false],[8937,8937,"um you should",false],[8949,8958,"help",false],[8963,8963,"should",false],[9011,9014,"take",false],[9031,9043,"OK.",false],[9079,9084,"now.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'Onset 1–2 months ago'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial couple of days of tiredness not documented."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins-and-needles, numbness'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand specified."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","'Right hand pins-and-needles, arm weakness'."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","partial","'lasting up to 3 days' understates 3-4 days."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","'leg weakness ... during episodes'."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'abnormal gait during episodes' (colleague omitted)."],["The note captures: Gait is normal outside the episodes.","partial","'during episodes' only implies normal gait otherwise."],["The note captures: Generally feels tired and weak.","partial","'General fatigue' but general weakness not stated."],["The note captures: Sometimes feels nauseous.","yes","'occasional nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not documented."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'increased from weekly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'several times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding coffee cup during attacks'."],["The note captures: Drinking is slightly harder during episodes.","no","Drinking difficulty not documented."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","'during attacks' but not the last couple of days."],["The note captures: No difficulty swallowing currently.","no","Not documented."],["The note captures: During episodes, feels as if something is in his throat.","partial","'occasional throat sensation' vague and not tied to episodes."],["The note captures: No difficulty speaking during episodes.","yes","'speech intact'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'No visual changes'."],["The note captures: Currently asymptomatic at the time of consultation.","no","Current asymptomatic state not documented."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","Not documented."],["The note captures: Cholesterol previously checked and normal.","no","Not documented."],["The note captures: Previously screened for diabetes; normal.","no","Not documented."],["The note captures: Blood pressure previously checked; normal.","no","Not documented."],["The note captures: No other illnesses; normally fit and well.","no","Not documented."],["The note captures: Takes aspirin 75 mg once daily.","yes","'aspirin 75 mg once daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated after his father's stroke surgery' omits purpose and internet source."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Not documented."],["The note captures: Allergic to penicillin.","no","Not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","partial","Only an aside 'father's stroke surgery', not clearly a surgery to reduce stroke risk."],["The note captures: Non-smoker.","no","Not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","'Objective: Not discussed'; video loss/no exam not captured."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Probable transient ischemic attack (TIA) / mini-stroke'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","'Immediate referral' conveys urgency but no rationale (FHx, young age)."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Immediate referral to stroke/TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected appointment within 1–2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","no","Carotid ultrasound not mentioned."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","no","Brain scan not mentioned."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","partial","'go to A&E if symptoms recur or worsen' omits the persistent/prolonged criterion."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","'Advise attend promptly' does not say it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","partial","'may call clinic or GP for guidance' not tied to symptom recurrence/phone assessment."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","no","Not documented."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","no","Not documented."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","no","Not documented."]],"claims":[["Episodes lasting up to 3 days","Patient said episodes last three or four days."],["go to A&E if symptoms recur or worsen","Doctor advised A&E only if symptoms return and persist/are prolonged; for recurrence he said to contact the practice; 'worsen' was not said."],["Continue aspirin 75 mg daily as self-medicated.","The clinician gave no plan to continue aspirin; this was not said."]],"note":"Subjective\n\nChief Complaint::\n\nRecurrent episodes of pins‑and‑needles, numbness and weakness in right hand/arm with fatigue and occasional nausea.\n\nHistory of Presenting Complaint::\n\nOnset 1–2 months ago, episodes lasting up to 3 days.\n\nFrequency increased from weekly to several times daily.\n\nRight hand pins‑and‑needles, arm weakness, leg weakness, abnormal gait during episodes.\n\nGeneral fatigue, occasional nausea, difficulty holding coffee cup during attacks.\n\nNo visual changes, speech intact, occasional throat sensation.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nProbable transient ischemic attack (TIA) / mini‑stroke pending work‑up.\n\nPlan\n\nMedications::\n\nPatient reports taking aspirin 75 mg once daily, self‑initiated after his father’s stroke surgery.\n\nImmediate referral to stroke/TIA clinic; expected appointment within 1–2 days.\n\nAdvise attend promptly; go to A&E if symptoms recur or worsen.\n\nPatient may call clinic or GP for guidance while awaiting appointment.\n\nContinue aspirin 75 mg daily as self‑medicated.","review":620.25,"saved":-134.25,"faster":-27.623456790123456,"clean":false,"effort":61.95652173913043,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial couple of days of tiredness not documented."],["partial","Episodes are transient, lasting a few days (three or four days), then return to normal.","'lasting up to 3 days' understates 3-4 days."],["partial","Gait is normal outside the episodes.","'during episodes' only implies normal gait otherwise."],["partial","Generally feels tired and weak.","'General fatigue' but general weakness not stated."],["missing","Low motivation; does not feel like doing anything.","Low motivation not documented."],["missing","Drinking is slightly harder during episodes.","Drinking difficulty not documented."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","'during attacks' but not the last couple of days."],["missing","No difficulty swallowing currently.","Not documented."],["partial","During episodes, feels as if something is in his throat.","'occasional throat sensation' vague and not tied to episodes."],["missing","Currently asymptomatic at the time of consultation.","Current asymptomatic state not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","Not documented."],["missing","Cholesterol previously checked and normal.","Not documented."],["missing","Previously screened for diabetes; normal.","Not documented."],["missing","Blood pressure previously checked; normal.","Not documented."],["missing","No other illnesses; normally fit and well.","Not documented."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated after his father's stroke surgery' omits purpose and internet source."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Not documented."],["missing","Allergic to penicillin.","Not documented."],["partial","Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","Only an aside 'father's stroke surgery', not clearly a surgery to reduce stroke risk."],["missing","Non-smoker.","Not documented."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","'Objective: Not discussed'; video loss/no exam not captured."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","'Immediate referral' conveys urgency but no rationale (FHx, young age)."],["missing","TIA clinic will do carotid artery ultrasound.","Carotid ultrasound not mentioned."],["missing","TIA clinic may do a brain scan to check for a bleed.","Brain scan not mentioned."],["partial","Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","'go to A&E if symptoms recur or worsen' omits the persistent/prolonged criterion."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","'Advise attend promptly' does not say it is not an immediate emergency."],["partial","If symptoms recur, can contact the practice for phone assessment and advice.","'may call clinic or GP for guidance' not tied to symptom recurrence/phone assessment."],["missing","TIA clinic and PALS contact numbers to be left in the consultation notes.","Not documented."],["missing","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Not documented."],["missing","If there is any delay (not called or cannot make the appointment), contact the practice again.","Not documented."],["fabrication","Episodes lasting up to 3 days","Patient said episodes last three or four days."],["fabrication","go to A&E if symptoms recur or worsen","Doctor advised A&E only if symptoms return and persist/are prolonged; for recurrence he said to contact the practice; 'worsen' was not said."],["fabrication","Continue aspirin 75 mg daily as self-medicated.","The clinician gave no plan to continue aspirin; this was not said."]],"mb":26.91012,"latency":27.119,"finalised":647.369},{"label":"Run 3","wer":14.459745762711865,"text":"Hi there. Good morning.\nI'm Dr. Jim. Nice to see you. Okay, so before we start your appointment, could I confirm your full name is Dr. Birth, please? Yes.\nJohn Smith. And I am 32 years old.\nSorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay, could you tell me the first line of your address and your postcode, please? It's 4 Park\nAvenue and\nit's AB1BB2. That's great. Thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yes. Okay, so how can I help you today? You've been having some problems with your asthma, is that right? Sorry, how can I help you today? So I've been experiencing\nvery\nweird symptoms over the past month or so. I don't know what's causing them. I have googled it and nothing coming up. I thought I'd come and speak to you about it. Okay, so tell me a bit more about these weird.\nSo it started with feeling very tired for a couple of days, and then I get back to normal, and then I started using feeling from my hand and arms. I get a weird sensation, like\nI get pins and needles. Right. The connection is not so great. You've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right?\nYes.\nOkay, we've lost video now. Maybe is a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\nYeah, that's fine.\nAll right. So you've been having these pins and needles, episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nThe.\nPins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts three days and then goes back to normal. So it's very weird. Right. Okay. Is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal, and again, it's only for three days or three or four days. Okay. You said you've been having weird symptoms for about a month. Yeah. So what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything. Right, okay. And you know, your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time.\nI get my arm symptoms, my leg feels weaker. Right. Okay. And you know, the abnormal gait, has that been present outside of these episodes? No, it has not. So normally I'm fit and well, actually. All right. Okay. And these. These episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week to every once at once a month. But now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When did it all start? A month and a half, maybe two months. Right. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So.\nRecently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that at all? No, I can speak fine. Any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, can I just ask, is there any history of stroke or mini strokes in your harmony? Yes. My father has had an operation to the side of his.\nNeck to reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that? Along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked and my cholesterol was fine. Good. Excellent. So you had a blood test done. Did they check the diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic. Okay. Do you have any other illnesses at all? No. No. Are you on any medication? I take an Aspirin, 75 milligrams once a day, but that's because of something I read on the Internet. Okay, so why is that? Why did you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Have you ever told a doctor before yourchial.\nGP that you're on Aspirin? Yes, I took. I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. And has any GP ever spoken to you about the risks of Aspirin and whether you should be on it, or have you not told the gp? No, I haven't. Okay. All right. Now, in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No, I live with my wife. Okay.\nFantastic. Do you smoke at all? No, I don't. Right, okay, that's fine. Now, obviously you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks. And so that's something quite urgent. And given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do, in fact what I'm going to do is I'm going to refer you to a stroke TIA clinic now, just to double check. Do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic.\nI send that referral off now and then you can attend them. They'll usually call you in within the next one to two days. Okay. Because it's something relatively urgent. Now today it's Wednesday, so we've got a few days before the weekend. So basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had and they'll be doing maybe they might do a scan of the brain as well. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. You haven't got, any kind of stroke or mini stroke. Now if your symptoms return and they persist, then you may need to attend A and E. Okay. Because a presumptive working diagnosis is.\nMini stroke or TIA. Okay? And if a mini stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital, in that instance, as soon as possible. Okay? Sure. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the time. That's not the problem. You've got easy access to us. Okay, so this is the plan going forward. I'm going to do that referral. You should hear back from the hospital relatively soon. The hospital? You could actually ring them on the PALS number. And then there's also the CIA clinic number. I'm going to put that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. Today in the afternoon, Wait one or two hours or tomorrow morning, just to find out. One day at time to slot you in and.\nJust to make sure they've got you in the system that they've got in the books and they're going to be calling you in. Okay, great. This isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us. Okay, great. All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have. Yes, you have the information at your hands in order to. Okay, great. Thank you. All the best. Take care then. Bye. Bye.","marks":[[28,36,"Doctor from GP at Hand.",false],[54,58,"Hi. OK.",false],[128,134,"and date of",false],[150,154,"Yeah it's",false],[374,381,"AB one CB two.",true],[604,604,"say that .",false],[761,768,"um nothing's",false],[872,872,"symptoms you've been having.",false],[983,988,"losing",true],[997,1001,"in",false],[1005,1009,"hands",false],[1052,1055,"guess",false],[1080,1080,"again",false],[1085,1098,"connection's",false],[1318,1318,"there a a",false],[1702,1707,"few",false],[2259,2259,"you've",false],[2366,2366,"Can",false],[2625,2625,"Right .",false],[2936,2936,"when",false],[2953,2953,"Was it a month ago probably",false],[3669,3669,"Any",false],[3839,3839,"has uh",false],[3896,3903,"family Uh",false],[4435,4440,"OK. Now",false],[4643,4646,"do",false],[4729,4734,"OK. Do",false],[4770,4780,"your",false],[5042,5042,"in the past",false],[5059,5064,"You haven't OK. Um",false],[5092,5092,"your uh",false],[5185,5185,"Uh I'm uh",false],[5568,5568,"you're a",false],[5655,5665,"actually",false],[6025,6028,"I am",false],[6209,6217,"gonna",false],[6228,6236,"uh I'm gonna",false],[6650,6650,"we're",false],[6794,6800,"arteries",false],[6805,6805,"your",false],[6873,6876,"your",false],[6891,6891,"to check if",false],[7037,7037,"OK whether",false],[7042,7049,"have",true],[7077,7089,"mini-stroke. Sure.",false],[7134,7134,"they're prolonged.",false],[7187,7188,"um our",false],[7282,7282,"then uh",false],[7665,7670,"phone. That's that's",false],[7694,7694,"you know you",false],[7871,7876,"can",false],[7942,7945,"TIA",false],[7974,7977,"leave",false],[8257,8267,"when they got",false],[8411,8423,"OK.",false],[8488,8491,"A and E.",false],[8585,8585,"if there's",false],[8704,8731,"",false],[8736,8743,"you get",false],[8763,8763,"back",false],[8773,8785,"OK.",false],[8971,8971,"um you should",false],[8983,8992,"help",false],[8997,8997,"should",false],[9046,9058,"take things further OK.",false],[9094,9099,"now.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","'over past month'; 'began ~1-2 months ago'."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","partial","'began ... with intermittent fatigue' - duration and return to normal missing."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","'pins and needles, numbness ... right hand'."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","partial","'pins and needles, numbness, weakness in right hand/arm' - does not separate hand sensory from arm weakness."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","'up to 3 days, then resolves'."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","partial","'leg weakness' noted but not linked to occurring with arm symptoms."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","'abnormal gait' (colleague detail immaterial)."],["The note captures: Gait is normal outside the episodes.","yes","'Gait abnormality only during episodes'."],["The note captures: Generally feels tired and weak.","no","General tiredness and weakness not documented."],["The note captures: Sometimes feels nauseous.","yes","'nausea'."],["The note captures: Low motivation; does not feel like doing anything.","no","Not documented."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","'increased from weekly'."],["The note captures: Episodes now occur a couple of times a day.","yes","'several times daily'."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","'difficulty holding coffee cup during episodes'."],["The note captures: Drinking is slightly harder during episodes.","no","Drinking difficulty not documented."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","'during episodes' but not the last couple of days onset."],["The note captures: No difficulty swallowing currently.","yes","'no ... swallowing changes'."],["The note captures: During episodes, feels as if something is in his throat.","no","Throat sensation during episodes not documented."],["The note captures: No difficulty speaking during episodes.","yes","'no ... speech ... changes'."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","'no visual ... changes'."],["The note captures: Currently asymptomatic at the time of consultation.","no","Not documented."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","Not documented."],["The note captures: Cholesterol previously checked and normal.","no","Not documented."],["The note captures: Previously screened for diabetes; normal.","no","Not documented."],["The note captures: Blood pressure previously checked; normal.","no","Not documented."],["The note captures: No other illnesses; normally fit and well.","yes","'otherwise fit and well'."],["The note captures: Takes aspirin 75 mg once daily.","yes","'Aspirin 75 mg once daily'."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","'self-initiated after father's stroke surgery' - reason incomplete."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","Not documented."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","'father's stroke surgery' (family history accepted)."],["The note captures: Non-smoker.","no","Not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","no","Objective blank; no exam/video loss not documented."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","'Presumptive diagnosis: transient ischemic attack (TIA) / mini-stroke'."],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","partial","Urgent referral but family history/young age rationale absent."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","'Urgent referral to stroke/TIA clinic'."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","'expected within 1-2 days'."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","'carotid ultrasound'."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","'brain imaging' without bleed purpose."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","partial","'attend A&E if symptoms recur or worsen' - omits the persistent/prolonged criterion."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not captured."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","yes","'Contact clinic for phone assessment if needed'."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","yes","'Provide clinic contact numbers in notes'."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","no","Not documented."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","no","Not documented."]],"claims":[["no visual, speech, or swallowing changes","When asked about swallowing during episodes, patient said he feels there is something in his throat."],["Urgent referral to stroke/TIA clinic for carotid ultrasound and brain imaging","Clinician said they 'might do a scan of your brain'; brain imaging was a possibility, not definite."],["Advise attend A&E if symptoms recur or worsen.","A&E advised only if symptoms return and persist/are prolonged; for recurrence the patient was told to contact the practice."]],"note":"Subjective\n\nChief Complaint::\n\nMain complaint: intermittent pins and needles, numbness, weakness in right hand/arm with leg weakness and abnormal gait over past month.\n\nHistory of Presenting Complaint::\n\nOnset: symptoms began ~1‑2 months ago with intermittent fatigue.\n\nEpisode duration: up to 3 days, then resolves.\n\nFrequency: increased from weekly to several times daily.\n\nAssociated features: nausea, difficulty holding coffee cup during episodes; no visual, speech, or swallowing changes.\n\nGait abnormality only during episodes; otherwise fit and well.\n\nObjective\n\n\n\n\n\n\n\nAssessment\n\nPresumptive diagnosis: transient ischemic attack (TIA) / mini‑stroke.\n\nPlan\n\nMedications::\n\nAspirin 75 mg once daily, self‑initiated after father’s stroke surgery.\n\nUrgent referral to stroke/TIA clinic for carotid ultrasound and brain imaging (expected within 1‑2 days).\n\nAdvise attend A&E if symptoms recur or worsen.\n\nContact clinic for phone assessment if needed.\n\nProvide clinic contact numbers in notes.","review":510.2763157894737,"saved":-24.2763157894737,"faster":-4.995126705653025,"clean":false,"effort":50.0,"sig":[["partial","Began with feeling very tired for a couple of days, then returning to normal.","'began ... with intermittent fatigue' - duration and return to normal missing."],["partial","Pins and needles confined to the hand; arm feels weaker during episodes.","'pins and needles, numbness, weakness in right hand/arm' - does not separate hand sensory from arm weakness."],["partial","Leg feels weaker at the same time as the arm symptoms.","'leg weakness' noted but not linked to occurring with arm symptoms."],["missing","Generally feels tired and weak.","General tiredness and weakness not documented."],["missing","Low motivation; does not feel like doing anything.","Not documented."],["missing","Drinking is slightly harder during episodes.","Drinking difficulty not documented."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","'during episodes' but not the last couple of days onset."],["missing","During episodes, feels as if something is in his throat.","Throat sensation during episodes not documented."],["missing","Currently asymptomatic at the time of consultation.","Not documented."],["missing","No personal history of stroke or mini-stroke (TIA).","Not documented."],["missing","Cholesterol previously checked and normal.","Not documented."],["missing","Previously screened for diabetes; normal.","Not documented."],["missing","Blood pressure previously checked; normal.","Not documented."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","'self-initiated after father's stroke surgery' - reason incomplete."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","Not documented."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Non-smoker.","Not documented."],["missing","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Objective blank; no exam/video loss not documented."],["partial","Considered urgent and needs excluding despite young age, given the family history of stroke.","Urgent referral but family history/young age rationale absent."],["partial","TIA clinic may do a brain scan to check for a bleed.","'brain imaging' without bleed purpose."],["partial","Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","'attend A&E if symptoms recur or worsen' - omits the persistent/prolonged criterion."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not captured."],["missing","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Not documented."],["missing","If there is any delay (not called or cannot make the appointment), contact the practice again.","Not documented."],["fabrication","no visual, speech, or swallowing changes","When asked about swallowing during episodes, patient said he feels there is something in his throat."],["fabrication","Urgent referral to stroke/TIA clinic for carotid ultrasound and brain imaging","Clinician said they 'might do a scan of your brain'; brain imaging was a possibility, not definite."],["fabrication","Advise attend A&E if symptoms recur or worsen.","A&E advised only if symptoms return and persist/are prolonged; for recurrence the patient was told to contact the practice."]],"mb":32.255642,"latency":41.089,"finalised":551.3653157894737},{"label":"Run 4","wer":15.201271186440678,"text":"Hi there. Good morning, I'm Dr. Jim, nice to see you. Okay, so before we start your appointment could I confirm your full name is Dr. Birth please? Yes, John Smith and I am 32 years old. Sorry I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay, could you tell me the first line of your address and your postcode please? At 4 Park Avenue and it's AB1B2. That's great, thank you so much for that. Are you in a private place where you're okay to speak at the moment? Yes. Okay, so how can I help you today? You've been having some problems with your asthma, is that right? Sorry, how can I help you today? So I've been experiencing very weird symptoms over the past month or so and I just causing them. I have googled it and nothing coming up. Okay, so tell me a bit more about these weird.\nSo it started with getting very tired for a couple of days, and then I get back to normal. And then I started losing feelings and arms. I get a weird sensation, like I get pins and\nneedles. Right. The connection is not so great. You've been getting pins and needles in the hand, is that right? Yeah, that's correct. Okay. Is that the right or left hand? My right hand. Is it always the right?\nYes.\nOkay, we've lost video now maybe is a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\nYes, that's fine.\nAll right. So you've been having these pins and needles, episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nThe.\nPins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts three days and then goes back to normal. So it's very weird. Right. Okay. Is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal, and again, it's only for three days or three or four days. Okay. You said you've been having weird symptoms for about a month. Yeah. So what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything. Right, okay. And you know, your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time.\nI get my arm symptoms, my leg feels weaker. Right. Okay. And you know, the abnormal gait, has that been present outside of these episodes? No, it has not. So normally I'm fit and well, actually. All right. Okay. And these. These episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week to every once at once a month. But now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When did it all start? A month and a half, maybe two months. Right. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So.\nRecently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that? No, I can speak fine. Any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, can I just ask, is there any history of stroke or mini strokes in your heredity? Yes. My father has had an operation to the side of his.\nNeck to reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that? Along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked and my cholesterol was fine. Good. Excellent. So you had a blood test done. Did they check the diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic. Okay. Do you have any other illnesses at all? No. No. Are you on any medication? I take an Aspirin, 75 milligrams once a day, but that's because of something I read on the Internet. Okay, so why is that? Why do you take that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Have you ever told a doctor before you're just.\nGP that you're on Aspirin? Yes, I took. I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. And has any GP ever spoken to you about the risks of Aspirin and whether you should be on it, or have you not told the GP in the past? No, I haven't. Okay. All right. Now, in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No, I live with my wife. Okay.\nFantastic. Do you smoke at all? No, I don't. That's fine. Now, obviously you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIAs, transient ischemic attacks. And so that's something quite urgent. And given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do, in fact what I'm going to do is I'm going to refer you to a stroke at the TIA clinic now, just to double check. Do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic.\nNick. I send that referral off now and then you can attend them. They'll usually call you in within the next one to two days. Okay. Because it's something relatively urgent. Now, today it's Wednesday, so we've got a few days before the weekend. So basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the arteries like your father had, and they'll be doing maybe they might do a scan of the brain as well. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. You haven't got, any kind of stroke or mini stroke. Now, if your symptoms return and they persist, then you may need to attend A and E. Okay. Because a presumptive working diagnosis is.\nMini stroke or TIA. Okay? And if a mini stroke is prolonged, then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital, in that instance, as soon as possible. Okay? Sure. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the phone. That's not the problem. You've got easy access to us. Okay, so this is the plan going forward. I'm going to do that referral. You should hear back from the hospital relatively soon. The hospital? You could actually ring them on the PALS number. And then there's also the CIA clinic number. I'm going to put that number in the notes for this consultation. Okay. So you have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. Today in the afternoon, wait one or two hours or tomorrow morning, just to find out when they plan to slot you in.\nJust to make sure they put you in the system that they've got in the books and they're going to be calling you in. Okay, great. This isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us. Okay, great. All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have. You should have the information at your hands in order to get things further. Okay, great. Thank you. All the best. Take care then. Bye. Bye.","marks":[[28,35,"Doctor from GP at Hand.",false],[54,58,"Hi. OK.",false],[127,133,"and date of",false],[148,151,"Yeah it's",false],[341,343,"It's",false],[367,373,"AB one CB two.",true],[596,596,"say that .",false],[702,706,"don't know what's",false],[743,750,"um nothing's",false],[762,766,"so I thought I'd come and speak to you about it. OK. OK.",false],[808,808,"symptoms you've been having.",false],[828,835,"feeling",false],[926,934,"feeling in my hands",false],[977,980,"guess",false],[1005,1005,"again",false],[1010,1023,"connection's",false],[1242,1242,"there a a",false],[1625,1630,"few",false],[2182,2182,"you've",false],[2289,2289,"Can",false],[2548,2548,"Right .",false],[2859,2859,"when",false],[2876,2876,"Was it a month ago probably",false],[3597,3597,"any",false],[3614,3614,"at all",false],[3755,3755,"has uh",false],[3812,3820,"family Uh",false],[4352,4357,"OK. Now",false],[4645,4650,"OK. Do",false],[4686,4698,"your",false],[4989,4994,"You haven't OK. Um",false],[5022,5022,"your uh",false],[5115,5115,"Uh I'm uh",false],[5485,5485,"you're a",false],[5572,5582,"actually",false],[5942,5945,"I am",false],[6133,6141,"gonna",false],[6152,6160,"uh I'm gonna",false],[6212,6217,"Um",false],[6581,6581,"we're",false],[6716,6716,"carotid",true],[6735,6735,"your",false],[6799,6802,"your",false],[6817,6817,"to check if",false],[6963,6963,"OK whether",false],[6968,6975,"have",true],[7003,7015,"mini-stroke. Sure.",false],[7061,7061,"they're prolonged.",false],[7114,7115,"um our",false],[7209,7209,"then uh",false],[7605,7605,"that's that's",false],[7622,7622,"you know you",false],[7799,7804,"can",false],[7870,7873,"TIA",false],[7902,7905,"leave",false],[7963,7966,"you'll",false],[8191,8195,"got time",false],[8230,8238,"they've got",false],[8327,8339,"OK.",false],[8404,8407,"A and E.",false],[8501,8501,"if there's",false],[8620,8647,"",false],[8652,8659,"you get",false],[8679,8679,"back",false],[8689,8701,"OK.",false],[8887,8887,"um you should",false],[8899,8904,"help",false],[8963,8966,"take",false],[8983,8995,"OK.",false],[9031,9036,"now.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"Symptoms began ~1–2 months ago\" with episodic symptoms."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial couple of days of tiredness then return to normal not captured; fatigue only listed during episodes."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"episodic pins‑and‑needles, numbness ... in right hand\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right-sided hand symptoms documented: \"right‑hand paresthesia\"."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"right‑hand paresthesia, right‑arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"Each episode lasts up to 3–4 days\"."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"leg weakness\" listed during episodes."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"altered gait\" during episodes captured; colleague as observer omitted but clinical point present."],["The note captures: Gait is normal outside the episodes.","partial","Altered gait listed only \"during episodes\", implying normal otherwise, but not explicitly stated."],["The note captures: Generally feels tired and weak.","partial","Fatigue mentioned during episodes; general weakness not clearly captured."],["The note captures: Sometimes feels nauseous.","yes","\"nausea\" documented."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not mentioned."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"initially weekly\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"now several times daily\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding a coffee cup\" during episodes."],["The note captures: Drinking is slightly harder during episodes.","no","Difficulty drinking not mentioned."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","Cup difficulty placed during episodes, but recent onset (last couple of days) omitted."],["The note captures: No difficulty swallowing currently.","yes","\"No ... swallowing problems noted\"."],["The note captures: During episodes, feels as if something is in his throat.","no","Throat sensation during episodes not mentioned."],["The note captures: No difficulty speaking during episodes.","yes","\"No ... speech difficulty\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"No visual changes\"."],["The note captures: Currently asymptomatic at the time of consultation.","no","Current asymptomatic status not stated."],["The note captures: No personal history of stroke or mini-stroke (TIA).","no","No personal history of stroke/TIA not documented."],["The note captures: Cholesterol previously checked and normal.","no","Prior cholesterol check not mentioned."],["The note captures: Previously screened for diabetes; normal.","no","Prior diabetes screen not mentioned."],["The note captures: Blood pressure previously checked; normal.","no","Prior BP check not mentioned."],["The note captures: No other illnesses; normally fit and well.","yes","\"General baseline health: fit, no chronic illnesses reported.\""],["The note captures: Takes aspirin 75 mg once daily.","yes","\"Aspirin 75 mg once daily\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","yes","\"self‑initiated for stroke risk reduction\"."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","No GP discussion of aspirin risks not captured."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","no","Father's neck operation / family history not documented."],["The note captures: Non-smoker.","no","Smoking status not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","Objective \"Not discussed\" implies no exam, but lost video/remote context not stated."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"Working diagnosis: transient ischemic attack (TIA) / mini‑stroke.\""],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","no","Urgency and rationale (family history despite young age) not captured."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Referral to TIA/ministroke clinic; expected appointment within 1–2 days\" conveys urgent referral."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"expected appointment within 1–2 days\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","no","Carotid ultrasound not mentioned."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","no","Brain scan not mentioned."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","partial","\"immediate ED presentation if symptoms recur or worsen\" – omits persistence/prolonged criterion, overstates recurrence alone."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","partial","\"contact clinic for further guidance\" present but not tied to recurrence/phone assessment."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","partial","\"Provide clinic contact numbers (PALS and CIA clinic) in notes\" – TIA clinic mis-rendered as \"CIA\"."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","no","Advice to ring clinic this afternoon/tomorrow to confirm referral not captured."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","yes","\"contact clinic ... if appointment delayed\"."]],"claims":[["during episodes: ... fatigue, nausea","Transcript describes general tiredness/weakness and sometimes nausea over the period, not symptoms occurring during the episodes."],["No ... swallowing problems noted.","Patient reported a sensation of something in his throat during episodes and harder drinking; only currently has no difficulty swallowing."],["Advise immediate ED presentation if symptoms recur or worsen.","Clinician advised A&E only if symptoms return and persist/are prolonged; if they recur, contact the practice."],["Provide clinic contact numbers (PALS and CIA clinic) in notes.","Transcript refers to the TIA clinic number, not a 'CIA clinic'."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports episodic pins‑and‑needles, numbness and weakness in right hand/arm with accompanying leg weakness and abnormal gait.\n\nHistory of Presenting Complaint::\n\nSymptoms began ~1–2 months ago, initially weekly, now several times daily.\n\nEach episode lasts up to 3–4 days; during episodes: right‑hand paresthesia, right‑arm weakness, leg weakness, altered gait, fatigue, nausea, difficulty holding a coffee cup.\n\nNo visual changes, speech difficulty, or swallowing problems noted.\n\nGeneral baseline health: fit, no chronic illnesses reported.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nWorking diagnosis: transient ischemic attack (TIA) / mini‑stroke.\n\nPlan\n\nMedications::\n\nAspirin 75 mg once daily (self‑initiated for stroke risk reduction).\n\nReferral to TIA/ministroke clinic; expected appointment within 1–2 days.\n\nAdvise immediate ED presentation if symptoms recur or worsen.\n\nPatient to contact clinic for further guidance or if appointment delayed.\n\nProvide clinic contact numbers (PALS and CIA clinic) in notes.","review":548.4342105263158,"saved":-62.43421052631584,"faster":-12.846545375785151,"clean":false,"effort":56.52173913043478,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial couple of days of tiredness then return to normal not captured; fatigue only listed during episodes."],["partial","Gait is normal outside the episodes.","Altered gait listed only \"during episodes\", implying normal otherwise, but not explicitly stated."],["partial","Generally feels tired and weak.","Fatigue mentioned during episodes; general weakness not clearly captured."],["missing","Low motivation; does not feel like doing anything.","Low motivation not mentioned."],["missing","Drinking is slightly harder during episodes.","Difficulty drinking not mentioned."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","Cup difficulty placed during episodes, but recent onset (last couple of days) omitted."],["missing","During episodes, feels as if something is in his throat.","Throat sensation during episodes not mentioned."],["missing","Currently asymptomatic at the time of consultation.","Current asymptomatic status not stated."],["missing","No personal history of stroke or mini-stroke (TIA).","No personal history of stroke/TIA not documented."],["missing","Cholesterol previously checked and normal.","Prior cholesterol check not mentioned."],["missing","Previously screened for diabetes; normal.","Prior diabetes screen not mentioned."],["missing","Blood pressure previously checked; normal.","Prior BP check not mentioned."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","No GP discussion of aspirin risks not captured."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","Father's neck operation / family history not documented."],["missing","Non-smoker.","Smoking status not documented."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Objective \"Not discussed\" implies no exam, but lost video/remote context not stated."],["missing","Considered urgent and needs excluding despite young age, given the family history of stroke.","Urgency and rationale (family history despite young age) not captured."],["missing","TIA clinic will do carotid artery ultrasound.","Carotid ultrasound not mentioned."],["missing","TIA clinic may do a brain scan to check for a bleed.","Brain scan not mentioned."],["partial","Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","\"immediate ED presentation if symptoms recur or worsen\" – omits persistence/prolonged criterion, overstates recurrence alone."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not an immediate emergency."],["partial","If symptoms recur, can contact the practice for phone assessment and advice.","\"contact clinic for further guidance\" present but not tied to recurrence/phone assessment."],["partial","TIA clinic and PALS contact numbers to be left in the consultation notes.","\"Provide clinic contact numbers (PALS and CIA clinic) in notes\" – TIA clinic mis-rendered as \"CIA\"."],["missing","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Advice to ring clinic this afternoon/tomorrow to confirm referral not captured."],["fabrication","during episodes: ... fatigue, nausea","Transcript describes general tiredness/weakness and sometimes nausea over the period, not symptoms occurring during the episodes."],["fabrication","No ... swallowing problems noted.","Patient reported a sensation of something in his throat during episodes and harder drinking; only currently has no difficulty swallowing."],["fabrication","Advise immediate ED presentation if symptoms recur or worsen.","Clinician advised A&E only if symptoms return and persist/are prolonged; if they recur, contact the practice."],["fabrication","Provide clinic contact numbers (PALS and CIA clinic) in notes.","Transcript refers to the TIA clinic number, not a 'CIA clinic'."]],"mb":28.186597,"latency":30.093,"finalised":578.5272105263158},{"label":"Run 5","wer":14.883474576271185,"text":"Hi there. Good morning, I'm Dr. Jim. Nice to see you. Okay, so before we start your appointment, could I confirm your full name is date of birth please? Yes, John Smith. And I am 32 years old. Sorry, I didn't catch your date of birth. I'm 32 years old. 32 years old. Okay, could you tell me the first line of your address and your postcode to you? 4 Park Avenue. And it's AB1. AB2. That's great. Thank you so much. Are you in a private place where you're okay to speak at the moment? Yes. Okay, so how can I help you today? You've been having some problems with your asthma, is that right? Sorry, how can I help you today? So I've been experiencing very weird symptoms over the past month or so and I just causing them. I have googled it and nothing's coming up. I thought I'd come and speak to you about it. Okay, so tell me a bit more about these wheeze.\nSo it started with feeling very tired for a couple of days, and then I get back to normal, and then I started losing feeling. I get a weird sensation like I get pins and\nneedles. Right. The connection is not so great. You've been getting pins and needles in the hand. Is that right? Get up. Correct. Okay. Is that the right or left hand? My right hand. Is it always the right?\nYes.\nOkay, We've lost video now maybe is a button you can press. Okay. Are you happy for us to carry on without the video? I can't see you at the moment.\nYeah, that's fine.\nAll right. So you've been having these pins and needles, episodes of numbness in the right hand. Is it just the hand, or does it go up the arm as well?\nThe picture.\nPins and needles are in the hand, but I feel like my arm is getting weaker. But it only lasts few days and then goes back to normal. So it's very weird. Right. Okay. Is there any involvement of your leg at all? My colleague said I'm walking slightly differently to normal. And again, it's only for three days or three or four days. Okay. You said you've been having weird symptoms for about a month. Yeah. So what has been happening from the beginning of the month? What else has been happening? I generally feel tired and weak and sometimes I feel nauseous and I don't feel like I want to do anything. Right, okay. And you know, your colleague said you've not been walking normally. Yes. Do you feel anything different on either side in terms of your legs? Have you noticed anything different? Yes. So at the same time.\nI get my arm symptoms, my leg feels weaker. Right. Okay. And you know, the abnormal gait, has that been present outside of these episodes? No, it has not. So normally I'm fit and well, actually. All right. Okay. And these. These episodes, how often have they been happening? They have been getting more regular. So at the start, it would be maybe once a week to every once at once a month. But now it's getting a couple of times a day. Right. Okay. And how long have these episodes been going on for? When did it all start? A month and a half, maybe two months. Right. Okay. And along with these symptoms of the weakness and numbness, do you have any other symptoms at the same time, like swallowing or difficulty speaking or vision problems? So.\nSo recently, I've noticed I can't hold my cup of coffee. And when I do drink coffee, it's slightly harder to drink. And that's only been in the last couple of days, I guess. Right. Is that during these episodes or outside of these episodes? Only during the episodes. Okay. Do you have any difficulty swallowing at all? Not currently, no. During the episodes, do you have any difficulty swallowing? I feel like there's something in my throat. What about difficulty speaking during these episodes? Any issues with that? No, I can speak fine. Any visual problems during these episodes? I don't think so, but I wear glasses. Okay. All right. Now, can I just ask, is there any history of stroke or mini strokes in your heredity? Yes. My father has had an operation to the side of his.\nNeck to reduce the risk of stroke. Right. Okay. And how about yourself? Have you had any history of mini strokes or anything like that? Along those lines? I know you're quite young. No. So after my dad had his operation, I was required to be checked and my cholesterol was fine. Good. Excellent. So you had a blood test done and did they check the diabetes as well? They checked my diabetes, my blood pressure and my cholesterol and the doctor said it was all okay. Fantastic. Okay. Do you have any other illnesses at all? No. No. Are you on any medication? I take an Aspirin, 75 milligrams once a day, but that's because of something I read on the Internet. Okay, so why is that? Why do you check that? I think it's meant to reduce your risk of stroke and heart attack. Okay. Have you ever told a doctor before you're just.\nGP that you're on Aspirin? Yes. I started taking it after my father had his operation, but that wasn't the doctor telling me. Okay. And has any GP ever spoken to you about the risks of Aspirin and whether you should be on it, or have you not told the GP in the past? No, I haven't. Okay. All right. Now, in terms of your kind of social situation, are you working at the moment? Yes, I am. What do you work as? I'm actually a doctor. You're a medical doctor? Yes. Okay. Which specialty are you in? I work in plastic surgery. Plastic surgery. Okay, great. And do you have any allergies to any medication at all? I'm allergic to penicillin only. Okay. And are you living alone? No, I live with my wife. Okay.\nFantastic. Do you smoke at all? No, I don't. That's fine. Now, obviously you're a medic yourself. Did you have any thoughts as to what might be going on? I've absolutely got no idea. Well, the way you're describing these episodes, they make me concerned about mini-strokes or TIA, transient ischemic attacks. And so that's something quite urgent. And given that you've got a family history of stroke, even though you're quite young, I think it's something that we need to exclude. So what I'm probably going to do, in fact what I am going to do is I'm going to refer you to a stroke and TIA clinic now, just to double check. Do you have the symptoms right now? No, I'm perfectly fine at the moment. Okay, so what I'm going to do is I'm going to refer you to a mini-stroke clinic or a TIA clinic.\nI send that referral off now and then you can attend them. They'll usually call you in within the next one to two days. Okay. Because it's something relatively urgent. Now today it's Wednesday, so we've got a few days before the weekend. So basically the deadline should be Thursday, Friday. We're expecting to be seen by that time. That's the kind of turnaround we're looking at. And in that clinic, they'll be doing a number of things. They'll be checking, they'll be doing the ultrasound of the carotid artery like your father had and they'll be doing maybe they might do a scan of the brain as well. There's any signs of a bleed there. But they'll be doing a range of tests in a short time frame in order to exclude whether you have any illness. You haven't got, any kind of stroke or mini stroke. Now if your symptoms return and they persist, then you may need to attend A and E. Okay. Because a presumptive working diagnosis is.\nMini stroke or TIA. Okay? And if a mini stroke is prolonged, then. Then we end up thinking that this might be a stroke. And in that case, that becomes even more of an emergency. So we're not talking about waiting one or two days. We want you to go to hospital, in that instance, as soon as possible. Okay? Sure. Now, if things happen again, feel free to contact us. We can assess you over the phone. We can give you direction and guidance over the time. That's not the problem. You know, you've got easy access to us. Okay, so this is the plan going forward. I'm going to do that referral. You should hear back from the hospital relatively soon. The hospital? You could actually ring them on the PALS number. And then there's also the clinic number. I'm going to put that number in the notes for this consultation. Okay? So you'll have all the information you need to chase this appointment. And if you want, you can ring them either today or tomorrow morning. Today in the afternoon, you wait one or two hours or tomorrow morning just to find out. One day at time to slot you in and.\nJust to make sure they've got you in the system, that they've Codeine in the books, and they're going to be calling you in. Okay, great. This isn't an immediate emergency that you need to rush down to any, but it's something quite urgent that we need to deal with in a short space of time. Okay. So if there's any delay that transpires, for example, you can't make the appointment or, you know, you don't get called, something needs to be done. You need to get in contact back with us. Okay, great. All right. Did you have any questions at all? No, I think that covers most of it. Okay, great. So just bear with me a few minutes and then I'll send that all through and then you should be able to have. Yes, you have the information at your hands in order to get things further. Okay, great. Thank you. All the best. Take care then. Bye. Bye.","marks":[[28,36,"Doctor from GP at Hand.",false],[54,58,"Hi. OK.",false],[153,156,"Yeah it's",false],[340,346,"please It's",false],[372,381,"AB one CB two.",true],[595,595,"say that .",false],[701,705,"don't know what's",false],[849,856,"weird symptoms you've been having.",true],[982,982,"in my hands and arms.",false],[1014,1017,"guess",false],[1042,1042,"again",false],[1047,1060,"connection's",false],[1140,1147,"And. Yeah that's",false],[1274,1274,"there a a",false],[1563,1571,"",false],[2221,2221,"you've",false],[2328,2328,"Can",false],[2587,2587,"Right .",false],[2898,2898,"when",false],[2915,2915,"Was it a month ago probably",false],[3639,3639,"any",false],[3656,3656,"at all",false],[3797,3797,"has uh",false],[3854,3862,"family Uh",false],[4397,4402,"OK. Now",false],[4612,4617,"take",false],[4691,4696,"OK. Do",false],[4732,4744,"your",false],[4778,4778,"took I",false],[5027,5032,"You haven't OK. Um",false],[5060,5060,"your uh",false],[5153,5153,"Uh I'm uh",false],[5523,5523,"you're a",false],[5610,5620,"actually",false],[5727,5730,"TIAs",false],[6168,6176,"gonna",false],[6187,6195,"uh I'm gonna",false],[6609,6609,"we're",false],[6753,6759,"arteries",false],[6764,6764,"your",false],[6832,6835,"your",false],[6850,6850,"to check if",false],[6996,6996,"OK whether",false],[7001,7008,"have",true],[7036,7048,"mini-stroke. Sure.",false],[7093,7093,"they're prolonged.",false],[7146,7147,"um our",false],[7630,7635,"phone. That's that's",false],[7846,7851,"can",false],[7916,7916,"TIA",false],[7945,7948,"leave",false],[8231,8241,"when they got",false],[8329,8336,"got",true],[8391,8403,"OK.",false],[8468,8471,"A and E.",false],[8565,8565,"if there's",false],[8684,8711,"",false],[8716,8723,"you get",false],[8743,8743,"back",false],[8753,8765,"OK.",false],[8951,8951,"um you should",false],[8963,8972,"help",false],[8977,8977,"should",false],[9025,9028,"take",false],[9045,9057,"OK.",false],[9093,9098,"now.",false]],"facts":[["The note captures: Episodic neurological symptoms, starting about 1.5 to 2 months ago (also described as the past month or so).","yes","\"duration ~1‑2 months\" with intermittent episodes."],["The note captures: Began with feeling very tired for a couple of days, then returning to normal.","no","Initial tiredness for a couple of days not captured; note says episodes began with pins-and-needles."],["The note captures: Pins and needles / loss of feeling (numbness) in the hand.","yes","\"right‑hand pins‑and‑needles\"."],["The note captures: Symptoms affect the right hand, always the right side.","yes","Right hand documented."],["The note captures: Pins and needles confined to the hand; arm feels weaker during episodes.","yes","\"right‑hand pins‑and‑needles, progressed to arm weakness\"."],["The note captures: Episodes are transient, lasting a few days (three or four days), then return to normal.","yes","\"each episode lasts a few days then resolves\"."],["The note captures: Leg feels weaker at the same time as the arm symptoms.","yes","\"brief leg weakness\" during episodes."],["The note captures: Colleague noticed he walks differently from normal during episodes.","yes","\"abnormal gait\" during episodes; colleague as observer omitted but clinical point present."],["The note captures: Gait is normal outside the episodes.","no","Normal gait outside episodes not stated."],["The note captures: Generally feels tired and weak.","partial","\"Associated fatigue\" but general weakness/tiredness not clearly captured."],["The note captures: Sometimes feels nauseous.","yes","\"nausea\"."],["The note captures: Low motivation; does not feel like doing anything.","no","Low motivation not mentioned."],["The note captures: Episodes becoming more frequent: initially roughly once a week to once a month.","yes","\"increased from weekly\"."],["The note captures: Episodes now occur a couple of times a day.","yes","\"to several times daily\"."],["The note captures: Unable to hold a cup of coffee during episodes.","yes","\"difficulty holding coffee cup during episodes\"."],["The note captures: Drinking is slightly harder during episodes.","no","Difficulty drinking not mentioned."],["The note captures: Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","partial","During episodes captured, but recent onset (last couple of days) omitted."],["The note captures: No difficulty swallowing currently.","no","Absence of current swallowing difficulty not documented."],["The note captures: During episodes, feels as if something is in his throat.","yes","\"sensation of throat fullness\"."],["The note captures: No difficulty speaking during episodes.","yes","\"no ... speech changes\"."],["The note captures: No visual problems noticed during episodes (wears glasses).","yes","\"no visual ... changes\"."],["The note captures: Currently asymptomatic at the time of consultation.","no","Current asymptomatic status not stated."],["The note captures: No personal history of stroke or mini-stroke (TIA).","yes","\"No prior TIA/stroke\"."],["The note captures: Cholesterol previously checked and normal.","no","Prior cholesterol check not mentioned."],["The note captures: Previously screened for diabetes; normal.","no","Prior diabetes screen not mentioned."],["The note captures: Blood pressure previously checked; normal.","no","Prior BP check not mentioned."],["The note captures: No other illnesses; normally fit and well.","no","No other illnesses / normally fit and well not stated."],["The note captures: Takes aspirin 75 mg once daily.","yes","\"aspirin 75 mg daily\"."],["The note captures: Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","partial","\"self‑prescribed\" but reason (stroke/heart attack risk) omitted."],["The note captures: No GP has discussed the risks of aspirin or whether he should be on it.","no","No GP discussion of aspirin risks not captured."],["The note captures: Allergic to penicillin.","no","Penicillin allergy not documented."],["The note captures: Father had surgery on the side of his neck to reduce stroke risk (family history of stroke/cerebrovascular disease).","yes","\"father had carotid surgery\"."],["The note captures: Non-smoker.","no","Smoking status not documented."],["The note captures: Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","partial","Objective \"Not discussed\" implies no exam, but lost video/remote context not stated."],["The note captures: Presumptive working diagnosis: transient ischaemic attacks (mini-strokes).","yes","\"Presumptive diagnosis: transient ischemic attack (TIA) / mini‑stroke.\""],["The note captures: Considered urgent and needs excluding despite young age, given the family history of stroke.","no","Rationale (urgent exclusion given family history despite young age) not captured."],["The note captures: Urgent referral to TIA (mini-stroke) clinic.","yes","\"Urgent referral to stroke/TIA clinic\"."],["The note captures: Expected to be seen within 1 to 2 days (by Thursday/Friday; consultation on Wednesday).","yes","\"appointment expected within 1‑2 days\"."],["The note captures: TIA clinic will do carotid artery ultrasound.","yes","\"carotid Doppler\"."],["The note captures: TIA clinic may do a brain scan to check for a bleed.","partial","\"brain imaging\" captured but purpose (check for bleed) omitted."],["The note captures: Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","partial","\"attend ED if symptoms recur or worsen\" – omits persistence/prolonged criterion."],["The note captures: Currently not an immediate emergency requiring A&E, but urgent.","no","Not stated that it is not an immediate emergency."],["The note captures: If symptoms recur, can contact the practice for phone assessment and advice.","partial","\"may contact clinic by phone for guidance\" but not tied to symptom recurrence."],["The note captures: TIA clinic and PALS contact numbers to be left in the consultation notes.","no","Contact numbers in notes not mentioned."],["The note captures: Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","no","Advice to ring clinic this afternoon/tomorrow not captured."],["The note captures: If there is any delay (not called or cannot make the appointment), contact the practice again.","no","Contacting practice if appointment delayed not captured."]],"claims":[["Urgent referral to stroke/TIA clinic for carotid Doppler and brain imaging","Clinician said the clinic might do a brain scan; stated here as a definite part of the referral."],["Advise attend ED if symptoms recur or worsen before specialist review.","Clinician advised A&E only if symptoms return and persist/are prolonged; if they recur, contact the practice."],["follow-up after specialist assessment","No follow-up after specialist assessment was discussed in the transcript."]],"note":"Subjective\n\nChief Complaint::\n\nIntermittent paresthesia and weakness in right hand/arm with occasional leg weakness, duration ~1‑2 months.\n\nHistory of Presenting Complaint::\n\nOnset ~1‑2 months ago; episodes began with right‑hand pins‑and‑needles, progressed to arm weakness and brief leg weakness with abnormal gait.\n\nFrequency increased from weekly to several times daily; each episode lasts a few days then resolves.\n\nAssociated fatigue, nausea, difficulty holding coffee cup during episodes; sensation of throat fullness; no visual or speech changes.\n\nNo prior TIA/stroke; father had carotid surgery; patient self‑prescribed aspirin 75 mg daily.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPresumptive diagnosis: transient ischemic attack (TIA) / mini‑stroke.\n\nPlan\n\nMedications::\n\nAspirin 75 mg PO daily (self‑initiated).\n\nUrgent referral to stroke/TIA clinic for carotid Doppler and brain imaging; appointment expected within 1‑2 days.\n\nAdvise attend ED if symptoms recur or worsen before specialist review.\n\nPatient may contact clinic by phone for guidance; follow‑up after specialist assessment.","review":534.3421052631579,"saved":-48.34210526315792,"faster":-9.946935239332905,"clean":false,"effort":54.347826086956516,"sig":[["missing","Began with feeling very tired for a couple of days, then returning to normal.","Initial tiredness for a couple of days not captured; note says episodes began with pins-and-needles."],["missing","Gait is normal outside the episodes.","Normal gait outside episodes not stated."],["partial","Generally feels tired and weak.","\"Associated fatigue\" but general weakness/tiredness not clearly captured."],["missing","Low motivation; does not feel like doing anything.","Low motivation not mentioned."],["missing","Drinking is slightly harder during episodes.","Difficulty drinking not mentioned."],["partial","Cup-holding and drinking difficulty only in the last couple of days, and only during episodes.","During episodes captured, but recent onset (last couple of days) omitted."],["missing","No difficulty swallowing currently.","Absence of current swallowing difficulty not documented."],["missing","Currently asymptomatic at the time of consultation.","Current asymptomatic status not stated."],["missing","Cholesterol previously checked and normal.","Prior cholesterol check not mentioned."],["missing","Previously screened for diabetes; normal.","Prior diabetes screen not mentioned."],["missing","Blood pressure previously checked; normal.","Prior BP check not mentioned."],["missing","No other illnesses; normally fit and well.","No other illnesses / normally fit and well not stated."],["partial","Aspirin self-started (after reading online, after father's operation) to reduce stroke and heart attack risk; not prescribed by a doctor.","\"self‑prescribed\" but reason (stroke/heart attack risk) omitted."],["missing","No GP has discussed the risks of aspirin or whether he should be on it.","No GP discussion of aspirin risks not captured."],["missing","Allergic to penicillin.","Penicillin allergy not documented."],["missing","Non-smoker.","Smoking status not documented."],["partial","Video lost during the remote consultation; doctor could not see the patient, so no examination was done.","Objective \"Not discussed\" implies no exam, but lost video/remote context not stated."],["missing","Considered urgent and needs excluding despite young age, given the family history of stroke.","Rationale (urgent exclusion given family history despite young age) not captured."],["partial","TIA clinic may do a brain scan to check for a bleed.","\"brain imaging\" captured but purpose (check for bleed) omitted."],["partial","Safety-netting: if symptoms return and are persistent/prolonged (possible stroke), go to A&E / hospital as soon as possible rather than waiting for the clinic.","\"attend ED if symptoms recur or worsen\" – omits persistence/prolonged criterion."],["missing","Currently not an immediate emergency requiring A&E, but urgent.","Not stated that it is not an immediate emergency."],["partial","If symptoms recur, can contact the practice for phone assessment and advice.","\"may contact clinic by phone for guidance\" but not tied to symptom recurrence."],["missing","TIA clinic and PALS contact numbers to be left in the consultation notes.","Contact numbers in notes not mentioned."],["missing","Patient may ring the TIA clinic this afternoon or tomorrow morning to confirm the referral has been received and booked.","Advice to ring clinic this afternoon/tomorrow not captured."],["missing","If there is any delay (not called or cannot make the appointment), contact the practice again.","Contacting practice if appointment delayed not captured."],["fabrication","Urgent referral to stroke/TIA clinic for carotid Doppler and brain imaging","Clinician said the clinic might do a brain scan; stated here as a definite part of the referral."],["fabrication","Advise attend ED if symptoms recur or worsen before specialist review.","Clinician advised A&E only if symptoms return and persist/are prolonged; if they recur, contact the practice."],["fabrication","follow-up after specialist assessment","No follow-up after specialist assessment was discussed in the transcript."]],"mb":26.693793,"latency":32.155,"finalised":566.4971052631579}]}}